ReasonPharm

On hiatus

2011-06-29T06:30:00.002-04:00

So, yeah, I haven't posted in a while. I've lost my mojo, as Austin Powers would say -- finding the motivation to write about health care is really, really difficult at the moment. Diana Hsieh's post, "Blogging in Pursuit of Values," really struck a chord with me.

Hence, ReasonPharm is on hiatus indefinitely, until I get some of the energy and motivation back that I need to sound the alarm on health care.

Asses 'n' elbows, or, why I love CrossFit.

2011-05-16T21:48:00.002-04:00

Today in my CrossFit class, we worked handstand pushups. I, of course, do not have the ability to do a handstand pushup yet. Among other things, a handstand pushup takes a certain amount of core and upper-body strength, as well as a certain amount of balance, that I don't yet have.

CrossFit being scalable to various levels of ability, I did not sit out this workout. Instead, the instructor had me work on kicking up into a handstand position (with assistance) and then seeing if I could try at least a few inches' worth of pushup. Didn't happen. Afterward, when the instructor encouraged me to at least try and hold a handstand for a few seconds, I had trouble with even that much. It was a day when I felt like, as another instructor at my gym puts it, "asses 'n' elbows."

"Asses 'n' elbows" is not a new feeling to me. I've never been particularly coordinated. My athletic and highly coordinated husband marvels at how many times I can drop something -- a book, a fork, an iPod -- in the course of a normal day. I was picked last for every team in every gym class, from elementary school all the way through high school. And I'll never forget the first time I took a tango class with my husband. The course claimed to be a "crash course for beginners," but I was sub-beginner; I was so terrible at it that even though there were fewer women than men in the class, one man actually declined to dance with me when his turn came, preferring to go without a partner. OUCH.

So, yeah, I've felt clumsy and inept many times. What I've noticed I do differently since starting CrossFit, though, is how I handle those "asses 'n' elbows" moments.

In school, it stung to be chosen last every. single. time. I'm pretty sure I cried about it at least a few times after school. After that horrible dance experience, it took years of coaxing on my husband's part to get me back into another tango class. (Yes, my husband, not I, is the one who always wanted to learn to tango.) Hell, even in the first few weeks of CrossFit I found myself feeling ashamed for doing light weights compared with the other girls, or having trouble mastering a movement (snatch, anyone?).

But the great thing about CrossFit is that you get better, and you can measure how much better you're getting. My gym likes to do what they call "strength cycles," in which we'll focus on the same set of movements for four weeks, getting a little stronger and better at those movements each time. The strength cycle before this one, we focused on the clean. I stank at it the first time I tried it. The clean has quite a few moving parts; every time I remembered to keep the bar close to my body, I'd let my feet drift too wide in the squat, or I wouldn't get my elbows far enough forward, or something. Yup, asses 'n' elbows again.

I kept trying to clean, though, and by my third exposure to the movement, I was able to start adding weight, even though I wasn't exactly nailing every aspect of it. And on the fourth and final exposure, something crazy happened: I stopped feeling like a klutz. The clean came smoothly that day. I still have a long way to go -- you won't be mistaking me for an Olympic lifter any time soon -- but for the most part, I was getting it right and feeling good about it.

That was, I think, a defining moment in my CrossFit experience. Now, when I feel all klutzy, I can think back to that day and remember that, as much as it sucks to feel like asses 'n' elbows, it's just a step on the way to mastery and confidence. And that's why today's experience, which might have made me cry just a few months ago, felt so different. No, I was not coordinated or good at this movement in the least -- but that didn't bother me. (And it didn't hurt that my gym is full of encouraging people who are not at all like the schmuck who wouldn't dance with me in that tango class.)

Here's to embracing the process of getting fitter and stronger, even the awkward bits!

No, I do not want to write you a check for $1,000,000

2011-05-12T14:19:00.000-04:00

I don't care if you're somebody's grandma; I don't care if you've never been able to hold a job that paid more than $20K a year; I don't care what your health problems are. I don't want to pay for your Social Security and your Medicare. As John Cogan puts it in today's Wall Street Journal, Medicare and Social Security are like handing a million-dollar check to every elderly couple -- except your name and mine are on the payer line.

Cogan rightly points out that there's going to be some pain involved in cutting back entitlements. (He doesn't seem to advocate eliminating them altogether, which is what we really should be doing -- but scaling back would be a start.) Yes, some seniors who've already paid into the system are not going to get everything they paid for. That's unavoidable because, as Cogan says, the money's already been spent; the Ponzi scheme can't go on forever, nor even for very much longer.

I know that if Social Security and Medicare are eliminated, as they should be, I myself will have paid tens of thousands of dollars, probably well over six-figure sums by the time such a thing should happen, into the system, not a cent of which I will recover. This pisses me off, but I would rather that, than that we continue to violate the right of every individual to keep and dispose of his own property, and than that I get soaked for even bigger sums that I won't get back.

To answer Mr. Cogan's question -- no, I don't want my children to be the ones backing that million-dollar check. I don't even want to be the one backing that check. Instead, we should be allowed to keep what we earn, so we can all plan and save for our own retirement.

Doing healthcare reform right: Safeway

2011-05-02T15:01:00.002-04:00

THIS is how you ACTUALLY lower healthcare costs: by tying them to people's choice! Safeway CEO Steven Burd writes in the Wall Street Journal that his company's policy of financially rewarding workers who don't smoke, maintain a healthy weight, and otherwise cost less to insure has paid off in terms of lowering healthcare costs for the company. In fact, Burd would like to offer more behavioral incentives to his employees -- the $312 he is allowed by law to pay each worker for not smoking is far less than the $1,400 extra it costs to insure a smoker vs a nonsmoker, so he'd like to make that incentive even bigger to get more employees on the wagon.

As Burd says, Safeway's ideas are not new; they're borrowed from the auto insurance industry, which does not require good drivers to pay more to subsidize payouts for bad drivers. As with driving a car, one's health is in large part under one's direct control. Why shouldn't the market reflect that by rewarding those who take responsibility for their health and punishing those who don't?

It's ironic that the same liberals who want to force "predatory lenders" to have more "skin in the game" -- that is, more of their own money at risk -- don't think the same way about health. It certainly doesn't seem to bother many Americans that their literal skin (and internal organs, and teeth, and eyes, etc.) is in the game when it comes to taking care of their health. Why shouldn't each of us have some financial skin in the game as well? And why wouldn't insuring everybody at the same price, regardless of health conditions, encourage self-destructive behavior?

