These are horrible questions, but these questions must be asked. I do not claim to know the answers, but I do know that what we are doing now does not make sense.
The truth is that an extremely disproportionate percentage of health care costs are incurred in the last year of a person’s life. Over ¼ of Medicare expenditures (27%) are made on patients in their last year. ( http://www.usatoday.com/money/industries/health/2006-10-18-end-of-life-costs_x.htm ) Roughly, $2000.00 to $3000.00 dollars are spent in a patient's last week of life.( http://archinte.ama-assn.org/cgi/content/short/169/5/480 ) As the baby boomers age, unpleasant choices are going to have to be made.
However, no one (understandably) wants to say, “Sorry, now that your best years are behind you and your utility to us has ended, you are more of a burden than you are worth, so if you wouldn’t mind too terribly, would you please die now?” “Broke your arm? Here is some morphine. These casts are getting expensive.”
Of course, the above is absurd, but it begs the question: Where do we draw the line? To what degree do we care for the health of the elderly before we decide it is not worth it? Is it moral to ask that question at all? Is it a sliding scale? Starting at the age of 70, is a person entitled to less care with each passing year? Do we draw the line according to condition, as in a broken finger is treated but a stroke is not? Do we draw the line according to prognosis, as in once the doctor decides that a person will not last a year, the morphine drip is wheeled in? If you thought insurance companies were tough on claims before, what happens when this Pandora’s Box is opened? Once it is considered reasonable for insurance companies to deny claims for terminal patients, what happens when the patients do not die as quickly as predicted? What if the doctor was wrong and the patient has 10 years left?
Our success with medical technology is ironically a part of the problem. It sounds horrible to ask, but in some twisted way, are we a little too good at keeping people alive?
This issue makes me upset, because my parents are in their mid-to-late 60’s.
We can not fix this problem by rationing care and deciding who gets what. This is not an issue that politicians can fix or bureaucrats can manage. The only way this problem will be alleviated is if our opinions about death and our opinions about our life cycle change.
In the meantime, I guess it all needs to come back to what is best for the patient.
Showing posts with label University of the Sciences in Philadelphia. Show all posts
Showing posts with label University of the Sciences in Philadelphia. Show all posts
Friday, May 1, 2009
The Terms "Right to Die" and "Assisted Suicide" Won't Do
As I write this posting about end of life issues, I am well aware that I am not an expert on this topic. Thus, I am writing more in the spirit of asking questions rather than making statements. Even the statements that I make here will be along the lines of “thinking out loud.”
I consider life precious. It is a gift. We have been admitted into the club of human existence. Regardless of the quality or circumstances of one’s life, just being born makes one fortunate. I am not naive. Some lives turn out badly. However, to be given a shot at life makes a person one of the elite entities in the history of (as far as we know) the universe. While the following sayings are not valid when taken to extremes, there is an element of truth when people say “I never had a bad day in my life” and “I’m great just as long as I’m on the right side of the grass.”
I think that suicide by an otherwise healthy person is an unnatural act brought about by mental illness. However, if a person is physically (not mentally) suffering and that person’s best days are definitely chronologically behind him or her, then it is understandable why one may want to end their lives.
The term “assisted suicide” is one of those “b.s.” semantic terms used to place a spin on a philosophy, like “pro-life,” “pro-choice,” and the agenda-laden “anti-choice.” Besides, “assisted suicide” does not account for the terminal nature of the lives of those who choose to end things. I know I just criticized re-naming things for “spin” reasons, but I think in the context of end-of-life issues, it might be warranted. Euthanasia, while a legitimate term, has become such a loaded word that it seems no longer appropriate. Besides, we euthanize cats, dogs, and horses, and those animals do not choose to end their lives. Humans need their own term, one that reflects the choice one has made to end their own suffering on their own terms. I am not sure what term to suggest. I have some mind, but I will refrain from writing them here.
Though I never was passionate about the issue, I had always considered ‘assisted suicide” wrong. Dr Kevorkian seemed a little creepy to me, like he was a little too into it. He was turning what otherwise should have been the ultimate moment of dignity for a person into a circus.
My mind changed on the subject when I had surgery a few years ago to try to correct my sleep apnea. The surgery involved trying to open up my nasal passages. I then understood why suffering, terminally ill patients would want to end it all. My suffering was so great that if I did not know that I would get better, I would have wanted to die.
What is a better way? Have the person sign a do not resuscitate (DNR), no breathing assistance and no feeding tube letter then fill them with morphine to ease their last days?
Somehow, I think that might be the way to go. Unless I am mistaken, that is what we are doing now. Maybe we need to let more people know they have that option.
I do not know the answers here. I am just asking questions.
Another aspect of this issue is the cost of end-of life care. I will cover that in my next posting.
I consider life precious. It is a gift. We have been admitted into the club of human existence. Regardless of the quality or circumstances of one’s life, just being born makes one fortunate. I am not naive. Some lives turn out badly. However, to be given a shot at life makes a person one of the elite entities in the history of (as far as we know) the universe. While the following sayings are not valid when taken to extremes, there is an element of truth when people say “I never had a bad day in my life” and “I’m great just as long as I’m on the right side of the grass.”
I think that suicide by an otherwise healthy person is an unnatural act brought about by mental illness. However, if a person is physically (not mentally) suffering and that person’s best days are definitely chronologically behind him or her, then it is understandable why one may want to end their lives.
The term “assisted suicide” is one of those “b.s.” semantic terms used to place a spin on a philosophy, like “pro-life,” “pro-choice,” and the agenda-laden “anti-choice.” Besides, “assisted suicide” does not account for the terminal nature of the lives of those who choose to end things. I know I just criticized re-naming things for “spin” reasons, but I think in the context of end-of-life issues, it might be warranted. Euthanasia, while a legitimate term, has become such a loaded word that it seems no longer appropriate. Besides, we euthanize cats, dogs, and horses, and those animals do not choose to end their lives. Humans need their own term, one that reflects the choice one has made to end their own suffering on their own terms. I am not sure what term to suggest. I have some mind, but I will refrain from writing them here.
Though I never was passionate about the issue, I had always considered ‘assisted suicide” wrong. Dr Kevorkian seemed a little creepy to me, like he was a little too into it. He was turning what otherwise should have been the ultimate moment of dignity for a person into a circus.
My mind changed on the subject when I had surgery a few years ago to try to correct my sleep apnea. The surgery involved trying to open up my nasal passages. I then understood why suffering, terminally ill patients would want to end it all. My suffering was so great that if I did not know that I would get better, I would have wanted to die.
What is a better way? Have the person sign a do not resuscitate (DNR), no breathing assistance and no feeding tube letter then fill them with morphine to ease their last days?
Somehow, I think that might be the way to go. Unless I am mistaken, that is what we are doing now. Maybe we need to let more people know they have that option.
I do not know the answers here. I am just asking questions.
Another aspect of this issue is the cost of end-of life care. I will cover that in my next posting.
Congress, the Food and Drug Administration (FDA), and Dietary Supplements
The dietary supplement industry is huge in the United States. A 2002 FDA survey concluded that 75% of Americans used dietary supplements (vitamin or herbal) within the previous year. That survey also concluded that 14.5 of Americans (a different survey said 20%) used herbal (non-vitamin/non-mineral, NVNM) supplements within the previous year. About 6% of Americans used NVNM supplements every day. The most used NVNM supplements were Echinacea, ginkgo balboa, garlic pills, ginseng and saw palmetto.
Before Congress got involved in 1994, the FDA regulated dietary supplements under The Federal Pure Food and Drugs Act (1906) and The Federal Food, Drug, and Cosmetic Act (FD&C Act) (1938). Under these laws, supplements were treated as food, and the FDA emphasized truth in labeling and safety.
In 1958, the FD&C Act New Food Additive Amendments added supplements to the items under FDA control. With these laws, all new food additives needed prior approval.
