As the Associated Press reports, abstinence-only sex education in schools, championed by conservatives, is in jeopardy of losing federal funding now that we have a Democrat in the White House.
The Religious Right loves abstinence-only programs, because living Biblically means no sex before marriage. If they can't get actual Bible teachings into public schools, at least getting tax dollars to pay for sex education that tells teens that abstaining from sex is the only safe option still helps to advance their agenda. On the other hand, groups like Planned Parenthood hate abstinence-only; they think that kids will have sex no matter what, so we ought to be teaching them about all the options -- contraceptives, condoms, and all -- in the hopes that when teenagers do have sex, they will take measures to protect themselves. Who is right?
When it comes to government funding, the answer is: It doesn't matter.
Yes, that's right. It doesn't matter -- because the government has no business making this kind of decision.
It's every parent's right to educate his or her child as he or she sees fit. A family in the Bible Belt who believes that Jesus hates premarital sex should be able to teach their children that -- and should not have to pay to teach other children about safer-sex methods that clash with their religion. Similarly, a liberal who believes premarital sex is just fine should be able to tell her child so, and should not have to fund abstinence-only programs through her tax dollars.
When the government decides what children are taught in school, then it is politics that drives what to teach. When the Religious Right is in power, we get "no sex before marriage" in schools; when liberals take control, we get "use a condom." Instead of parental choice, the curriculum is chosen by whatever group happens to be in control -- and those who aren't part of that group have to see their tax dollars spent to spread ideas they don't believe in. The whim of the majority, not the free individual choice of a parent, decides what your child will learn.
This isn't just about sex education; it's about everything that kids learn in school. One year it might be Darwinian evolution, the next intelligent design. One year The Color Purple is banned for explicit language, the next it's trumpeted as a must-read. No government -- federal, state, or local -- should be making these decisions. Parents should. That's why the government must get out of all education, sex or otherwise.
Monday, January 26, 2009
Friday, January 16, 2009
It's not wrong to put a price on health
In yesterday's New York Times, Pauline Chen lamented our growing comfort with the role of money in medicine. She refers to healthcare as "the gift of life," which cannot be reduced to a mere commodity that can be quantified and analyzed. And she cites the example of a man suing his estranged wife for either the return of the kidney he donated to her or $1.5 million as evidence that medicine has become too commoditized, saying that there "should have been outrage over putting a dollar value on human life." Is she right?
It's telling that Ms. Chen calls healthcare "the gift of life." Throughout the whole article, the tone is: Healthcare is getting easier to assess and quantify in monetary terms, and that's a bad thing. She would prefer "compassionate care" and "patient-centered partnerships." The implication is clear: Altruism needs to play a bigger role in medicine. Thus, healthcare is not a trade between individuals to mutual benefit, but "the gift of life."
But bringing altruism into medicine harms patients rather than helping them. If we allowed people to buy and sell organs in this country, we would see the supply of available organs increase; is it more "compassionate" to allow thousands of patients to die waiting for an organ, just to keep money out of the equation? If we go toward a freer market in medicine, rather than move in the direction of price controls and government mandates for lower payments to doctors, more bright young people will want to go to medical school; is it "compassionate" to create a shortage of doctors, or to tell someone who has spent many years in extensive postgraduate training that he doesn't deserve to make money just because people need his services?
It's true that quantifying the cost-effectiveness of healthcare has caused dissatisfaction in some ways: The insurance company decides that your doctor's time is worth a lower amount this year than last year, so he shortens the length of a visit and sends you off feeling as though you were rushed through the appointment. Your policy raises the copay for prescription drugs, so your asthma medication costs more, but delivers you no more value than it did when you were paying less. And so on and so forth.