From gag rule to speech at the point of a gun

2011-04-20T08:57:00.002-04:00

In Atlas Shrugged, the apes in power try to make a productive man say what they want him to say by holding a gun to his back -- and the FDA is now doing the same thing to the makers of painkillers. (Thanks to Jared Rhoads of the Lucidicus Project, from whom I first heard about this story.)

The FDA has its knickers in a twist because prescription painkillers are often used, not for the purpose for which they are prescribed, but to get high. Because our nanny state can't possibly allow a man to make his own choice about what he puts into his own body, and to bear the consequences if he makes a mistake, the FDA is joining the DEA (and probably other alphabet agencies) in trying to stamp out prescription painkiller abuse.

The issue that FDA wants addressed is that the vast majority of prescription painkiller users do not get the drug because it was prescribed to them by a doctor. They get it from a dealer, or because someone they know was prescribed the pills and passed them on.

So FDA's solution is to force the manufacturers of opioid painkillers to develop anti-abuse education materials. These materials are supposed to persuade the patient for whom the drugs are actually prescribed not to give them away, and to educate the doctor on how to talk to patients and/or recognize that a drug he's prescribing may not be going to the patient it's being prescribed for.

Never in this process is it assumed that a) the patient has a brain, probably knows that opioid painkillers have addiction potential (duh!), and knows exactly what he is doing if he decides to supply drug to someone else; b) the doctor wasn't born yesterday (but also is under huge time constraints imposed by our current healthcare system, itself the result of government regulations, and therefore may not have time to ask all the questions required to determine whether a patient is really in pain or is a "drug seeker"); and c) that all parties involved, including the drug abuser, have a right to enter into whatever mutual agreements they please, including agreements that result in someone getting high on pain pills!

Instead, the FDA is holding a gun to manufacturers' backs and telling them they have 120 days to produce educational materials (which, according to the agency's logic, will surely cause patients, sheep-like, to stop handing drugs to their friends and family) and submit them to the agency. (The gun, of course, is the unspoken but palpable threat that FDA will force manufacturers to pull these products from the market.) As Jared Rhoads has pointed out, 120 days is just about enough time, should the manufacturers start working feverishly right now, to get the materials reviewed by their internal legal and regulatory personnel. Then the FDA gets to look at the materials and force the manufacturers to make additional changes as it sees fit.

Unfortunately, unlike in Atlas Shrugged, the manufacturers are not reacting by pointing out the gun at their backs for what it is, and proudly standing up for their right to sell their products without government interference. In fact, one manufacturer's representative meekly says, "We really support [FDA] efforts...we think education is the right way to tackle this issue," as the Wall Street Journal reports. Not that I can condemn them for it -- as Ayn Rand said, morality ends where a gun begins, and these producers recognize that they risk losing their entire operations should they fail to comply with the FDA's demands. But I can condemn the FDA for trampling on the rights of producers and patients alike.

Another gag rule from the FDA

2011-04-11T12:52:00.003-04:00

I've already posted many times about how FDA gags pharmaceutical companies -- preventing them from making many kinds of claims, even if true, about their products. But I didn't know until today that the FDA's coercive power extends to journalists as well -- the agency forbids reporters from consulting outside experts with regard to embargoed news.

Let's talk about what a news embargo is, first. A company or organization wants certain news released, but it wants to control the timing of when that news is released. So it enters into voluntary agreements with reporters: You get the scoop in exchange for promising not to release that news until an agreed-upon date. So far, so good; we have a voluntary agreement between reporters and companies or trade groups. (We'll leave aside the case that the need for an embargo may have arisen because of an FDA requirement that a company not publicize its offerings prior to a certain date; in that case, the FDA is clearly violating rights, but the embargo itself remains a voluntary agreement.)

But the FDA has decided to meddle with this process, forbidding reporters to consult with third-party experts about embargoed news. This means that the reporter, who is likely a well-educated layman with respect to the drug or device he's reporting on, is not allowed to verify the story he's about to print with someone who is more qualified to evaluate the claims being made. As the Association of Health Care Journalists puts it, "Reporters who want to be competitive on a story will essentially have to write only what the FDA wants to tell the world, without analysis or outside commentary." That's a clear violation of free speech.

The FDA needs to butt out of healthcare communications entirely. It's scary that the arm of the state reaches beyond forcing pharmaceutical companies and medical device makers to denounce their own product, and into making the press say what it wants.

How insurance encourages us not to ask questions: An example

2011-04-01T16:18:00.006-04:00

[Warning: slightly icky medical details follow.] I have a plantar wart. If you've never had the pleasure of dealing with one (I've read that about 15% of Americans have), allow me to inform you that a plantar wart is what happens when HPV decides to take up residence somewhere on the sole of your foot. The warts HPV causes in this way are not really painful, but they can be uncomfortable. They are also tenacious as all get out. All kinds of over-the-counter remedies exist for getting rid of plantar warts. Often, as has been the case with me, they don't work. After trying and failing to kill the ~~little bastard~~ ~~son of a bitch~~ darn thing for six months with OTC salicylic acid patches, I finally gave up and headed to a podiatrist.

Podiatrist has a look at my foot, confirms that I indeed have a plantar wart, and informs me of the stronger options available to treat such things when there's a prescription involved. Fine. (Well, except for the hour and a half beyond my scheduled appointment time I had to wait to see him, which is an example for a different argument against government regulation in health care...but that's for another day.)

At this point, the doctor told me he would shave off part of the wart so that the medication he prescribed me to put on it would be absorbed more efficiently. He took out his scalpel and scraped for about 30 seconds. I thought nothing of this at the time. But, a few days ago, I got my insurance company's "explanation of benefits," a statement I receive any time I visit a doctor or hospital. The EOB, as they abbreviate it, explains what services I received from the doctor, how much the doctor billed the insurance company, how much the insurance company actually paid out (since, frequently, they negotiate lower rates than the doctor initially bills), how much of a copay I had, and if there's any further obligation on my part to pay the doctor. (Usually, since I have a pretty generous insurance policy, there isn't.)

When I got the EOB for the podiatrist visit, I saw that the doctor had billed about $150 for a "visit" and gotten paid the negotiated rate of $75. He also billed the insurance company $100 for "surgery," and got paid $53. It took me several minutes to figure out that this "surgery" was the 30 seconds' worth of shaving he'd done to my foot in the office! Would I have paid $53 for this service, let alone the requested rate of $100, if I were paying for my medical care directly? Oh, hell, no. It's something I easily could have done myself, at home, for the price of an Xacto knife. I'll admit, I probably wouldn't have thought to ask the doctor the price of such a simple "operation" before he performed it, but if he had had the nerve to try and charge me that much for it, I would have argued and, if he insisted on charging me in the end, I could have refused to see him for any further care and posted a negative review on one of the many ratings websites out there.