Everything changed in 1994, when Congress passed the Dietary Supplement Health and Education Act (DSHEA). The new law removed dietary supplements from food category and created a new, separate, and essentially unregulated “dietary supplement” category. The DSHEA defined dietary supplements as “a concentrate, metabolite, constituent, extract, or combination of vitamins, minerals, herbs (or other botanicals), or amino acids used to supplement the diet by increasing the total dietary intake.”
“Dietary Supplement” implies nutritional content though many have none.
The Dietary Supplement Health and Education Act of 1994 created a facade of regulation but essentially stripped the FDA of all authority in regulating the claims these products. The FDA lost its ability to insure that these products actually are what they say they are. An example of this “regulation facade” is the requirement that the supplement industry “evaluate” pill composition. However, the industry is not required to report that evaluation to the FDA. The FDA also cannot require submission of efficacy and safety information prior to the pill going on the market. New supplements do not require FDA approval. The FDA can act only after a dietary supplement has been on the market and there is a problem. The law mandated only voluntary adverse event reporting. Prescription drug companies are required to tell the FDA about any problems possibly related to their drugs, but the supplement companies were not required to do so. The law also stipulated that the supplements could not claim to “diagnose, cure, mitigate, treat, or prevent illness.” However, the supplements do just that, along with a disclaimer that says, “This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.” Supplement labels make claims on the front of the label while showing the disclaimer less prominently on the rear of the label. Even worse, the Federal Trade Commission (which regulates all drug advertising outside of the control of the FDA) does not require the disclaimer in dietary supplement advertising.
Do you remember Ephedra? Between 1993 and 1997, over 800 Ephedra adverse event reports were made by doctors. As a result, in 1997, the FDA proposed a ban on ephedra but could not get supporting evidence. The FDA was not allowed to demand adverse event information or product samples. In 2000, the FDA finally bowed to Congressional pressure and dropped the ban proposal. In 2002, the government ordered a safety study. In 2003, some states banned Ephedra. After a 2003 high-profile pro-athlete death (a pitcher for the Baltimore Orioles), Congress finally was forced to allow the FDA to ban Ephedra in 2004.
In 2006, there was growing pressure from the public to regulate the dietary supplement industry. Therefore, Congress passed another law that was designed to give the appearance of protecting the American people but in reality was designed to help the dietary supplement industry. It was “the Dietary Supplement and Nonprescription
Drug Consumer Protection Act.” In this law, the supplement industry gave an inch and took a mile. The new law said companies must report serious adverse events (a government term loosely defined here as a health problem resulting in death or hospitalization) along with a copy of the product label. The supplement companies were also required to keep records of (but not report) all non-serious adverse events for six years. The new law also required product labels to include contact information.
All of this sounds good on the surface, but the supplement industries got a lot more than they gave up. Companies were still not required to provide any information to the FDA before selling a supplement. The adverse event reporting rules result in only about 1% of all adverse events being reported to the FDA. If there is a serious adverse event, the supplement company does not have to send a sample of the product along with the report. The law also (and this is the biggie) prohibited states from regulating supplements in any way whatsoever. The companies still did not have to prove that their products were good, but the FDA still (if it wanted to act) had to prove the supplements were bad AFTER something happened. In the first year of serious adverse event reporting, 608 serious adverse events were reported (368 required reports from supplement companies and 236 from private citizens and healthcare workers). Previously, before the reporting requirement, the supplement industry said they never received any adverse event complaints against any of their products.
Still, the FDA is doing what it can. In 2007, the FDA issued “Dietary Supplement Current Good Manufacturing Practices.” While prohibited from going any further by law, the guidance covered design and construction of physical plants, manufacturing operations, quality control procedures, testing materials, consumer complaints handling, and records maintenance. However, the FDA cannot enforce these practices, and nothing still need be submitted prior to a supplement going on the market.
Because the FDA is not allowed to require it, there is little clinical evidence that these supplements are effective or safe. Some clinical trials have been done on dietary supplements, but lack of standardization leaves results inconclusive at best and meaningless at worst. A given herb has varying potency depending on where and how it was grown (weather, altitude, soil quality, sunlight exposure, etc.) and prepared. The National Institutes of Health said, “Most of the studies we examined do not provide strong evidence for beneficial health-related effects of supplements taken singly, in pairs, or in combinations of three or more....However, several other studies also provide disturbing evidence of risk, such as increased lung cancer risk with β-carotene use among smokers.”
The problem of the FDA’s lack of authority over the supplement industry is made worse by the public’s perception that the supplement industry is subject to FDA authority. The vast majority of Americans believe that supplements are approved by the FDA and are thus effective and safe. Further, the conflicting claims and disclaimers on product labels result in people believing what they want to believe. Studies that show a lack of effectiveness do not cause a nationwide decrease in supplement use. Only well publicized incidents relating to safety result in decreased use.
For the future, the U.S. General Accounting Office recommends that supplement companies be required to 1) Register as dietary supplement companies, 2) provide all supplement names with labels and 3) report all adverse events related to dietary supplements. The General Accounting Office also recommends that the FDA “educate consumers that it does not analyze and approve dietary supplements and seek more authority over supplements sold in U.S.”
I do not expect it to happen anytime soon. Money talks.
References
Sadovsky R, Collins N, Tighe A, Brunton S, Safeer R. Patient use of dietary supplements: a clinician’s perspective. Current Medical Research and Opinion. Vol. 24, No. 4, 2008, 1209–1216
Dietary Supplement Health and Education Act of 1994, Public Law 103-417, 103rd Congress. Available at: http://www.fda.gov/opacom/laws/dshea.html [accessed March 3, 2006]
U.S. Food and Drug Administration. Dietary Supplements Overview. http://www.cfsan.fda.gov/~DMS/supplmnt.html Accessed 4/21/09
Dietary Supplements: FDA Should Take Further Actions to Improve Oversight and Consumer Understanding. The U.S. Government Accountability Office http://www.gao.gov/products/GAO-09-250 Accessed 4/21/09
Public Law 109–462—Dec. 22, 2006 http://www.fda.gov/cder/regulatory/public_law_109462.pdf Accessed 4/21/06
AJ Perez. (2008, September 23). Dietary supplements cause 600 'adverse events' :First data since reporting law. USA TODAY,p. D.7. Retrieved April 22, 2009, from National Newspaper Abstracts (3) database. (Document ID: 1560768251).
Katherine Wong. (2007). New Mandatory Reporting Requirements for Dietary Supplements and Nonprescription Drugs Solve Very Little. The Journal of Law, Medicine & Ethics, 35(2), 336-339. Retrieved April 22, 2009, from Research Library database. (Document ID: 1334834441).
Sarah Lueck and Anna Wilde Mathews. (2003, December 30). FDA Is Expected to Ban Ephedra, Citing Supplement's Health Risks. Wall Street Journal (Eastern Edition), p. A.1. Retrieved April 22, 2009, from ABI/INFORM Complete database. (Document ID: 517744241).
Metabolife Praises FDA Withdraw of Proposed Ephedra Restrictions. (3 April). PR Newswire,1. Retrieved April 22, 2009, from ABI/INFORM Complete database. (Document ID: 52164278).
References
Timbo BB, Ross MP, McCarthy PV, Lin CT. Dietary supplements in a national survey: prevalence of use and reports of adverse events. J Am Diet Assoc 2006;106:1966-74
Dietary Supplement Current Good Manufacturing Practices (CGMPs) and Interim Final Rule (IFR) Facts. U.S. Food and Drug Administration. http://www.foodsafety.gov/~dms/dscgmps6.html Accessed 4/22/09
Report: FDA lacks authority over supplements – Without necessary resources, 'it's like the Wild West' USA TODAY (Arlington, VA) - Wednesday, March 4, 2009 Author: Elizabeth Weise: (c) USA TODAY
Bent S. Herbal Medicine in the United States: Review of Efficacy, Safety,
and Regulation J Gen Intern Med 23(6):854–9. 2008
Foote, J. Protecting Consumers in the Wake of the U.S. Dietary Supplement Health and Education Act. Journal of Allied Health , Spring 2007
Bent S, Ko R. Commonly Used Herbal Medicines in the United States: A Review
Am J Med. 2004 ;116:478–485.