But such examples do not prove that altruism is the solution. They only illustrate the problem with trying to pretend that healthcare has no monetary cost. When patients have to pay for their own care, they become cost-conscious: They evaluate for themselves whether it's worth it to pay more money for a doctor who has more time to spend with each patient, or whether the cost savings is worth a quick visit with less time to discuss medical issues. When a third party is introduced, the patient is insulated from the true cost of care. He starts to want the best of everything, regardless of how much it costs -- because his insurance company is covering the cost. The insurance company, on the other hand, wants to reduce costs as much as possible, even if it means that some patients are dissatisfied with their care. Thus, instead of mutual trade to mutual benefit, we get a system nobody is happy with.
Doctors, medical researchers, and pharmaceutical company executives do not work for the benefit of others. They work because of the pleasure they get from tackling the problems of human disease -- and because of the financial rewards they stand to gain. And nobody can be expected to donate an organ to a stranger out of brother-love alone. The fact that there's money in medicine is not a sad fact to be lamented -- it's the reason that we can enjoy good care.
It's telling that Ms. Chen calls healthcare "the gift of life." Throughout the whole article, the tone is: Healthcare is getting easier to assess and quantify in monetary terms, and that's a bad thing. She would prefer "compassionate care" and "patient-centered partnerships." The implication is clear: Altruism needs to play a bigger role in medicine. Thus, healthcare is not a trade between individuals to mutual benefit, but "the gift of life."
But bringing altruism into medicine harms patients rather than helping them. If we allowed people to buy and sell organs in this country, we would see the supply of available organs increase; is it more "compassionate" to allow thousands of patients to die waiting for an organ, just to keep money out of the equation? If we go toward a freer market in medicine, rather than move in the direction of price controls and government mandates for lower payments to doctors, more bright young people will want to go to medical school; is it "compassionate" to create a shortage of doctors, or to tell someone who has spent many years in extensive postgraduate training that he doesn't deserve to make money just because people need his services?
It's true that quantifying the cost-effectiveness of healthcare has caused dissatisfaction in some ways: The insurance company decides that your doctor's time is worth a lower amount this year than last year, so he shortens the length of a visit and sends you off feeling as though you were rushed through the appointment. Your policy raises the copay for prescription drugs, so your asthma medication costs more, but delivers you no more value than it did when you were paying less. And so on and so forth.
But such examples do not prove that altruism is the solution. They only illustrate the problem with trying to pretend that healthcare has no monetary cost. When patients have to pay for their own care, they become cost-conscious: They evaluate for themselves whether it's worth it to pay more money for a doctor who has more time to spend with each patient, or whether the cost savings is worth a quick visit with less time to discuss medical issues. When a third party is introduced, the patient is insulated from the true cost of care. He starts to want the best of everything, regardless of how much it costs -- because his insurance company is covering the cost. The insurance company, on the other hand, wants to reduce costs as much as possible, even if it means that some patients are dissatisfied with their care. Thus, instead of mutual trade to mutual benefit, we get a system nobody is happy with.
Doctors, medical researchers, and pharmaceutical company executives do not work for the benefit of others. They work because of the pleasure they get from tackling the problems of human disease -- and because of the financial rewards they stand to gain. And nobody can be expected to donate an organ to a stranger out of brother-love alone. The fact that there's money in medicine is not a sad fact to be lamented -- it's the reason that we can enjoy good care.
Tuesday, January 6, 2009
Why some New Year's resolutions work and others don't
Surprise, surprise: The New York Times reports that lots of people who buy home exercise equipment use it less than they hoped they would when they bought it. And every time I go to the gym this month, I expect to be waiting in line for a treadmill behind hordes of people who signed up as a New Year's resolution -- and who will be gone by about Valentine's Day.
According to the Times article, behavioral scientists think that stick-to-it-iveness comes from a sense of self-efficacy -- if you believe you can achieve your goals, you'll keep working out. And if you set realistic goals, rather than aiming to lose 50 pounds in a month, you're less likely to quit.