In any case, there would have been much more pressure on the doctor -- whether from me or from patients who'd seen him before me -- to put a much lower price on such a small service. Instead, there was no incentive at all for the doctor to charge a low price, or for me to question the bill afterward. After all, I'm not paying it -- my insurance company is. Except that, when this kind of decision is made by millions of people, guess what? Premiums go up!

Remember, we owe this distorted system to the tax policy that makes it advantageous for our employers to buy us generous health benefits rather than raising our salaries. In a free market -- free of coercive taxation -- most of us would likely buy far less comprehensive health care policies in order to save money, and then we'd scrutinize our health care expenses far more closely in order to save more money.

OH HELL NO, South Dakota.

2011-03-23T13:41:00.003-04:00

Yesterday, South Dakota became the first state in the nation to require that women obtain counseling from a "pregnancy help center" (read: anti-abortion center) before they may legally have an abortion. Apparently women in the state already had to hear the lie that abortion "will terminate the life of a whole, separate, unique living human being."

Anti-abortionist Leslee Unruh says, "What are they so afraid of? That women might change their minds?" No. It's not fear. It's indignation and anger that our rights are being trampled upon. As a woman of childbearing age, I don't fear people who want to tell me what to do with my uterus. But I damn well don't want to listen to them (much less pay for gas money to drive to a faraway "help center" and waste hours waiting in line), and in a proper society, I wouldn't have to. The GOP would like me to have to. Hell, what they'd really like is for me to have to carry any pregnancy to term, whether I wanted the child or not.

Memo to Republicans: This is not why we voted for you. We voted for you because there is too much government intrusion into our lives, and we want it cut back. We certainly did not vote for you because we want more government controls. Butt out!

If I didn't pay their salaries, I wouldn't care how much they make.

2011-03-16T12:55:00.002-04:00

The New York Times points an accusing finger at hospital executives for daring to accept seven-figure salaries in tough economic times, when payments to doctors and hospitals are being cut left and right by cash-strapped states.

Yaron Brook and Don Watkins (and others) have already made the case for why CEOs earn their pay. People with the big-picture vision to lead a company to large gains in value are rare indeed, and they are worth millions of dollars a year. I don't begrudge them that, as many leftists do...

...except when I'm paying their salaries without benefiting from the goods and services their companies produce.

Do I care how much Steve Jobs makes? Hell, no -- he can get paid gobs of cash and stock every year, and I will nod and smile and say thank you to him for leading the company that has produced all kinds of gadgets without which my husband and I would be lost. If I thought his salary made Apple products more expensive than they're worth to me, I could quit buying those products and look for something cheaper that meets my needs. But I don't care that I earn far, far less money in a year than he does. I don't have the vision to run a large company. I don't even desire the responsibility of running a small one! So why would I resent what he earns -- yes, earns?

But let's talk about those hospital executives. As with Steve Jobs, I wouldn't have to care about what they make if it weren't for the fact that I pay tens of thousands of dollars in state, federal, and local taxes every year, and because Medicare, Medicaid, and other health programs are such a huge chunk of that tax burden. So I am helping to pay for these guys' salaries!

Do I benefit from the work of hospital executives? Sort of -- on the rare occasions (exactly twice thus far in my lifetime) that I, a healthy young person, have needed hospital care, I have gotten it, and hospital executives, by knowing where to allocate resources and plan for the future, in part made that possible. But, for the most part, I don't need their services at this point in my life, and in a free market, I wouldn't have to pay their salaries. In fact, hospital executives are probably doing me a disservice because part of their job is to see how they can squeeze more money out of the government -- if an executive successfully lobbies for higher payments from the government, for example, or broader coverage of hospital procedures, he might be awarded a higher salary because he's managed to capture a bigger share of government loot. So no, I don't want to contribute to the high salary of someone who gets that high salary in part because he's good at stealing even more of my money!

That being said, I still don't want the government stepping in and dictating hospital executive pay. As Brook and Watkins put it when Washington was making noise about dictating Wall Street executive pay, this is just an overture to give the government a say in all CEOs' pay, which it should not have. What I want is for the government to get out of medicine -- so that Americans wouldn't have any reason to be upset over how much hospital executives make.

Unintended, but not unforeseeable

2011-03-09T11:11:00.002-05:00

The Wall Street Journal reports that ObamaCare has had all kinds of unintended side effects, one of which is that Americans are now going to their doctors to get prescriptions for aspirin and cough syrup.

Why is that? Well, Washington used to give us a tax break on over-the-counter medications -- if you wanted to, you could set aside money, tax-free, in a health spending account to cover over-the-counter expenses such as pain relievers and diaper rash cream. As part of ObamaCare, the Democrats decided they wanted to "curb wasteful healthcare spending" by removing that tax exemption.

It never ceases to amaze me how politicians think they can just slap a new tax down and that people will go on behaving as they always have, thereby producing more money for the government, or else change their behavior in ways that politicians want them to. It never occurs to them that taxes spur tax-avoidance behaviors. Man wants to be free to do as he chooses. So when a new tax makes it harder for him to do that, he doesn't stop doing what the politician doesn't want him to, or keep doing it the same way and paying taxes on it. He tries to find a way to keep doing what he was doing without paying the extra tax!

In this case, the tax-avoidance behavior that ObamaCare has produced is that cost-conscious Americans are going to their doctors to get prescriptions for medications that don't require a prescription! That means: Even the nanny state agrees that these medications are safe enough that Americans should be allowed to make their own decisions about whether or not to take them, without being chained by the requirement of a prescription...but now Americans have to waste their doctors' already scarce time getting prescriptions so they can save on their tax bills!

We already have a physician shortage (and it's going to get far worse as the population ages). When was the last time you saw a doctor and didn't have to sit in the waiting room? And now we're going to exacerbate that by placing extra pressure on doctors to fill out even more paperwork (that's on top of the rest of the extra paperwork imposed by ObamaCare's myriad regulations and requirements) just so that patients can buy the same drugs they were buying already without needing to ask a doctor first? Effing brilliant, Washington!

Unrealistic optimism means...what?

2011-03-03T17:04:00.003-05:00

Pauline Chen writes in the New York Times that patients, particularly those with cancer, who participate in clinical trials are often unrealistic about what their participation actually means. Although many experimental drugs fail to benefit patients -- Chen's estimate is that less than 5% of patients who participate in early-stage trials (as against later-phase trials, which test drugs that have shown promise in early-stage trials) benefit from their treatment. Furthermore, patients who experience no benefit often experience the downsides of treatment in the form of serious, sometimes life-threatening side effects. Yet patients with cancer often assume that they will be the ones who beat the odds -- the so-called "Lake Wobegon" phenomenon ("where everyone is above average").