NIH State-of-the-Science Conference Statement on Multivitamin/Mineral Supplements
and Chronic Disease Prevention. The National Institutes of Health. NIH Consensus and State-of-the-Science Statements Volume 23, Number 2. 2006
Tilburt J, Emanuel E. Does the Evidence Make a Difference in Consumer Behavior? Sales of Supplements Before and After Publication of Negative Research Results. J Gen Intern Med 23(9):1495–8 2008.
Monday, April 27, 2009
Health in the News is not the Health News
The media distorts the nature of our country’s challenges, especially those pertaining to our public health. One of those challenges is what the government calls “homicide by discharge of firearms.” While it is a more prevalent cause of death for certain demographic groups (I will use age as an example), firearms homicide is far from the predominant cause of death in society as a whole. When it comes to protecting the life and health of our citizens, several other health issues are much more important than firearms homicide. My intention here is not to defend guns as much as shed light on how the media emphases different public health issues disproportionately to the issues' true effects on society.
Here is the CDC’s list of the leading American causes of death for 2005 (all statistics in this article are from 2005):
Top Death Causes (Actual #) (% of Total)
All causes (2,448,017) (100.0)
Cardiovascular disease (856,030) (35.0)
Cancer (559,312) (22.8)
Cerebrovascular diseases (143,579) (5.9)
Chronic lower respiratory diseases (130,933) (5.3)
Diabetes mellitus (75,119) (3.1)
Alzheimer's disease (71,599) (2.9)
Non-transportation accidents (69,368) (2.8)
Influenza and pneumonia (63,001) (2.6)
Motor vehicle accidents (45,343) (1.9)
Kidney failure (42,868) (1.8)
Infection (34,136) (1.4)
Suicide (32,637) (1.3)
Chronic liver disease and cirrhosis (27,530) (1.1)
Hypertension / hypertensive renal disease (24,902) (1.0)
Parkinson's disease (19,544) (0.8)
Lung Tissue Inflammation (17,129) (0.7)
Human immunodeficiency virus (12,543) (0.5)
Homicide by discharge of firearms (12,352) (0.5)
Granted, the above data is for the entire population and is skewed toward natural causes and disease because of the inclusion of the elderly.
However, if we isolate the age group with the highest number of firearms homicide victims, firearms homicide is still far from the number one cause of death. Just as the general population numbers are skewed by the elderly against firearms homicide, the numbers for ages 15-24 are skewed in favor of firearms homicide (plus auto and other accidents) because of this group’s superior overall physical health and lack of world experience. In plain language, when people between the ages of 15 and 24 die, it is least likely from natural causes and most likely from their own stupidity.
Top Death Causes Ages 15-24 (Actual #) (% of Group)
All causes (34,234) (100)
Motor vehicle accidents (10,908) (31.9)
Homicide by discharge of firearms (4,499) (13.1)
Non-transportation accidents (4,465) (13.0)
Suicide (4,212) (12.3)
Cancer (1,717) (5.0)
This 15-24 age group is an extreme example. While the number of firearm homicides is unacceptably high for this age group, where is the outcry over the number of deaths from motor vehicle accidents? While a discussion about outlawing cars would be absurd, why is there not a similar (let alone a greater)media lust for traffic safety as there is for gun control? Why is it that motor vehicle accidents kill twice as many people as firearm homicide, yet the latter is hyped up in the news while the former is not?
To put it in perspective, let us look at an age group that 1) eliminates the very young and very old outliers and 2) has the firearm homicide death rate (4.6 per 100,000) closest to the firearm homicide death rate for the entire population (4.2 per 100,000). That age group is 35-44.
Top Death Causes Ages 35-44 (Actual #) (% of Group)
All causes (84,785) (100)
Cardiovascular disease (15,852) (18.7)
Cancer (14,566) (17.2)
Non-transportation accidents (9,624) (11.3)
Motor vehicle accidents (6,748) (8.0)
Suicide (6,550) (7.7)
Human immunodeficiency virus (4,363) (5.2)
Chronic liver disease and cirrhosis (2,688) (3.2)
Diabetes mellitus (2,045) (2.4)
Homicide by discharge of firearms (2,010) (2.4)
Going by the statistics for this demographic group, if the primary motivation of the media was the welfare of Americans, then there would be over three times as many stories in the national news about traffic safety as there were about firearm homicide. There would also be three times as many stories about suicide as there were about firearm homicide. One would think there might be at least twice as many (let alone eight times as many) stories about cardiovascular disease as there were about firearm homicide.
It is pretty safe to say that is not the case.
It would seem that the media is less motivated by the health, safety, and well-being of the American people than it is motivated by a hatred of guns.
Here is one last point, to emphasize that I am not defending gun violence but attacking what the media chooses to emphasize. During the darkest days of the Iraq war, the media howled incessantly about our soldiers dying in Iraq, while a much worse slaughter was happening here at home. In 2005, 673 Americans were killed in action in Iraq, while 18,124 Americans (27 times that number) were firearms homicide victims here at home. Relying on the media, one would not have realized that.
The lesson here is, when it comes to health news (and all news in general), view the stories that the media chooses and thus emphasizes with a great deal of skepticism.
Sources
Kung HC, Hoyert DL, Xu JQ, Murphy SL. Deaths: Final data for 2005. National vital statistics reports; vol 56 no 10. Hyattsville, MD: National Center for Health Statistics. 2008. http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_10.pdf Accessed 4/25/09
United States Department of Defense. Global War on Terrorism - Operation Iraqi Freedom
By Month http://siadapp.dmdc.osd.mil/personnel/CASUALTY/oif-total-by-month.pdf Accessed 4/26/09
Here is the CDC’s list of the leading American causes of death for 2005 (all statistics in this article are from 2005):
Top Death Causes (Actual #) (% of Total)
All causes (2,448,017) (100.0)
Cardiovascular disease (856,030) (35.0)
Cancer (559,312) (22.8)
Cerebrovascular diseases (143,579) (5.9)
Chronic lower respiratory diseases (130,933) (5.3)
Diabetes mellitus (75,119) (3.1)
Alzheimer's disease (71,599) (2.9)
Non-transportation accidents (69,368) (2.8)
Influenza and pneumonia (63,001) (2.6)
Motor vehicle accidents (45,343) (1.9)
Kidney failure (42,868) (1.8)
Infection (34,136) (1.4)
Suicide (32,637) (1.3)
Chronic liver disease and cirrhosis (27,530) (1.1)
Hypertension / hypertensive renal disease (24,902) (1.0)
Parkinson's disease (19,544) (0.8)
Lung Tissue Inflammation (17,129) (0.7)
Human immunodeficiency virus (12,543) (0.5)
Homicide by discharge of firearms (12,352) (0.5)
Granted, the above data is for the entire population and is skewed toward natural causes and disease because of the inclusion of the elderly.
However, if we isolate the age group with the highest number of firearms homicide victims, firearms homicide is still far from the number one cause of death. Just as the general population numbers are skewed by the elderly against firearms homicide, the numbers for ages 15-24 are skewed in favor of firearms homicide (plus auto and other accidents) because of this group’s superior overall physical health and lack of world experience. In plain language, when people between the ages of 15 and 24 die, it is least likely from natural causes and most likely from their own stupidity.