Well, that's part of it. But I think just having a sense of self-efficacy isn't enough. You have to actually be efficacious; your assessment of yourself must be in line with reality. If you think you can reach your goals, but you're not actually doing what you need to do in order to get there, you'll be disappointed. Every time I go to the gym, I see at least one overweight person who's walking at 3 miles an hour with no incline on the treadmill, or pedaling on a reclining bike at the lowest level of resistance. I always suspect these people think they are working out. But if you walk on a treadmill at 3 mph for 30 minutes, you've burned less than 200 calories, unless you are morbidly obese. That's fine if you're cutting a lot of calories when eating, but I know this game all too well, as I played it with myself when I was fat. I had "worked out," so I would allow myself a "little treat" -- say, a bowl of ice cream, or a few Oreos. Except I hadn't burned off enough calories to justify more than a tablespoon of ice cream, or maybe one Oreo. So I stayed fat, and wondered why the exercise wasn't working.
It's reason that will get you results: an unbreached commitment to figuring out what you need to do, what steps you need to take in the short and long term in order to achieve your goal, and whether or not you are actually doing what you need to do. Evasion at any step in the process will lead to failure. Set the wrong goal -- like "I'm going to train for the marathon that's in six months" while evading the fact that you haven't run a step since elementary school -- and you'll get frustrated and give up. Fail to plan how many calories you need to cut and how often you need to exercise to attain a reachable goal, like losing 10 pounds in a month, and you'll be sitting there at the end of the month wondering why the 10 pounds are still there. And if you evade the fact that you're barely breaking a sweat when you work out, you'll wonder why you haven't met your goal of looking more toned.
My own goals this year are to lose 10 pounds by May (which will make me more fit for the NYC Marathon in November, and will have the nice bonus of helping me look hot in my wedding dress), to kick my Coke habit, and to spend more time on injury prevention. Here's to using my rational mind to guide my body to those goals!
According to the Times article, behavioral scientists think that stick-to-it-iveness comes from a sense of self-efficacy -- if you believe you can achieve your goals, you'll keep working out. And if you set realistic goals, rather than aiming to lose 50 pounds in a month, you're less likely to quit.
Well, that's part of it. But I think just having a sense of self-efficacy isn't enough. You have to actually be efficacious; your assessment of yourself must be in line with reality. If you think you can reach your goals, but you're not actually doing what you need to do in order to get there, you'll be disappointed. Every time I go to the gym, I see at least one overweight person who's walking at 3 miles an hour with no incline on the treadmill, or pedaling on a reclining bike at the lowest level of resistance. I always suspect these people think they are working out. But if you walk on a treadmill at 3 mph for 30 minutes, you've burned less than 200 calories, unless you are morbidly obese. That's fine if you're cutting a lot of calories when eating, but I know this game all too well, as I played it with myself when I was fat. I had "worked out," so I would allow myself a "little treat" -- say, a bowl of ice cream, or a few Oreos. Except I hadn't burned off enough calories to justify more than a tablespoon of ice cream, or maybe one Oreo. So I stayed fat, and wondered why the exercise wasn't working.
It's reason that will get you results: an unbreached commitment to figuring out what you need to do, what steps you need to take in the short and long term in order to achieve your goal, and whether or not you are actually doing what you need to do. Evasion at any step in the process will lead to failure. Set the wrong goal -- like "I'm going to train for the marathon that's in six months" while evading the fact that you haven't run a step since elementary school -- and you'll get frustrated and give up. Fail to plan how many calories you need to cut and how often you need to exercise to attain a reachable goal, like losing 10 pounds in a month, and you'll be sitting there at the end of the month wondering why the 10 pounds are still there. And if you evade the fact that you're barely breaking a sweat when you work out, you'll wonder why you haven't met your goal of looking more toned.
My own goals this year are to lose 10 pounds by May (which will make me more fit for the NYC Marathon in November, and will have the nice bonus of helping me look hot in my wedding dress), to kick my Coke habit, and to spend more time on injury prevention. Here's to using my rational mind to guide my body to those goals!