Chen's argument is often used by supporters of the FDA to say that, thank goodness we have a regulatory agency to make sure that evil pharmaceutical companies won't prey on the hopes of dying patients, and that only drugs that have thoroughly proven, to a regulator's standards, that they work can be given to Americans as a whole.

No.

Yes, it is true that people make mistakes -- and dying people, clinging to any hope they can, may make the mistake of placing more trust in an experimental drug than is warranted. But isn't that their right? A patient who has advanced cancer knows that death -- perhaps even a drawn-out, painful death -- awaits him if he does nothing. Can trying something new and unproven be any worse than that? Even if it can, is it not his body, his life, and his choice to make -- not the choice of some little Washington bureaucrat who doesn't care how many patients die while he waits for the evidence to be presented to his liking?

WSJ: Want better drugs? Scrutinize the FDA.

2011-02-28T16:42:00.002-05:00

Today's Wall Street Journal contains an excellent editorial, "The FDA and Slower Cures," that points out the irony of a government that wants more new drugs (badly enough to get itself into the business of research and development, at taxpayers' expense) and yet does so much, via the FDA, to make it impossible for the pharmaceutical companies to offer any kind of real innovation.

The editorial follows the story of pixantrone, a drug for patients with an advanced form of lymphoma -- a drug doomed, not because it doesn't work, but because the FDA doesn't like the way the clinical trial used to prove that the drug does work was conducted. Says WSJ, "The Catch 22 is that if a trial deviates from protocol, even with such impressive real-world results, it becomes more difficult to generate the 'proof' beyond any doubt that the FDA requires." In other words, the drug is guilty until proven innocent -- and the result is that people who are dying don't get to decide for themselves whether to take a chance on a new drug.

As WSJ says, "The real victims" of this policy "are the patients with no attractive options who needlessly suffer when the government delays drugs like pixantrone." Too true. I submit that all of us are deprived, not just patients who have run out of options to treat a fatal disease. We have no idea what kinds of cures and therapies for all manner of ailments, from mild to serious, could have been developed if the FDA would just get the hell out of the way.

Enforced paid maternity leave? No, thank you.

2011-02-23T10:25:00.002-05:00

The Boston Globe reports that America "lags behind" other nations in having a nationwide policy of paid family leave -- that is, that we are behind other countries in forcing those who don't have children to subsidize those who do.

In California and New Jersey, paid leave is "financed entirely through small payroll tax contributions by workers." Well, "contribution" is just a euphemism for "money taken without the consent of the person who earned it." Why should those who are single and childless fund paid leave for those who choose to have a child? Why should those who stop at one kid have to pay for those who have three or four? They shouldn't, of course; no one is his brother's keeper, and those who want a child should be prepared for the financial implications, rather than placing some of the burden of their choice on the shoulders of others.

I'm sure the far-lefties would prefer that paid parental leave be financed, not by payroll taxes, but by simply forcing businesses to offer it (why shouldn't those evil corporations have to pay for everything?). What such people fail to realize is that not only are they violating rights (of employers to offer employment on whatever terms are mutually agreeable to themselves and employees), but that childless employees will still pay the price for paid parental leave, in the form of lower salaries than they would receive in a free market. Who knows but that employers might be less likely to hire women of childbearing age, in hopes that their costs for paid leave will go down?

Ah, says the lefty, but we have laws to prevent discrimination. Well, those are bad, too -- it is absolutely an employer's right to hire according to whatever bias he chooses (although, if he's irrational enough to have a bias that has no basis in fact, he's probably not going to be successful enough as a business owner to be making that much of a difference in the job market anyway). I've always had a suspicion that the fact that it's illegal to ask certain questions in a job interview (age, whether the employee has children or intends to have them, etc.) only hurts job applicants -- especially women, one of the groups such laws are intended to protect. Example: I'm a woman in my early thirties, and I look approximately my age. Suppose I'm interviewing for a job. The employer isn't allowed to ask me whether I have children or whether I have plans to have any. So instead of asking me and getting a forthright answer from me ("yes, I am married, but my husband and I do not plan on having children for another two to three years"), the employer is likely going to look at me, see that I'm a woman, recognize that women are more likely than men to take an extended leave upon the birth of a child (or to miss work to care for a child who's already there), and make an assumption. Perhaps he'll bypass me in favor of an equally qualified man or older woman, simply because those people look less likely to choose a child's needs over an employer's needs. (More likely, given that my industry is small enough that everyone knows everyone else, he'll call as many former coworkers of mine as possible off the record -- but this isn't possible in many industries.)

I don't want to pay for other people's choices, nor do I want anyone else paying for mine. When it comes time to have a child, if I can negotiate paid leave because I am of such high value to my company that they consider it an investment in my future at the company, I'll take it. I don't want it on the terms of other workers being forced to pay for it, or because some anti-discrimination law caused my employer to hire me despite preferring someone else who's less likely to ask for such a perk.

Let's compensate ALL donors.

2011-02-14T12:36:00.002-05:00

Kumud Majumder, the father of a preteen boy who died waiting for a bone marrow transplant, writes in the USA Today that Americans should be allowed to offer compensation for bone marrow donors -- currently a federal crime, even when the compensation is simply to reimburse the donor for time lost from work or for housing costs. Mr. Majumder is one of a number of Americans who is challenging the law that makes compensation for bone marrow donation a crime. He correctly asserts that this law has done nothing but create shortages -- just 2% of Americans are registered as bone marrow donors, and many of those decline when actually asked to donate because they can't take time off work for the procedure. Given that a perfect match between two unrelated individuals is so rare, what this means to patients with cancer and other bone marrow diseases is that they may have to wait for years to get a transplant, if they get one at all.

Compensation, Mr. Majumder argues, would alleviate this shortage. If we could just pay donors a modest amount, he says, we could increase the number of people willing to donate. Perhaps scholarships would encourage younger Americans -- who are most likely to have usable marrow -- to give.

I say Mr. Majumder is on the right track, but he hasn't gone far enough. He understands that the bone marrow shortage that killed his son could be remedied, if only the federal government weren't standing in the way. What he doesn't understand is that we need a fully free market in tissue donation -- and organs as well.