Top Death Causes Ages 15-24 (Actual #) (% of Group)
All causes (34,234) (100)
Motor vehicle accidents (10,908) (31.9)
Homicide by discharge of firearms (4,499) (13.1)
Non-transportation accidents (4,465) (13.0)
Suicide (4,212) (12.3)
Cancer (1,717) (5.0)
This 15-24 age group is an extreme example. While the number of firearm homicides is unacceptably high for this age group, where is the outcry over the number of deaths from motor vehicle accidents? While a discussion about outlawing cars would be absurd, why is there not a similar (let alone a greater)media lust for traffic safety as there is for gun control? Why is it that motor vehicle accidents kill twice as many people as firearm homicide, yet the latter is hyped up in the news while the former is not?
To put it in perspective, let us look at an age group that 1) eliminates the very young and very old outliers and 2) has the firearm homicide death rate (4.6 per 100,000) closest to the firearm homicide death rate for the entire population (4.2 per 100,000). That age group is 35-44.
Top Death Causes Ages 35-44 (Actual #) (% of Group)
All causes (84,785) (100)
Cardiovascular disease (15,852) (18.7)
Cancer (14,566) (17.2)
Non-transportation accidents (9,624) (11.3)
Motor vehicle accidents (6,748) (8.0)
Suicide (6,550) (7.7)
Human immunodeficiency virus (4,363) (5.2)
Chronic liver disease and cirrhosis (2,688) (3.2)
Diabetes mellitus (2,045) (2.4)
Homicide by discharge of firearms (2,010) (2.4)
Going by the statistics for this demographic group, if the primary motivation of the media was the welfare of Americans, then there would be over three times as many stories in the national news about traffic safety as there were about firearm homicide. There would also be three times as many stories about suicide as there were about firearm homicide. One would think there might be at least twice as many (let alone eight times as many) stories about cardiovascular disease as there were about firearm homicide.
It is pretty safe to say that is not the case.
It would seem that the media is less motivated by the health, safety, and well-being of the American people than it is motivated by a hatred of guns.
Here is one last point, to emphasize that I am not defending gun violence but attacking what the media chooses to emphasize. During the darkest days of the Iraq war, the media howled incessantly about our soldiers dying in Iraq, while a much worse slaughter was happening here at home. In 2005, 673 Americans were killed in action in Iraq, while 18,124 Americans (27 times that number) were firearms homicide victims here at home. Relying on the media, one would not have realized that.
The lesson here is, when it comes to health news (and all news in general), view the stories that the media chooses and thus emphasizes with a great deal of skepticism.
Sources
Kung HC, Hoyert DL, Xu JQ, Murphy SL. Deaths: Final data for 2005. National vital statistics reports; vol 56 no 10. Hyattsville, MD: National Center for Health Statistics. 2008. http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_10.pdf Accessed 4/25/09
United States Department of Defense. Global War on Terrorism - Operation Iraqi Freedom
By Month http://siadapp.dmdc.osd.mil/personnel/CASUALTY/oif-total-by-month.pdf Accessed 4/26/09
Sunday, April 26, 2009
Homeland Security? For Swine Flu?
I watched the press conference today in which the Homeland Security Secretary, Janet Napolitano, was coordinating the United States’ Swine Flu efforts.
From its inception, the Department of Homeland Security has been chargrd with taking the lead in a pandemic (which we do not yet have). I need convincing that this is the best policy.
Not only does a DHS Secretary lack the medical qualifications and expertise to lead the planning for this possible crisis, but this takes her attention away from the whole reason her position exists—protecting the United States from terrorism. The message is that we are not offering the most appropriate response in one area of concern while taking our eye off the ball in another area of concern.
She has been put in charge over the Cabinet Secretary (or actually Acting Secretary—that this position is still not officially filled three months into the administration points to another problem) whose assumed area of expertise is in the current area of concern—public health. The DHS Secretary was placed in charge over the Department of Health and Human Services (HHS) Acting Secretary Charles E. Johnson and the various agencies under his direction, including the Centers for Disease Control.
The Department of Homeland Security was created specifically to guard against terrorism on U.S. soil. Being the DHS Secretary requires one’s area of expertise to be protecting the U.S. against terrorism. If her area of expertise is in health rather than terrorism, then why is DHS Secretary in charge of health policy? One can argue that a possible pandemic IS a matter of domestic security, but that is wrong, especially at this juncture. The Department of Homeland Security should only become involved only if a pandemic had caused a breakdown of society with the resulting chaos placing the country’s infrastructure and citizens at greater risk of terrorism. We are not even near that situation, but even then, the DHS Secretary would not have the lead but be one of many considerations. Instead, a Department Secretary whose supposed area of expertise is not even in the area of current concern is in charge of Secretaries who are better qualified to handle the situation than she is.
From its inception, the Department of Homeland Security has been chargrd with taking the lead in a pandemic (which we do not yet have). I need convincing that this is the best policy.
Not only does a DHS Secretary lack the medical qualifications and expertise to lead the planning for this possible crisis, but this takes her attention away from the whole reason her position exists—protecting the United States from terrorism. The message is that we are not offering the most appropriate response in one area of concern while taking our eye off the ball in another area of concern.
She has been put in charge over the Cabinet Secretary (or actually Acting Secretary—that this position is still not officially filled three months into the administration points to another problem) whose assumed area of expertise is in the current area of concern—public health. The DHS Secretary was placed in charge over the Department of Health and Human Services (HHS) Acting Secretary Charles E. Johnson and the various agencies under his direction, including the Centers for Disease Control.
The Department of Homeland Security was created specifically to guard against terrorism on U.S. soil. Being the DHS Secretary requires one’s area of expertise to be protecting the U.S. against terrorism. If her area of expertise is in health rather than terrorism, then why is DHS Secretary in charge of health policy? One can argue that a possible pandemic IS a matter of domestic security, but that is wrong, especially at this juncture. The Department of Homeland Security should only become involved only if a pandemic had caused a breakdown of society with the resulting chaos placing the country’s infrastructure and citizens at greater risk of terrorism. We are not even near that situation, but even then, the DHS Secretary would not have the lead but be one of many considerations. Instead, a Department Secretary whose supposed area of expertise is not even in the area of current concern is in charge of Secretaries who are better qualified to handle the situation than she is.
Saturday, April 25, 2009
Swine Flu and the Right Thing to Do?
The outbreak of swine flu in Mexico (which has spread to the U.S.) raises some difficult questions.
As of this writing early Saturday evening (4/25/09), news outlets were reporting that 20 to 80 are dead in Mexico with over 1000 infected, and 0 dead in the U.S. with roughly 15 infected (California, Texas, Kansas and New York). The Mexican president has declared an emergency, giving himself broad powers to impose quarantines and cancel events. The Mexico City government has closed school indefinitely and canceled other activities involving gatherings. This strain of swine flu does not kill only the very young or very old. An unnamed Mexican government source claimed most of the dead there are between 25 and 45 years old.
I am not an expert in the spread of disease, so I do not know if it is too late for travel and trade restrictions, should conditions in Mexico deteriorate to the point where they may be needed. When should health-related travel restrictions be placed between countries, essentially placing a country under quarantine? A pre-mature travel ban could spark cries of racism or xenophobia. If a travel ban should be necessary, will authorities wait longer than they otherwise would out of racial or diplomatic sensitivity? Feelings and pride are irrelevant when lives are at stake.
There are other questions. What are the rights of private citizens to move around and conduct commerce vs. society’s right to be protected from the spread of disease? How far should worldwide swine flu conditions have to deteriorate before the World Health Organization (WHO) declares a pandemic? A pandemic declaration by the WHO asks for voluntary worldwide trade and travel restrictions. With the world economy already in shambles, there will doubtless be pressure to postpone a pandemic declaration as long as possible. Some countries would comply, while others would not. What actions should be taken against countries that are not complying and are thought to be endangering other populations?
If we are fortunate, we will not have to learn the answers to these questions.