Saturday, January 3, 2009
Bye-bye, tchotchkes
As of Thursday, you're going to see a lot less of something the next time you visit your doctor: pens, Post-It notes, clipboards, flash drives, and other items branded with a pharmaceutical product's logos. Watchdog groups have long claimed that these items should be banned because they influence doctors' prescribing habits. Is a cheaper generic drug just as good for you as a branded version? You might get prescribed the expensive brand anyway, argue such groups, because the doctor just got a desk clock splashed with the logo and colors of the expensive drug.
Although Congress has not yet placed an outright ban on these gifts, PhRMA (Pharmaceutical Research and Manufacturers of America), an industry group based in Washington, has agreed to a moratorium on them beginning this year. PhRMA claims that the move is not an admission that gifts influence prescribing behavior, but rather a chance for pharmaceutical companies to focus on their educational relationship with doctors.
PhRMA's decision worries me, and it's not just because I work for a pharmaceutical advertising agency. Why? Because as much as this moratorium is much-vaunted as being "voluntary," it really isn't. Pharmaceutical manufacturers do not want to stop giving out pens and notebooks. PhRMA is creating "voluntary" restrictions so as to avoid involuntary regulation from Congress that would create harsher bans: for example, some industry critics would prefer if drug reps were not allowed to see doctors at all, much less drop off a box of free pens on their way out. In their dream world, doctors would get all of their information from supposedly unbiased sources, meaning anywhere but the pharmaceutical industry.
People who assume that the drug industry is out to get you, and that any contact between pharmaceutical companies and the doctor is bad, are making a plethora of bad assumptions: First, that the doctor is too stupid to evaluate information for himself. Is he really going to prescribe one painkiller over another just because he has a shiny new pen -- or because he listened to a sales rep whose presentation was all style and no substance? Are we really going to accuse people who have been through at least four years of postgraduate education, plus rigorous training once they're out of medical school, of being as gullible as that? I have yet to visit a doctor who prescribed me a branded drug willy-nilly. The experience I've had with my gynecologist is, I suspect, far more typical: When he talked to me about various birth control pill options, he told me that Seasonale (which was, at the time, not available as a generic) would not be any better or worse for me than taking a generic Pill and skipping the placebos, but that my insurance might make co-pays for the latter option tricky because I'd be taking the generic on a non-FDA-approved schedule. My doctor gave me all the information. He didn't leave anything out because the Seasonale rep left him a gift.
Second, that pharmaceutical companies lie about their products. A company that commits fraud is not going to stay in business for long, and even one that overhypes the benefits of its products to a degree short of fraud can't fool the consumer forever. The path to long-term success lies in mutual trade to mutual advantage -- not fleecing consumers for as long as a company can get away with it.
Third, that third-party sources are automatically "better" sources of information. Who would know more about a drug than the manufacturer of the drug itself? Doctors should be able to weigh information from as many sources as they choose when making treatment decisions.
And fourth, that gifts automatically lead to prescriptions. You've probably noticed on a trip to your doctor's office that he doesn't have just one kind of branded pen or notebook -- he has them in every color of the rainbow, from every pharmaceutical company. Even if your doctor were easily influenced by these gifts, the fact that he's getting them from a number of different companies who are competing with each other would mean that he's going to have to go back to making up his own mind.
PhRMA is making a bad assumption, too, or at least they're hoping that their assumption -- "If we voluntarily cut back on tchotchkes, we won't have to stop doing the other things we like to do, like have our reps make presentations to doctors" -- is true. But the moratorium hasn't shut up the watchdog groups at all -- they'd still like nothing better than to muzzle pharmaceutical companies completely. Just make your drugs and keep quiet! And if they can sway enough politicians, PhRMA and the companies it represents may find themselves facing the very regulations they're trying to avoid.
