Medicine by averages

Yesterday, Pfizer "voluntarily" withdrew its leukemia drug Mylotarg from the market (read: withdrew "voluntarily" because the FDA would have made Pfizer pull it otherwise) after a post-FDA-approval study showed that it didn't slow the advance of leukemia or extend patients' lives...

...in the aggregate, that is.

But, as Dr. Peter Marks of Yale-New Haven Hospital says, "Pfizer’s recall of the drug is 'very bad news' for leukemia patients who haven’t responded to other treatments...'There are some people who I can honestly say would not be on this earth were it not for this drug.'"

This is a perfect example of how practicing medicine by averages, which is what the FDA does (and what your doctor will increasingly have to do as ObamaCare sets in), screws patients over. Just because a drug did poorly over the aggregate group of patients in a study, does not mean that it did poorly for every patient in the study. Perhaps a minority of patients benefited from the drug. But, because the average is bad, other patients who didn't participate in the trial, but who are like that minority and could benefit from the drug, won't get to have it. No consideration is paid to the doctor's or the patient's judgment. Perhaps the doctor, in his medical knowledge, might understand why some patients do well and not others, and would then recommend the drug to those patients whom he believes need it -- or he could change the dose or the schedule of the medication in order to mitigate the side effects, as Dr. Marks does. Perhaps the patient, mindful of the fact that she has a terminal illness, might be willing to take a risk on the treatment because she knows that the treatment might kill her but the cancer definitely will.

Now, patients who had already been receiving Mylotarg will have to fill out all kinds of paperwork if they want to keep getting it, as will researchers who want to continue clinical studies with it -- because of course a bureaucrat's judgment is better than a doctor's or a patient's.

Practicing medicine by averages, rather than considering the individual needs and characteristics of each patient, is detrimental to patients who don't fit the "average" mold -- and that is exactly the kind of medicine we are going to get more of, the more government gets involved.

How to Protect Yourself Against ObamaCare

Don't miss Paul Hsieh's article, "How to Protect Yourself Against ObamaCare," in The Objective Standard this month. As long as we're stuck with this mess, Paul has some great advice for how to preserve your life when the government is doing its best to interfere.

Bringing smoking bans home

The New England Journal of Medicine contains a piece this week on whether or not smoking should be banned in public housing, as the New York Times reports. On the one hand, we have those who argue that any amount of smoke, no matter how small, is harmful, and that the right of nonsmokers to live without that harm trumps the right of smokers to do as they please in their own homes; furthermore, just as the government doesn't allow recipients of WIC to purchase soda and Doritos, it shouldn't support a smoker's unhealthy lifestyle by subsidizing a place where he can light up. On the other hand are those who argue that everyone has the liberty to do what he likes in his own residence, and that a smoking ban in public housing would "affect only the poorest persons."

The problem here is not smoking. The problem here is public ownership of housing. As long as "the public" owns a housing development, who is to decide what can be done in that development? The taxpayers who approve of smoking bans or the taxpayers who don't?

In a free market, landlords could decide whether to offer their buildings with a smoking ban or without. Some landlords, hoping to attract nonsmoking renters who don't want even the slightest trace of smoke in their living quarters, wanting to benefit from lower fire insurance rates, or wanting to save on cleaning costs, might ban smoking. Others who hope to make more money by charging higher rents to smokers, or who simply don't want to be encumbered with the burden of enforcing smoking bans, could adopt a permissive policy. And then tenants could choose to live in a home with a smoking policy they like.

Don't look to Rwanda for a model

The New York Times today presents a feature on Rwanda's national healthcare plan, with a none-too-subtle tsk-tsk at the U.S.: "Sunny Ntayomba, an editorial writer for The New Times, a newspaper based in the capital, Kigali, is aware of the paradox: his nation, one of the world’s poorest, insures more of its citizens than the world’s richest does." The New York Times author marvels at how Rwandans are guaranteed access to basic health care for a mere $2 per year in premiums, and more than 90% of Rwandans are covered. If Rwanda can make universal health care work, why can't America?