It's not just a modest amount of compensation that should be allowed; those who need bone marrow should be allowed to offer as much wealth as they want in exchange for the tissue they need. Leftists would argue that this creates inequities -- why should a rich person have access to marrow if a poor person doesn't? Well, why not? As long as the rich person has earned or inherited his wealth and not stolen it or gotten it by political favors, he can properly use it to buy anything he likes from anyone who will sell it to him -- and that includes bone marrow from someone who wouldn't sell it at a price the poor can afford. Nobody has a right to anyone else's bone marrow; the only way a patient should be able to get some is by mutual agreement between donor and donee (or, in a proper society, buyer and seller). By cutting off the possibility of any kind of compensation at all, the government simply makes it undesirable for nearly all Americans to donate; by allowing compensation but only at a modest level, the government would increase the pool, but not by as much as removing all restrictions would do.

Furthermore, Mr. Majumder makes an error when he argues that bone marrow donor compensation, but not organ donor compensation, should be allowed because bone marrow can be regenerated by the body, but organs cannot. Tell that to the families of those who have died waiting for a kidney, a heart, or a liver. In fact, organ donor compensation is desperately needed precisely because organ donation is more final than bone marrow donation. Currently, if you want an organ from a stranger, that stranger has to die -- what living person would give up, say, one of his kidneys for nothing more than a "thank you"? As I argued in my 2009 post "Not Enough Encouragement," most of us want to have full organ function, and would only give it up in exchange for a greater value, like the life of a loved one -- not the life of a stranger. But if there's money or other compensation involved, perhaps that compensation would be a greater value to some people than the continued use of their organs. What if, with the proceeds from giving up a kidney, a young mother could afford to quit working and stay home with her child for a year? Or a man who's been looking for seed money for his small business could finally have it? It would not be cruel and inhumane to allow this kind of transaction -- in fact, the exact opposite! Both parties would gain an enormous benefit -- the donor, a substantial sum of money; the donee, his health. Yes, allowing financial incentives would mean that many Americans would be confronted with a decision that the government currently makes impossible to them -- the permanent loss of an organ along with a better financial situation, or keeping the organ and the financial difficulties? But we should allow Americans to make that decision for themselves, not assume paternalistically that selling the organ is never the correct choice and that Americans should be forced not to make that choice.

Mr. Majumder is right -- compensation for bone marrow donation should be legal. And he's wrong -- because compensation for organs should be allowed, too.

Getting better at life takes time

2011-02-12T13:03:00.003-05:00

At my last Foundations session for CrossFit, the coach wound me down after the workout of the day (known by CrossFitters as the "WOD") by talking to me about the trajectory of a new CrossFit athlete. The idea is not to kill yourself to get into a bikini by Memorial Day, then let yourself go once swimsuit season is over. You're working, as he put it, to "get better at life." Which means you have the rest of your life to do it...and that means take your time and get it right. You're not supposed to jump in full-force right away, because that can lead to injury.

What I'm finding this means is that, with the advice of the coaches, I err on the side of caution a lot. Sometimes this turns out to be a good thing, in that I'm not as strong in one area as I thought I was and a light weight or a low number of reps does, in fact, turn out to be a very challenging workout. But sometimes it means I have a workout that's considerably easier than I hoped it would be. That happened today; the prescribed WOD was as many rounds as possible in 10 minutes of 5 deadlifts at 155 pounds and 20 double-unders (jump rope so that the rope passes under your feet twice with each jump). When scaling the weight for the deadlift, I only had one prior workout to go on when asking the coach for advice; I don't have lots of data like one-rep maximum or how I feel at a weight of X pounds, the way other CrossFitters do. So we set my deadlift weight at 75 pounds.

This turned out to be wussy. The workout didn't feel nearly as intense as I knew it should, especially given that I had to do my rope jumping as single-unders (I haven't yet mastered doubles, so I would have spent the whole ten minutes trying to do 20 of them). I felt frustrated that I didn't work as hard as I now know I could have.

But you know what? That's okay. I now know some important information about my capabilities that I didn't before. And the next time deadlifts show up in a WOD, I sure as hell won't be doing them at 75. I just need to keep in mind Coach Fox's motto that I am doing this, not with some hard time goal in mind, but to get better at life. I will not get better at life if I err in the opposite direction, throw too many plates on my barbell, and injure myself. I will get better at life if I take this slowly and learn by experience how much I can do.

Brook/Watkins series on health care in Forbes

2011-02-11T08:19:00.004-05:00

I'm excited about an upcoming series of articles on why our health care system is broken by Yaron Brook and Don Watkins in Forbes. The first installment in the series ran yesterday.

America needs to hear these arguments in a forum as large as Forbes. I preach to the choir a lot about this stuff, but these men will be addressing many more people who don't understand why the government shouldn't meddle in medicine. I'm sure that Brook and Watkins will cover the moral case for a free market in health care -- which desperately needs to be heard -- along with the many pragmatic reasons we need one.

Emphasis wrong?

2011-02-08T22:58:00.003-05:00

John Stossel writes of Michelle Obama's attempts to persuade restaurants to serve smaller portions and "healthier" food:

"At least what Michelle is doing appears to be voluntary."

I would argue that the emphasis is on the wrong word:

"What Michelle is doing appears to be voluntary." As in, it really isn't. We've already seen that her husband is a firm believer in the (nonexistent) right of Washington to force us to do what it deems best for us, and that this belief extends to deciding what foods Americans will eat. The President joked around that his signing of the school lunch bill was part of maintaining marital bliss with the First Lady. Maybe he was joking, but the truth is that if restaurants don't do Mrs. Obama's bidding voluntarily, she can talk her husband into forcing them to serve food as she deems best. After all, it's not like he believes restaurateurs, or anybody else, have rights -- all they have are duties to other Americans (in this case, to keep us thin).

If Mrs. Obama were truly just an American citizen trying to get restaurateurs to adopt her cause by persuasive means alone, I would say have at it. But I don't believe for a second that that's what's really happening. This is "let me talk you into doing what I want" with an undertone of "or my husband will force you into doing what I want."

Stick to recipes, Mark Bittman.

2011-02-06T14:11:00.003-05:00

I have a love-hate relationship with Mark Bittman, author of How to Cook Everything and The Best Recipes in the World, among other excellent cookbooks. I love him because he's the author of those cookbooks; the two I mentioned are the most food-splattered in my kitchen, evidence of their frequent use. His recipes are easy to make, which means they're terrifically useful for turning out tasty meals on weeknights. They're not what I would call gourmet, but in terms of bang for the effort buck, he's authored a lot of great stuff.

I hate him because he also writes crap like this. I read this article without looking at the byline at first, and through the first bullet point I was nodding my head emphatically. Yes, indeed, we should stop subsidizing corn and soybeans! After that, though, the article runs off the rails. Instead, Bittman says, we ought to be subsidizing farmers' markets, giving the FDA the powers that the USDA has now, taxing "unhealthy" foods, subsidizing home cooking, and "encouraging" recycling (Bittman doesn't specifically say that the government should be doing the encouraging, but it's strongly implied).