Sources
http://in.reuters.com/article/oilRpt/idINN2443181920090424
http://www.bloomberg.com/apps/news?pid=20601087&sid=aEsNownABJ6Q&refer=worldwide
http://www.alertnet.org/thenews/newsdesk/N24449988.htm
http://www.breitbart.com/article.php?id=D97PNI383&show_article=1
As of this writing early Saturday evening (4/25/09), news outlets were reporting that 20 to 80 are dead in Mexico with over 1000 infected, and 0 dead in the U.S. with roughly 15 infected (California, Texas, Kansas and New York). The Mexican president has declared an emergency, giving himself broad powers to impose quarantines and cancel events. The Mexico City government has closed school indefinitely and canceled other activities involving gatherings. This strain of swine flu does not kill only the very young or very old. An unnamed Mexican government source claimed most of the dead there are between 25 and 45 years old.
I am not an expert in the spread of disease, so I do not know if it is too late for travel and trade restrictions, should conditions in Mexico deteriorate to the point where they may be needed. When should health-related travel restrictions be placed between countries, essentially placing a country under quarantine? A pre-mature travel ban could spark cries of racism or xenophobia. If a travel ban should be necessary, will authorities wait longer than they otherwise would out of racial or diplomatic sensitivity? Feelings and pride are irrelevant when lives are at stake.
There are other questions. What are the rights of private citizens to move around and conduct commerce vs. society’s right to be protected from the spread of disease? How far should worldwide swine flu conditions have to deteriorate before the World Health Organization (WHO) declares a pandemic? A pandemic declaration by the WHO asks for voluntary worldwide trade and travel restrictions. With the world economy already in shambles, there will doubtless be pressure to postpone a pandemic declaration as long as possible. Some countries would comply, while others would not. What actions should be taken against countries that are not complying and are thought to be endangering other populations?
If we are fortunate, we will not have to learn the answers to these questions.
Sources
http://in.reuters.com/article/oilRpt/idINN2443181920090424
http://www.bloomberg.com/apps/news?pid=20601087&sid=aEsNownABJ6Q&refer=worldwide
http://www.alertnet.org/thenews/newsdesk/N24449988.htm
http://www.breitbart.com/article.php?id=D97PNI383&show_article=1
A Non-Religious Case against Abortion
I have concluded that abortion is wrong, but my reasons are not based on religion. Don’t get me wrong. Unlike the specious Bill Maher, I am not anti-religion. However, “the Bible says so” is not an acceptable basis from which to argue a point. While I am religious, my conclusions about abortion are based on humanistic and (yes) secular considerations.
First off, life begins at conception. Once the egg is fertilized, a chain of events is unleashed that, outside of malformation, medical problems, homicide or accidental death, invariably result in a fully formed adult human.
From conception through their mid-teens, human beings are in a constant state of physical development, gaining physiological capabilities and self-sufficiency. Not being fully physically developed is not an acceptable rationale for discounting one’s humanity. Does a pre-pubescent inability to reproduce make a child any less human? Does a baby’s inability to walk or speak make her any less human? Does not having teeth make an infant any less human? Does an infant’s inability to feed or defend himself make him any less human? Does having a soft skull make an infant any less human?
Of course, it does not.
By that rationale, not breathing air but getting nutrients from an umbilical cord does not make a baby any less human. Not having fully formed eyes does not make her any less human. Not having a fully developed brain does not make him any less human. Thus, development at any stage, including nascent development, does not make a person less human.
Human beings are physically dependent on their parents (especially, and increasingly so in modern times, their mothers) for nutrition and protection to varying degrees from conception through their mid-teens. A ten-year old depends on her parents for protection (no one is inclined to go to extremes to protect a child as is that child’s biological parents) and the means to acquire food. A five year old depends on his parents for protection and nutrition (lacking the means and knowledge to acquire proper food, both today and in prehistoric times). A six month old is dependent on her parents for protection and nutrition (mother’s milk or formula). In the same way, a person in utero is dependent on her mother for nutrition and protection from conception to birth.
It is intellectually inconsistent that society charges parents with the responsibility of providing nutrition and protection to their post-utero children but not in utero.
Many people mistakenly think that a child in the beginning is not human but a mere glob of cells. Let us look at in utero child development.
In a previous blog, I wrote about how genetic testing of fertilized eggs is now used to pick traits in children such as eye color, skin pigmentation, hair color, sex and more. If those traits are already determined in a fertilized egg, it is difficult to argue that the egg, zygote, fetus, or whatever one wants to call it, is non-human. While not yet manifested at this age, the child’s traits, including eye color, hair color, sex and even (to a large extent) personality are set. He or she is more than mere nondescript cells.
For some reason, pregnancy is officially calculated as starting on the first day of the woman’s last period, though conception generally takes place two weeks after that. Thus, most discussions of child development are misleading, since people are left with the impression that the child is two weeks older then he or she really is. In reality, the child initially develops and manifests widely known human characteristics much more quickly than people are led to believe. Therefore, I am going to describe child development in terms of “weeks after conception” instead of the common (and in my opinion, misleading) “gestational weeks.”
The first week begins with conception, and the child instantly starts to grow new cells as she travels down the fallopian tubes and lands in the lining of the uterus.
In the second week after conception, the child continues to grow new cells that divide into different groups, laying the initial groundwork for different areas of the body.
In the third week after conception, the child’s heart, spine and brain begin to form, though he is only 1/25 of an inch long. (This is about the time generally when a woman is missing her period and suspecting an unplanned pregnancy.)
In the fourth week after conception, while she is not more than of an inch long, the child’s heart starts to beat, pushing her own blood around her own circulatory system.
In the fifth week after conception, the mouth and digestive system are beginning to develop. Arms, legs and hands are starting to form. The baby is roughly 1/8 of an inch long.
In the sixth week after conception, the baby is about 1/3 inch long, and the eyes and nostrils are developing. Fingers, toes, and genitalia are beginning to develop. (Roughly, 62% of abortions are performed by this time (8 weeks gestation)).[1]
In the seventh week after conception, fingers and toes are taking shape, and the baby is at least ½ inch long.
In the eighth week after conception, the internal organs (including testes or ovaries) are all formed and the baby is about 1 inch long.
In the ninth week after conception, the baby is 2 inches long, and his skeleton is developing.
In the tenth week after conception, the genitalia are identifiable and sex is distinguishable.
In the eleventh week after conception, the baby is 3 inches long and has fingernails and toenails. (Roughly, 88% of abortions are performed by this time (13 weeks gestation)).[1]
There are many social and economic reasons why women feel compelled to abort their children. However, whatever motive one has for aborting a child, one cannot claim that abortion does not kill a human being. It does. An aborted baby is more than a discarded glob of random, unorganized cells. "It" is a dead human being.
References
[1] Abortion Surveillance — United States, 2005. Centers for Disease Control and Prevention. November 28, 2008 / Vol. 57 / No. SS-13. http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5713a1.htm Accessed 4/24/09
Fetal development: What happens during the first trimester? Mayo Clinic. http://www.mayoclinic.com/health/prenatal-care/PR00112/METHOD=print Accessed 4/24/09
Pregnancy calendar. Nemours. http://www.nemours.org/e-service/kidshealth.html?p4if_ps=102 Accessed 4/24/09
First off, life begins at conception. Once the egg is fertilized, a chain of events is unleashed that, outside of malformation, medical problems, homicide or accidental death, invariably result in a fully formed adult human.
From conception through their mid-teens, human beings are in a constant state of physical development, gaining physiological capabilities and self-sufficiency. Not being fully physically developed is not an acceptable rationale for discounting one’s humanity. Does a pre-pubescent inability to reproduce make a child any less human? Does a baby’s inability to walk or speak make her any less human? Does not having teeth make an infant any less human? Does an infant’s inability to feed or defend himself make him any less human? Does having a soft skull make an infant any less human?
Of course, it does not.