It would be better if PhRMA were to stand up and make a principled defense of pharmaceutical companies' right to free speech. Pharmaceutical companies have the right to offer gifts, and doctors have the right to refuse such gifts. Patients, too, have the right to pay attention and quit seeing a doctor whom they think is unduly influenced by pharmaceutical company gifts. What's not a right? Watchdog groups don't have the right to use the government to restrict voluntary associations between pharmaceutical companies and doctors.
Although Congress has not yet placed an outright ban on these gifts, PhRMA (Pharmaceutical Research and Manufacturers of America), an industry group based in Washington, has agreed to a moratorium on them beginning this year. PhRMA claims that the move is not an admission that gifts influence prescribing behavior, but rather a chance for pharmaceutical companies to focus on their educational relationship with doctors.
PhRMA's decision worries me, and it's not just because I work for a pharmaceutical advertising agency. Why? Because as much as this moratorium is much-vaunted as being "voluntary," it really isn't. Pharmaceutical manufacturers do not want to stop giving out pens and notebooks. PhRMA is creating "voluntary" restrictions so as to avoid involuntary regulation from Congress that would create harsher bans: for example, some industry critics would prefer if drug reps were not allowed to see doctors at all, much less drop off a box of free pens on their way out. In their dream world, doctors would get all of their information from supposedly unbiased sources, meaning anywhere but the pharmaceutical industry.
People who assume that the drug industry is out to get you, and that any contact between pharmaceutical companies and the doctor is bad, are making a plethora of bad assumptions: First, that the doctor is too stupid to evaluate information for himself. Is he really going to prescribe one painkiller over another just because he has a shiny new pen -- or because he listened to a sales rep whose presentation was all style and no substance? Are we really going to accuse people who have been through at least four years of postgraduate education, plus rigorous training once they're out of medical school, of being as gullible as that? I have yet to visit a doctor who prescribed me a branded drug willy-nilly. The experience I've had with my gynecologist is, I suspect, far more typical: When he talked to me about various birth control pill options, he told me that Seasonale (which was, at the time, not available as a generic) would not be any better or worse for me than taking a generic Pill and skipping the placebos, but that my insurance might make co-pays for the latter option tricky because I'd be taking the generic on a non-FDA-approved schedule. My doctor gave me all the information. He didn't leave anything out because the Seasonale rep left him a gift.
Second, that pharmaceutical companies lie about their products. A company that commits fraud is not going to stay in business for long, and even one that overhypes the benefits of its products to a degree short of fraud can't fool the consumer forever. The path to long-term success lies in mutual trade to mutual advantage -- not fleecing consumers for as long as a company can get away with it.
Third, that third-party sources are automatically "better" sources of information. Who would know more about a drug than the manufacturer of the drug itself? Doctors should be able to weigh information from as many sources as they choose when making treatment decisions.
And fourth, that gifts automatically lead to prescriptions. You've probably noticed on a trip to your doctor's office that he doesn't have just one kind of branded pen or notebook -- he has them in every color of the rainbow, from every pharmaceutical company. Even if your doctor were easily influenced by these gifts, the fact that he's getting them from a number of different companies who are competing with each other would mean that he's going to have to go back to making up his own mind.
PhRMA is making a bad assumption, too, or at least they're hoping that their assumption -- "If we voluntarily cut back on tchotchkes, we won't have to stop doing the other things we like to do, like have our reps make presentations to doctors" -- is true. But the moratorium hasn't shut up the watchdog groups at all -- they'd still like nothing better than to muzzle pharmaceutical companies completely. Just make your drugs and keep quiet! And if they can sway enough politicians, PhRMA and the companies it represents may find themselves facing the very regulations they're trying to avoid.
It would be better if PhRMA were to stand up and make a principled defense of pharmaceutical companies' right to free speech. Pharmaceutical companies have the right to offer gifts, and doctors have the right to refuse such gifts. Patients, too, have the right to pay attention and quit seeing a doctor whom they think is unduly influenced by pharmaceutical company gifts. What's not a right? Watchdog groups don't have the right to use the government to restrict voluntary associations between pharmaceutical companies and doctors.
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