According to Bittman, "This isn’t nanny-state paternalism but an accepted role of government: public health." Well, just because public health is a commonly accepted role of government nowadays doesn't mean it isn't nanny-state paternalism!

Yes, I want the government out of subsidizing crops that make Americans fat. But I also don't want the government in the business of subsidizing food that will supposedly make us healthier, either. (Who gets to decide what that food is? Oh wait...LOBBYISTS!) I don't want the government making soft drinks more expensive (unless they do so by removing corn subsidies), I don't want the FDA deciding what I get to eat (goodness knows it does a crappy job deciding what drugs I get to take), I don't want the government paying me to cook at home. All I want is to be able to decide what I want to put in my belly, without interference and based on prices and data generated by a free market!

So, Mr. Bittman, stick to cooking and writing recipes. It's what you're good at.

If there's one good thing about ObamaCare...

2011-02-02T11:42:00.002-05:00

...it's that Congress ramming unwanted legislation down the country's throat has caused many Americans, myself included, to take a closer look at what the Constitution actually says, and to agree that it's a good thing that there's a document limiting how much power the federal government has.

I knew about the Democrats' lame attempts to justify forcing all of us to buy insurance as a legal government power under the commerce clause. Right...because not buying something constitutes commerce. Judge Vinson was quite right to show the absurdity of this creative reading of the Constitution and how it would quite literally give Congress the power to force us all to buy whatever food, clothing, shelter, or any other product it can label as necessary.

I did not know that, following the earlier strikedown of ObamaCare's individual mandate on the grounds that the commerce clause doesn't justify it, that the Democrats had turned to a new "argument" based on the Necessary and Proper Clause. As the Wall Street Journal puts it, "That clause empowers Congress to enact 'all Laws which shall be necessary and proper for carrying into Execution' its enumerated powers." Oh, that little thing about the powers having to be enumerated first? Not too meaningful to liberals who think they know best.

As lawmakers who want to do whatever they want love to cry, the Constitution is not, in fact, a perfect document. For example, as originally written, it allowed for slavery in America; as amended, it allows for income taxation. But, imperfect as it may be, it still provides limits on what the government may do, and it makes the process for expanding those limits difficult on purpose. That's so that it's not easy for power-hungry lawmakers to run roughshod over the rights of Americans.

I hope that ObamaCare's defeats continue to get the American people interested in what the Constitution actually says and why it was written that way.

My workout, not theirs

2011-01-30T22:07:00.002-05:00

One thing I thought I had learned from four years of running, and which I am now finding I am going to have to learn as I get into CrossFit:

I must do my own workout. I must not think about the workout of anyone else around me, except as an inspiration to do the best I can do.

If you're a runner, and especially if you run a much-used path, you are going to get passed by other runners every now and then. Maybe even more than every now and then, unless your name is Paula Radcliffe (and even she'll get beaten in a 10-K by elites who focus on that distance). You'll be running, keeping a comfortably hard pace, and suddenly someone will pull up on your side and then -- boom -- she's in front of you.

Some runners will respond to getting passed by turning on the juice. I learned rather quickly when I started running that this is a recipe for disaster. Trying to chase someone who is in better shape than I am, or who is running three fast miles when it's my day to run twenty slow and steady ones, or who is ten years younger, or who for any reason whatsoever is running faster than the pace that's best for my body and my training goals, only leads to my inability to finish the planned workout at best, and injury at worst. So I don't do it. Early in my running experience, I had to mentally instruct myself to ignore the frustration of being passed and to remember what my goal was. Sometimes I had to tell myself, "Hey, it's a guy passing you," or "You're running eight miles, maybe this chick is just doing two." Eventually, though, I stopped needing the self-talk because my emotions eventually grew to match my thought process. Now, when I run and I get passed, I don't bat an eyelash; I just keep doing what I'm doing.

Yesterday, however, I had my first CrossFit group class, and as it turns out, I haven't quite gotten rid of those emotions with regard to fitness in general, just with regard to running. I did all of my Foundations training privately, so I didn't have anyone to compare myself to while learning the movements and doing the prescribed workouts. Yesterday was the first time when that was no longer the case.

In CrossFit-land, I am still a baby beginner. The coaches do not want anyone trying to lift crazy amounts of weight without first having learned to do the movements with consistently good form. My trainer (who also happened to be the coach for yesterday's group class) has explained this to me many, many times, along with the reasons (to avoid injury and burnout). So I know the rationale. I do.

And I still felt embarrassed to be doing overhead squats with 55 pounds, when the other women in the class were doing one and a half times to twice that. I didn't want to write my squat weight on the big board where people write their accomplishments, and I really didn't want to write how many double unders I was able to do in the tabata session. (It was 27, whereas others in the class were getting anywhere from 85 to 200; although I have the cardiovascular conditioning to have done more, I haven't yet mastered the movement well enough to do them consistently without tripping on the jump rope.)

So, it's time for more self-talk. I need to remind myself that my classmates who are doing way more weight and way more double unders have been doing this for months or years, whereas I've been doing CrossFit for all of three weeks. Hell, I may never be able to do as much weight as that -- and that's okay. To paraphrase Jenn Casey, being upset that I can't do as much as other CrossFitters is being second-handed about my workout; being first-handed, on the other hand, means focusing on what's right for me at this point in my training. At some point it may very well be appropriate for me to be shooting for a 105-pound overhead squat, after I have learned how to do it properly and after I have spent time working up to that weight. That point is not now, and that's okay.

Freedom and fitness

2011-01-27T23:16:00.004-05:00

As the New York Times reports, traditional full-service gyms, whose business model relies on large numbers of members paying monthly fees for classes they may or may not take, lots of equipment, and perks like towel service and steam rooms, are not doing as well as they used to. Instead, consumers are turning to alternatives at both ends of the price spectrum -- no-frills, no-trainer gyms that offer nothing but standard cardio equipment and weights, and that charge a correspondingly low price; and a la carte, small group classes that can add up to more money per month than a traditional gym membership, but that offer a greater sense of community and support when working out.

I'm an example of this trend. I had a membership at New York Sports Clubs, a local big-box gym conglomerate, for years. I finally quit in September, once my husband and I moved into an apartment building with a small gym in the basement. It doesn't offer any classes, nor does it have a TV built into every cardio machine, but it has everything I need for the kind of workout I do, so it's no longer worth $80 a month to me to be a gym member. On the other hand, I've just finished Foundations training at CrossFit South Brooklyn, and although working out there twice a week is going to cost me nearly twice as much per month as I used to pay for unlimited workouts at NYSC, I consider it money well spent because I'm going to be learning skills that will make me stronger, with plenty of attention from coaches throughout the process.