By that rationale, not breathing air but getting nutrients from an umbilical cord does not make a baby any less human. Not having fully formed eyes does not make her any less human. Not having a fully developed brain does not make him any less human. Thus, development at any stage, including nascent development, does not make a person less human.
Human beings are physically dependent on their parents (especially, and increasingly so in modern times, their mothers) for nutrition and protection to varying degrees from conception through their mid-teens. A ten-year old depends on her parents for protection (no one is inclined to go to extremes to protect a child as is that child’s biological parents) and the means to acquire food. A five year old depends on his parents for protection and nutrition (lacking the means and knowledge to acquire proper food, both today and in prehistoric times). A six month old is dependent on her parents for protection and nutrition (mother’s milk or formula). In the same way, a person in utero is dependent on her mother for nutrition and protection from conception to birth.
It is intellectually inconsistent that society charges parents with the responsibility of providing nutrition and protection to their post-utero children but not in utero.
Many people mistakenly think that a child in the beginning is not human but a mere glob of cells. Let us look at in utero child development.
In a previous blog, I wrote about how genetic testing of fertilized eggs is now used to pick traits in children such as eye color, skin pigmentation, hair color, sex and more. If those traits are already determined in a fertilized egg, it is difficult to argue that the egg, zygote, fetus, or whatever one wants to call it, is non-human. While not yet manifested at this age, the child’s traits, including eye color, hair color, sex and even (to a large extent) personality are set. He or she is more than mere nondescript cells.
For some reason, pregnancy is officially calculated as starting on the first day of the woman’s last period, though conception generally takes place two weeks after that. Thus, most discussions of child development are misleading, since people are left with the impression that the child is two weeks older then he or she really is. In reality, the child initially develops and manifests widely known human characteristics much more quickly than people are led to believe. Therefore, I am going to describe child development in terms of “weeks after conception” instead of the common (and in my opinion, misleading) “gestational weeks.”
The first week begins with conception, and the child instantly starts to grow new cells as she travels down the fallopian tubes and lands in the lining of the uterus.
In the second week after conception, the child continues to grow new cells that divide into different groups, laying the initial groundwork for different areas of the body.
In the third week after conception, the child’s heart, spine and brain begin to form, though he is only 1/25 of an inch long. (This is about the time generally when a woman is missing her period and suspecting an unplanned pregnancy.)
In the fourth week after conception, while she is not more than of an inch long, the child’s heart starts to beat, pushing her own blood around her own circulatory system.
In the fifth week after conception, the mouth and digestive system are beginning to develop. Arms, legs and hands are starting to form. The baby is roughly 1/8 of an inch long.
In the sixth week after conception, the baby is about 1/3 inch long, and the eyes and nostrils are developing. Fingers, toes, and genitalia are beginning to develop. (Roughly, 62% of abortions are performed by this time (8 weeks gestation)).[1]
In the seventh week after conception, fingers and toes are taking shape, and the baby is at least ½ inch long.
In the eighth week after conception, the internal organs (including testes or ovaries) are all formed and the baby is about 1 inch long.
In the ninth week after conception, the baby is 2 inches long, and his skeleton is developing.
In the tenth week after conception, the genitalia are identifiable and sex is distinguishable.
In the eleventh week after conception, the baby is 3 inches long and has fingernails and toenails. (Roughly, 88% of abortions are performed by this time (13 weeks gestation)).[1]
There are many social and economic reasons why women feel compelled to abort their children. However, whatever motive one has for aborting a child, one cannot claim that abortion does not kill a human being. It does. An aborted baby is more than a discarded glob of random, unorganized cells. "It" is a dead human being.
References
[1] Abortion Surveillance — United States, 2005. Centers for Disease Control and Prevention. November 28, 2008 / Vol. 57 / No. SS-13. http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5713a1.htm Accessed 4/24/09
Fetal development: What happens during the first trimester? Mayo Clinic. http://www.mayoclinic.com/health/prenatal-care/PR00112/METHOD=print Accessed 4/24/09
Pregnancy calendar. Nemours. http://www.nemours.org/e-service/kidshealth.html?p4if_ps=102 Accessed 4/24/09
Monday, March 9, 2009
In Healthcare Reform, Caveat Emptor
Some might take issue with this article’s title. Applying ‘”caveat emptor” (“buyer beware”) to healthcare reform presupposes that healthcare is a commodity to be bought and sold. Like other services, healthcare IS a commodity that (to an extent) NEEDS to be bought and sold.
I admittedly do not know the details of the President’s health care proposal (I can not find any), but I know what I do not want to happen. I do not want the system to lose performance (including efficiency) incentives for doctors, patients, insurers, pharmaceutical companies, and device manufacturers. While some people are altruistic, the vast majority of people (and companies) are not.
Communism failed because there was no incentive for anyone to do anything.
The same principles apply to healthcare. If all doctors are paid the same, doctors will have no incentive to be better doctors. Even further, if the exceptional doctors are not rewarded, then exceptional people will not become doctors.
People like to rail against “the obscene profits of the drug companies.” Those obscene profits are the reason that drug companies bother to invent new drugs. It is not a coincidence that most pharmaceutical research is based in the United States. Our policies reward innovation and investment. Price controls on drugs would have many undesirable “side effects.”
If health care is "free," people are more likely to run to the doctor for trivial health complaints, further clogging a system that is guaranteed to become backlogged.
Getting any non-emergency procedure would likely require getting on a long waiting list, as they have to do for non-emergency procedures in Canada and Britain. There is a reason many Canadians come to the US for non-emergency procedures, and whatever the reason (waiting list or available quality of care), it is undeniable evidence that their system is not superior to ours.
One reason our health care system is comparatively expensive is the higher availability quality of care. Competition between hospitals and health care companies spurs them to have the latest technology to diagnose and treat patients. On the other hand, if people are forced to go to your hospital, you can do without that new MRI machine. You have no incentive to retain the best doctors, who WANT to have the latest technology to treat their patients. If it is a government monopoly, where else are the patients going to go? Where else are the doctors going to go? Perhaps, they will both go to another country.
While demonized (admittedly, some criticism is valid), health insurance companies do create pressure for efficiency. Without such scrutiny, inefficiencies would never be addressed. Money and resources that could have been used to actually treat people would be wasted.
Besides, I am not sure that private health insurance is currently as cost prohibitive as many people contend. On my own, I purchased health insurance from a major insurer that is almost as good as the programs I had through employers, and it is only $114 per month, including prescription benefits and the ability to choose my own doctor. Granted, I am a single man, but I am over 40 years of age. People use Cobra all the time as an example of out of control health premiums, but Cobra is a rip-off. After leaving my last two radio companies, I had Cobra offers of $500 and $600 per month. No thanks.
As the administration embarks on their effort to sell health care reform, people need to pay attention to the details. Scanning the administration’s health care reform website (http://www.healthreform.gov/), I found it contained a lot of platitudes and nebulous goals, but concrete recommendations were conspicuously absent.
If one pays attention to the details of the administration's sell job, it gets harder to buy into the feel good hype and harder to be frightened by the scare tactics. For instance, the number of Americans who have been bankrupted by medical expenses is grossly exaggerated by the administration. (http://blogs.abcnews.com/politicalpunch/2009/03/false-talking-1.html). While a comparatively smaller number of medical bankruptcies STILL is something that needs addressing, a comparatively smaller number of bankruptcies makes the changes needed to address them much less drastic.
Socialized medicine would not be free, as proponents think it would be. It would cost.
Boy, would it cost.
I admittedly do not know the details of the President’s health care proposal (I can not find any), but I know what I do not want to happen. I do not want the system to lose performance (including efficiency) incentives for doctors, patients, insurers, pharmaceutical companies, and device manufacturers. While some people are altruistic, the vast majority of people (and companies) are not.
Communism failed because there was no incentive for anyone to do anything.