But Rwanda isn't making universal health care work. As the author of the article admits, more than half of healthcare expenditures in Rwanda are paid for by foreign donors. In other words, this system only survives because of charity from the outside. There's nothing wrong with voluntary charity, of course, but don't extrapolate from the Rwandan system that "we can and should do this, too." Who will pay for the healthcare of Americans whose premiums don't cover the cost? Blank-out.

Furthermore, even the extremely basic coverage (treatment in facilities that may not even have running water; forget about all but the simplest medical procedures, unless a foreign doctor happens to be passing through) that Rwanda's plan affords is already more than some Rwandans can afford. "Even $5 for a Caesarean section can be too much for people as close to the edge as the Yankulijes, who live by growing beans and sweet potatoes and wear American castoffs (Mrs. Yankulije’s T-shirt read 'Wolverines Football')." As important a need as medical care is in an emergency, there are needs still more pressing, like food and shelter, and "most of the world’s poor, including Rwanda’s, resist what they see as the unthinkable idea of paying in advance for something they may never get." That's rational -- if you barely make enough to cover the things you need right now, there is no sense in spending money on insurance for an expense you may or may not have. Again, why should America emulate Rwanda in that respect? If Americans decide they get more value out of renting a larger apartment or investing for the future than in having comprehensive medical insurance, that's a valid choice.

The author of this article clearly sees Rwanda's system as one we should look to for ideas on improving the American system. But, as I and many others have argued before, the way to improve health care in America is to free the market. Universal health care isn't working in Rwanda, and it won't work here.

President Chalmers, er, Obama

The New York Times reports that the White House is set to issue rules telling employers they can't cut health benefits or increase employees' health insurance costs.

So, ObamaCare is going to increase health care costs. Employers recognize this. They would rationally respond by cutting benefits or asking workers to bear a share of the increased costs. But Obama doesn't want them to do that.

Tom Bowden astutely compared Obama's petulant issuing of orders in full defiance of reality to the behavior of politico Kip Chalmers in Ayn Rand's novel Atlas Shrugged. BO's behavior is no better with respect to health care than it is with respect to the BP oil crisis. He can't possibly not have known that the healthcare bill would increase costs. (At least, not honestly. Not when so much evidence has been presented.) So, even though he does know it, he expects employers to act as if their costs haven't changed, and is issuing rules to make them do so.

Of course, this can only lead to more "unintended" (but eminently foreseeable) consequences, just as it did for Kip Chalmers in the novel.

Hands off my street meat!

I just came back on Tuesday from a long business trip in Chicago. I never noticed until it was pointed out to me by a native that there are almost no food trucks in the city. That's not an accident; Chicago's draconian food-truck laws say that only trucks that don't perform cooking or preparation of any kind of their food can exist.

Fortunately, New York is more lenient...at least for now. Councilwoman Jessica Lappin wants to revoke the license of any food truck that gets three parking tickets within a year. Effectively, this would kill the food truck industry -- because it's nearly impossible for trucks to find an all-day legal spot to park, and because even police officers don't know which spots are legal and which are not. (Non-objective law, anyone?) Meanwhile, delivery companies regard parking tickets as a cost of doing business, and foreign diplomats ignore them entirely.

I will be very sad indeed if this law gets passed, putting food trucks out of business. New York's food scene is vibrant and wonderful in part because of trucks like the Cupcake Stop, Wafels and Dinges, the Bistro Truck, and many more that keep us Gothamites fed and happy at inexpensive prices.

The solution is not laws that effectively make it illegal to run a food truck in NYC. What we need is private property -- so that the owner of a street or sidewalk can decide whether his space is worth more to him as a parking spot, as a space for a food truck, or something else entirely.

"The Pill kills"

Heard through Ari Armstrong: Several anti-abortion groups intend to protest the birth control pill on the grounds that it allegedly affects the sexual development of fish species.

Obviously, these groups are not really upset about hermaphroditic fish. They'd like to ban birth control because it supposedly violates "God's" commandment to "be fruitful and multiply," even if that means sacrificing your values, and viewing sex not as a pleasure, but as a duty. They know they aren't going to convince any leftists with the "God says no" argument, so they're hoping to use an environmentalist one.

Their stated agenda, though, is just as anti-life as their hidden one. What they really want is to sacrifice real men and women to potential humans. And what they say they want is to sacrifice human beings for the sake of fish.

Either way, "pro-life" is still anti-life.