Now here's where I make this a post about health care, and not just about fitness: Isn't it a beautiful thing that we who like to work out have so many options? If all I need is a treadmill and some free weights, I can join a cheap gym like Steel, an NYC no-frills gym. If I want classes with an engaged (and engaging) teacher, I can choose from CrossFit, yoga, Core Fusion, Pilates, martial arts, and any number of other options. Or I can join a big-box gym like NYSC, if I like having access to a wide variety of classes and a number of locations across the city.

Why isn't health care like that? Why am I stuck with a choice of only three very similar health insurance plans chosen by my company, rather than being able to decide between a myriad of options -- from low-cost insurance, if all I want is to be protected in the event of a serious medical emergency, to high-premium, comprehensive policies?

The answer is that fitness remains far freer of government regulations and taxes than medicine. Without regulations dictating what kind of services a gym has to offer in order to open its doors, or whom it has to grant membership to, or what kind of prices it can charge, voila! You get customers with all different kinds of demands -- and entrepreneurs who find creative ways to deliver what the market is asking for.

Drug dealing by the federal government

2011-01-24T08:39:00.003-05:00

Apparently the Obama administration thinks we have an extra billion dollars (for initial financing, not to mention the costs down the road) to start a new research institute whose purpose is to find new drugs, because pharmaceutical companies haven't come up with enough innovative new therapies. How typical of Washington to blame private industry for problems Washington itself has caused with its strangling regulations and taxes.

As I argued in my 2008 Objective Standard article, "How the FDA Violates Rights and Hinders Health," the FDA is a major reason -- perhaps the primary reason -- that developing a new drug costs, on average, $800 million. Eight hundred million dollars! This has the effect of discouraging pharmaceutical companies from looking for new drugs to treat diseases that affect a small number of people (because that $800 million cost doesn't change whether the drug treats 200 people or 200 million), as well as encouraging them to look for drugs that are "tweaks" to existing therapies rather than completely new strategies. (The upside of finding a truly innovative therapy that does something no other drug has done before is, by far, offset by the huge risk of spending hundreds of millions of dollars on a drug that the FDA will ultimately reject, whereas a "tweak" strategy has higher odds of getting past the regulators.)

So it's the government that has caused the drug industry's dwindling pipelines. And the government now wants to cure the problem by doing research of its own? I somehow doubt Uncle Sam is going to do better at identifying targets for research than private companies have. The plan is that the government institute would come up with targets and pass that information on to drug companies...but the government won't be removing a single one of the obstacles it places in the path from "interesting target" to "therapeutic drug able to be sold to patients."

The government can help the pharmaceutical industry become more innovative...by getting the hell out of the way. This new institute won't do a thing but pour more of our tax dollars down the toilet.

We need more articles like this

2011-01-22T18:26:00.002-05:00

The New York Times offers an article entitled "How to Plan For and Handle the Cost of Braces" today. Among the helpful information: Ask about payment plans, look for a college or university with an orthodontics program that offers care from trainee orthodontists at a reduced cost, seek out charities that connect low-income patients with orthodontists willing to donate their work.

You'd never see an article like this about how to plan for and handle the cost of medical care, because we don't have anything like a free market in medical care, whereas orthodontics, considered "cosmetic" and "unnecessary," remains relatively free of government interference.

Granted, the need for medical care can't always be anticipated, as the need for braces usually is. This is where insurance -- real insurance, not prepaid medical care -- would come in, in a free market. But, in a free market, individuals could plan and pay for routine, and even nonroutine but noncatastrophic, medical expenses. We'd have more money to do so, because we'd be pouring less money down the toilet for taxes and crazy-expensive health "insurance" premiums. We'd be asking for advice just like the kind the NYT is giving for braces -- and getting it.

You don't ban cars because people drive them off cliffs, part 2

2011-01-14T10:08:00.002-05:00

Back in 2009, I wrote that the FDA was considering banning prescription painkillers such as Vicodin and Percocet, on the grounds that they contain acetaminophen, a common over-the-counter drug that can cause liver damage if taken at too high a dosage. Especially as patients become inured to the effects of the opioid portion of such painkillers, they end up more likely to take more of them and thus expose themselves to life-threatening doses of acetaminophen.

As I argued then, the government doesn't ban cars just because some idiots drive cars off cliffs; it doesn't ban pencils because pencils can be shoved into the eye; and it has no business banning a painkiller just because some patients don't know how to use it correctly.

The FDA has decided not to flat-out ban these opioid medicines, but it HAS now ordered the makers of opioid/acetaminophen combinations to find a way, within three years, to reduce the amount of acetaminophen in their pills below a prespecified amount, or else pull the products from the market.

Sounds easy, right? Why should something as simple as cutting the dose of one component of a pill take three years to accomplish?

Because the FDA won't accept drug manufacturers doing just that, that's why. Not without the manufacturers performing studies to show that the new formulations are just as effective as the old ones, that they don't present additional potential for addiction, and that they're safer. So the manufacturers of Vicodin and Percocet will have to spend all kinds of money -- money that they could have spent on research and development of innovative new drugs -- just to prove that something that already works deserves to stay on the market.

And all this money will be spent to force pharmaceutical companies to take responsibility for patients who weren't responsible enough to learn about the risks of something they're putting in their own bodies. Huh?!

Here's how this would work in a free market: If a substantial number of people were getting liver damage and dying because of Vicodin and Percocet, patients and doctors would start avoiding the drugs and demanding new, lower-acetaminophen options, giving pharmaceutical companies an incentive to offer those options. The drug companies wouldn't have to prove to a government agency that opioid drugs work on their own or with lower doses of acetaminophen, so patients could have those drugs right away. And patients and doctors would have an incentive to ask questions -- Is this drug safe? Are there other drugs I should avoid taking when I'm taking this drug? How much of this drug can I safely take? Instead, we have a nanny state holding back new options and trying to make drug companies responsible for protecting patients instead of allowing patients to protect themselves.

Another Objectivist CrossFit noob...

2011-01-10T14:04:00.003-05:00

Inspired by the success of Diana Hsieh, Jenn Casey, and other Objectivists who've tried CrossFit and found that it's improved their strength and overall fitness, I decided to make giving CrossFit a try one of my goals for 2011. I have plenty of endurance, as the four marathons I've completed will attest -- but I've never in my life been able to do a single unassisted pull-up. I'm also so inflexible that I can barely force my legs to a 90-degree angle for a floor sit. This, I've decided, needs to change.