The same principles apply to healthcare. If all doctors are paid the same, doctors will have no incentive to be better doctors. Even further, if the exceptional doctors are not rewarded, then exceptional people will not become doctors.
People like to rail against “the obscene profits of the drug companies.” Those obscene profits are the reason that drug companies bother to invent new drugs. It is not a coincidence that most pharmaceutical research is based in the United States. Our policies reward innovation and investment. Price controls on drugs would have many undesirable “side effects.”
If health care is "free," people are more likely to run to the doctor for trivial health complaints, further clogging a system that is guaranteed to become backlogged.
Getting any non-emergency procedure would likely require getting on a long waiting list, as they have to do for non-emergency procedures in Canada and Britain. There is a reason many Canadians come to the US for non-emergency procedures, and whatever the reason (waiting list or available quality of care), it is undeniable evidence that their system is not superior to ours.
One reason our health care system is comparatively expensive is the higher availability quality of care. Competition between hospitals and health care companies spurs them to have the latest technology to diagnose and treat patients. On the other hand, if people are forced to go to your hospital, you can do without that new MRI machine. You have no incentive to retain the best doctors, who WANT to have the latest technology to treat their patients. If it is a government monopoly, where else are the patients going to go? Where else are the doctors going to go? Perhaps, they will both go to another country.
While demonized (admittedly, some criticism is valid), health insurance companies do create pressure for efficiency. Without such scrutiny, inefficiencies would never be addressed. Money and resources that could have been used to actually treat people would be wasted.
Besides, I am not sure that private health insurance is currently as cost prohibitive as many people contend. On my own, I purchased health insurance from a major insurer that is almost as good as the programs I had through employers, and it is only $114 per month, including prescription benefits and the ability to choose my own doctor. Granted, I am a single man, but I am over 40 years of age. People use Cobra all the time as an example of out of control health premiums, but Cobra is a rip-off. After leaving my last two radio companies, I had Cobra offers of $500 and $600 per month. No thanks.
As the administration embarks on their effort to sell health care reform, people need to pay attention to the details. Scanning the administration’s health care reform website (http://www.healthreform.gov/), I found it contained a lot of platitudes and nebulous goals, but concrete recommendations were conspicuously absent.
If one pays attention to the details of the administration's sell job, it gets harder to buy into the feel good hype and harder to be frightened by the scare tactics. For instance, the number of Americans who have been bankrupted by medical expenses is grossly exaggerated by the administration. (http://blogs.abcnews.com/politicalpunch/2009/03/false-talking-1.html). While a comparatively smaller number of medical bankruptcies STILL is something that needs addressing, a comparatively smaller number of bankruptcies makes the changes needed to address them much less drastic.
Socialized medicine would not be free, as proponents think it would be. It would cost.
Boy, would it cost.
Wednesday, March 4, 2009
Is that Smell Tobacco Smoke or the Smell of Sausage Being Made?
If someone has read my blog postings and my comments on others’ blogs, it is not hard to figure out that I am conservative. True conservatives are often misunderstood, and the term “conservative” is most often erroneously viewed as interchangeable with the word “Republican.”
As a conservative, I believe that, as a general rule, less government interference is better. Also, I believe, as a general rule, that government agencies should exist only if they provide a service that directly benefits the entire population and that the private sector by its nature is incapable of providing. Examples of such agencies are the FAA (Federal Aviation Administration), the military, and the FDA (Food and Drug Administration).
The FDA is critical for the prosperity of this nation. For instance, I can be a lot more productive if I can concentrate on my business or job because I do not have to take a substantial part of my day every day to test my food to make sure it is not poison.
I read an article in today’s Washington Post (http://www.washingtonpost.com/wp-dyn/content/article/2009/03/03/AR2009030303661.html?hpid=moreheadlines) reporting that there is a bill making its way through Congress designed to allow the FDA to take over tobacco regulation. Such legislation is long overdue. However, there is one fatal problem with the bill. Existing products are grandfathered in, making the new rules essentially irrelevant. The new rules would apply only to new products.
Understandably, the tobacco company with the largest market share, Philip Morris, supports the legislation, while the companies that hope to take Philip Morris’ market share, namely everyone else, is against the legislation. New products that could conceivably take away Philip Morris’ market share would face the more daunting regulatory hurdles, while the existing products would not. Thus, the status-quo would be solidified.
Congressional politics are keeping the FDA from properly regulating tobacco, just as Congressional politics kept the FDA from properly regulating “dietary supplements” that (in most cases) do little more than produce very expensive urine.
In politics, they say that one needs to take what one can get. “Two steps forward, one step back.”
As a conservative, I believe that, as a general rule, less government interference is better. Also, I believe, as a general rule, that government agencies should exist only if they provide a service that directly benefits the entire population and that the private sector by its nature is incapable of providing. Examples of such agencies are the FAA (Federal Aviation Administration), the military, and the FDA (Food and Drug Administration).
The FDA is critical for the prosperity of this nation. For instance, I can be a lot more productive if I can concentrate on my business or job because I do not have to take a substantial part of my day every day to test my food to make sure it is not poison.
I read an article in today’s Washington Post (http://www.washingtonpost.com/wp-dyn/content/article/2009/03/03/AR2009030303661.html?hpid=moreheadlines) reporting that there is a bill making its way through Congress designed to allow the FDA to take over tobacco regulation. Such legislation is long overdue. However, there is one fatal problem with the bill. Existing products are grandfathered in, making the new rules essentially irrelevant. The new rules would apply only to new products.
Understandably, the tobacco company with the largest market share, Philip Morris, supports the legislation, while the companies that hope to take Philip Morris’ market share, namely everyone else, is against the legislation. New products that could conceivably take away Philip Morris’ market share would face the more daunting regulatory hurdles, while the existing products would not. Thus, the status-quo would be solidified.
Congressional politics are keeping the FDA from properly regulating tobacco, just as Congressional politics kept the FDA from properly regulating “dietary supplements” that (in most cases) do little more than produce very expensive urine.
In politics, they say that one needs to take what one can get. “Two steps forward, one step back.”
Tuesday, February 24, 2009
"Which Kid is the Favorite?” is Now a Life and Death Question
It is now reality. We can choose the traits of our children--boy, girl, blond, brunette, blue eyes, green eyes, brown eyes…. Before you get to excited, let us look at it a little closer. Like most things, paradoxically, the closer you get, the less clear things become.
How is it done? A number of eggs are fertilized. By taking a sample from each egg, the doctors identify genetic markers in each egg that will likely result in certain traits. The parents then pick the egg with the combination of traits they like best. The rest of the eggs are likely discarded. Do we want to live in a country where (for instance) the blond haired, blue-eyed boy gets to live while the brown eyed, brown haired girl does not? Let me put it this way: If this technology had been around in the late 1930's and early 1940's, the Nazis would have applied it with gusto.
Besides the moral question of determining who lives based on eye or hair color, there are practical considerations. Our species has been honed over the millennia by evolution (which is not a theory but a fact, period—no debate). Over time, a tapestry of genes and traits was woven that made our species more robust. Genetic mutations and different combinations of genes resulted in a more diverse gene pool (and thus more diverse traits) that made annihilation of the species by one disease or circumstance less likely. Some traits are linked with other traits, so when eye color, hair color or sex are manipulated, other seemingly unrelated traits are manipulated as well, affecting more than just appearance. For contemporary society, research has shown that, as politically correct as it sounds, some traits are more popular than others. What happens when we start to manipulate which genes get passed down and which genes do not? Are we unknowingly manipulating other traits (disease resistance, cancer susceptibility)? I am not a geneticist, but it seems possible.
While there are possible health-related consequences, there are also social consequences. What if boys are more desirable than girls? In many parts of the world (and subcultures within our own country), they are. Will we end up like China, where their 28 year-old policy of one child per family has resulted in female babies being aborted and a CURRENT ratio of 120 men for every 100 women? By one account, 70% of aborted babies in China are female. (http://www.msnbc.msn.com/id/5953508) While females are less “desirable” as a child, they are still desirable as a mate (that is putting it gingerly). Female abductions and trafficking are skyrocketing in China. As a man, I can state unequivocally that the consequences of that giant block of men without mates will cause problems for that society MUCH bigger than just part of its population merely being unfulfilled. As a result, women, and the entire society, will be adversely affected.
I am not saying we should stop or hinder science. It is great that we have this knowledge and ability. However, just because we have the knowledge does not mean we should use it trivially. Our knowledge in these fields is nascent, and we should proceed with extreme caution.
(This blog posting was inspired by this article: http://online.wsj.com/article/SB123439771603075099.html.)
How is it done? A number of eggs are fertilized. By taking a sample from each egg, the doctors identify genetic markers in each egg that will likely result in certain traits. The parents then pick the egg with the combination of traits they like best. The rest of the eggs are likely discarded. Do we want to live in a country where (for instance) the blond haired, blue-eyed boy gets to live while the brown eyed, brown haired girl does not? Let me put it this way: If this technology had been around in the late 1930's and early 1940's, the Nazis would have applied it with gusto.
Besides the moral question of determining who lives based on eye or hair color, there are practical considerations. Our species has been honed over the millennia by evolution (which is not a theory but a fact, period—no debate). Over time, a tapestry of genes and traits was woven that made our species more robust. Genetic mutations and different combinations of genes resulted in a more diverse gene pool (and thus more diverse traits) that made annihilation of the species by one disease or circumstance less likely. Some traits are linked with other traits, so when eye color, hair color or sex are manipulated, other seemingly unrelated traits are manipulated as well, affecting more than just appearance. For contemporary society, research has shown that, as politically correct as it sounds, some traits are more popular than others. What happens when we start to manipulate which genes get passed down and which genes do not? Are we unknowingly manipulating other traits (disease resistance, cancer susceptibility)? I am not a geneticist, but it seems possible.
While there are possible health-related consequences, there are also social consequences. What if boys are more desirable than girls? In many parts of the world (and subcultures within our own country), they are. Will we end up like China, where their 28 year-old policy of one child per family has resulted in female babies being aborted and a CURRENT ratio of 120 men for every 100 women? By one account, 70% of aborted babies in China are female. (http://www.msnbc.msn.com/id/5953508) While females are less “desirable” as a child, they are still desirable as a mate (that is putting it gingerly). Female abductions and trafficking are skyrocketing in China. As a man, I can state unequivocally that the consequences of that giant block of men without mates will cause problems for that society MUCH bigger than just part of its population merely being unfulfilled. As a result, women, and the entire society, will be adversely affected.
I am not saying we should stop or hinder science. It is great that we have this knowledge and ability. However, just because we have the knowledge does not mean we should use it trivially. Our knowledge in these fields is nascent, and we should proceed with extreme caution.
(This blog posting was inspired by this article: http://online.wsj.com/article/SB123439771603075099.html.)
Thursday, January 29, 2009
I hope some of you dislike me relatively soon.
This is my first blog entry ever, anywhere. I had no idea how I was going to approach it. As I read the various blogs of my peers with their different perspectives and approaches, I kept asking myself, “What should a biomedical ethics (bioethics) blog be?”
During the past Presidential election cycle, bloggers from various degrees of the political spectrum immolating (I think the term “flaming” is no longer adequate for the current level of political discourse) those of even slightly differing viewpoints defined (fairly ot unfairly) what it means to “blog.” However, my training in medical writing leaves no doubt that opinion has absolutely no place in biomedical writing. I think we can all agree that any individual blog, the collective blogosphere, and even the internet in general are poor places to gain credible knowledge of evidence-based medicine. (However, there are online repositories and databases of evidence-based medical information, such as http://www.ncbi.nlm.nih.gov/pubmed, http://www.medlineplus.gov/, and http://www.cochrane.org/.) By their nature, blogs have a point of view. They are for commentary and (more often) advocacy, not journalism.
In a bioethics blog, we are not primarily concerned about whether scientific medicine is effective or safe. That is for the scientists, the doctors, and (ultimately) the FDA to decide. In a bioethics blog, we are primarily concerned with the ethics associated with the application of scientific medicine. We have to ponder the difficult, even ugly, questions. A lot of these questions are in the news today:
No one questions the contention that stem-cell research may lead to medical advances. However, the ethical question is what happens when fetuses become valuable and thus become a commodity? Will there be incentives to harvest fetuses? What kind of behavior will that spur?
A related question (which is considered by some to be old and cliché but is more difficult and relevant than ever) is, “When does life begin?”
A wildly disproportionate percentage of health care expenditures in a person’s life is incurred at the very end of his or her life. It is a difficult question, but are those expenditures justifiable?
What is more important, providing “equitable” health care for all patients or preserving providers’ incentives to be innovative and efficient? (If you think that is an easy choice of the former over the latter, then think again.)
Who is to blame for the explosion of medicine-related lawsuits in America, “greedy, predatory lawyers” or “incompetent, indifferent doctors?”
Should the government place extra taxes on the manufacturers, sellers, and consumers of certain products (soda, fast food, tobacco, alcohol, etc.) or even ban them altogether? Where do self-responsibility and individual choice come in? Who decides what is bad for another? Where does it end? Could limits on TV watching eventually be mandated by law?
It will be fun exploring these issues. I tend to alienate everyone on every side of every issue, because I do not subscribe to any one orthodoxy. If at least one of you does not end up personally disliking me, then my blog will not have been very good.
During the past Presidential election cycle, bloggers from various degrees of the political spectrum immolating (I think the term “flaming” is no longer adequate for the current level of political discourse) those of even slightly differing viewpoints defined (fairly ot unfairly) what it means to “blog.” However, my training in medical writing leaves no doubt that opinion has absolutely no place in biomedical writing. I think we can all agree that any individual blog, the collective blogosphere, and even the internet in general are poor places to gain credible knowledge of evidence-based medicine. (However, there are online repositories and databases of evidence-based medical information, such as http://www.ncbi.nlm.nih.gov/pubmed, http://www.medlineplus.gov/, and http://www.cochrane.org/.) By their nature, blogs have a point of view. They are for commentary and (more often) advocacy, not journalism.
In a bioethics blog, we are not primarily concerned about whether scientific medicine is effective or safe. That is for the scientists, the doctors, and (ultimately) the FDA to decide. In a bioethics blog, we are primarily concerned with the ethics associated with the application of scientific medicine. We have to ponder the difficult, even ugly, questions. A lot of these questions are in the news today:
No one questions the contention that stem-cell research may lead to medical advances. However, the ethical question is what happens when fetuses become valuable and thus become a commodity? Will there be incentives to harvest fetuses? What kind of behavior will that spur?
A related question (which is considered by some to be old and cliché but is more difficult and relevant than ever) is, “When does life begin?”
A wildly disproportionate percentage of health care expenditures in a person’s life is incurred at the very end of his or her life. It is a difficult question, but are those expenditures justifiable?
What is more important, providing “equitable” health care for all patients or preserving providers’ incentives to be innovative and efficient? (If you think that is an easy choice of the former over the latter, then think again.)
Who is to blame for the explosion of medicine-related lawsuits in America, “greedy, predatory lawyers” or “incompetent, indifferent doctors?”
Should the government place extra taxes on the manufacturers, sellers, and consumers of certain products (soda, fast food, tobacco, alcohol, etc.) or even ban them altogether? Where do self-responsibility and individual choice come in? Who decides what is bad for another? Where does it end? Could limits on TV watching eventually be mandated by law?
It will be fun exploring these issues. I tend to alienate everyone on every side of every issue, because I do not subscribe to any one orthodoxy. If at least one of you does not end up personally disliking me, then my blog will not have been very good.
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