I'm coming at CrossFit from a different starting point than many other Objectivists: Although I've tried a few fitness fads in the past (spinning, kickboxing), I never found anything I could stick with until I started to run. I huffed and puffed through my first five-mile race, with a time well above 45 minutes (I can torch that now!), but kept at it. Nearly five years later, I've now completed four marathons (beating my personal record each time), am at the lowest weight I've ever maintained as an adult, and have had no injuries beyond a brief bout with plantar fasciitis a couple of years ago, which strength and stretching exercises seem to have permanently cured. I don't want to stop running; I love it, even on the days when I have to convince myself to do it (like when it's 26 degrees out, as it was on Saturday!). I was a bit apprehensive of CrossFit because of my commitment to running; would I be able to fit such an intense type of workout into the high-mileage work I already do?

With this apprehension in mind, I approached the CrossFit South Brooklyn gym and asked some questions. The owners assured me that, in addition to dedicated CrossFitters, they also have many members who integrate CrossFit workouts into training for running, triathlons, or boxing. They also invited me to come to a free teaser class, which I was finally able to do this past Saturday.

The workout, although challenging, was not nearly as hard as I've gotten the impression CrossFit can be; I suspect that the gym makes the teaser classes easy so as not to scare newbies away. On the other hand, I was tantalized by the potential of this type of workout to make me fitter. The range-of-motion exercises with which we opened the workout really helped me loosen up, and when we jumped into what I would call a "WOD-lite" (as many rounds as possible in 10 minutes of 10 push presses, 10 air squats, and 10 sit-ups), although I did very well relative to the other newbies, I could see where practice would improve me tremendously. (For example, our instructor dropped off squats with his butt below parallel with his knees, seemingly as easily as breathing; I could consistently hit parallel, but could go no lower.)

So, I enjoyed the class very much, and have signed up for private instruction to complete the gym's mandatory Foundations training (learning the basic moves so you don't hold back others in a group setting). I'm hoping to get my first lesson scheduled this week, and to be finished with Foundations work by the middle of next month.

Here's to a fitter and stronger New Year!

Pauline Chen, my favorite punching bag

2011-01-07T10:50:00.002-05:00

This week she tells the story of a 17-year-old girl awaiting a liver transplant whose insurance company stonewalled approval of the operation; when the insurance company finally caved under public pressure and paid for the transplant, it was too late and the young girl died. This is cited as an example of how greedy insurance company executives kill people in their quest for profits. Unsaid in the article, but strongly implied, is that private industry has no business making these kinds of decisions.

But...government bureaucrats should? Take a look at countries where they do, like the UK; they have an entire government agency (ironically named "NICE") whose job it is to decide how much a patient's life is worth. If we had public health insurance in this country, we'd have our own NICE -- and, unlike with private insurance, we would have no recourse should such an agency deny treatment. (Note that, if a patient in the UK wants a drug that NICE hasn't approved, he can buy it -- but only if he pays the entire cost of his treatment, including everything that NHS normally would have covered. This, whether or not he has paid taxes to fund what the NHS would have paid for.) At least the family of Nataline Sarkisyan, the 17-year-old of the story, would not have been forced by her insurance company to pay for all of her previous treatment had they been able to raise money to pay for her transplant!

Chen is absolutely right that insurance companies, in their quest to make as much money as possible, often say no to medical care, and that the care they say no to might have been lifesaving in some cases. Does this bother you? It should. Do you want someone you don't know, who doesn't know you, your situation, your values, your full medical history, deciding whether or not you get a medical treatment? I sure as hell don't.

But the answer is not government intervention. All that means is that it's a government bureaucrat, who more often than not will be making decisions on a political basis (Breast cancer advocacy group waging a campaign for mammograms? Sure, we'll cover mammograms! Fiscal watchdog think we're doing too many unnecessary MRIs? Sure, we'll slash coverage for MRIs!), will be saying no, not that everyone will get a "yes."

The answer is a free market in medicine -- so that the only person saying yes or no is you, based on your values and what you can afford. In a free market, most of us wouldn't purchase the kind of low-deductible, routine-expense-covering policies we call "insurance." We'd very likely buy real insurance against catastrophic events, pay out of pocket for routine expenses, and save gobs of money -- some of which we could budget for emergencies. We could shop around to make sure that catastrophic coverage really did cover what we want it to. We'd have more money in our pockets to donate to charity, if we chose, so that a truly unfortunate person who believes an experimental treatment could save his life, but whose insurance company doesn't, could ask for help.

Is she STILL beating that drum?!

2011-01-06T10:26:00.002-05:00

Nancy Pelosi, that is. In the face of a possible effort by the House to repeal ObamaCare, she's still claiming it will save taxpayers $1.3 trillion? Sure, if you:

Assume that no individual or company will change its behavior to avoid new taxes and regulations. Uh-huh. Good luck with that.
Move all kinds of health care-related spending to other bills, so it looks like this one saves people money. Medicare rate fix, anyone?
Keep pretending that government force can ever produce anything.

*eye roll*

My silence on Avastin

2011-01-03T10:57:00.003-05:00

As Paul Hsieh, Tom Bowden, and others have written about, the FDA recently pulled its approval for Avastin, a drug that has effects in many types of cancer, as a treatment for breast cancer. This decision has huge implications for the government's ability to control your medical care. So why haven't I said a word about it?

Avastin is marketed by Genentech, which is a major client of both the advertising agency I work for and its parent agency. Suppose I criticize the FDA for its decision. Suppose the FDA thinks my clients put me up to it. The FDA could take legal action against Genentech -- for words I say as a private citizen. Yes, it's 100% possible. After all, this is the same agency that thinks doctors can't be trusted to make decisions based on their medical judgment if pharma companies give them gifts like laser pointers and pens -- and that's how PhRMA, the industry trade association, got pressured into "voluntarily" disallowing such gifts by its member companies.

It's one thing for my clients or my employer, without government coercion, to say, "We do not want anyone who works for us to comment publicly on our products outside of the workplace." In that case, I am being offered a value (employment and the commensurate salary) with conditions attached. I am free to accept the conditions or to walk away if I don't wish to accept them. That's called a trade.

But when the government says, "We will punish you for anything you say about drugs that we don't agree with," I am not being offered any kind of value in return for my silence. That's not a trade. That is a violation of rights at gunpoint.

So, no. I'm not giving anyone my opinion about the Avastin situation...but the fact that I'm not giving it says something very loudly about the level of government intrusion in health care.

Goals for 2011

2010-12-22T16:52:00.005-05:00

I did pretty darn well with my 2010 goals. I'm no longer setting myself one for my weight -- having maintained myself at 135 pounds for about a year and a half, I'm pretty sure that keeping a healthy weight has become a habit for me, and not something I need to give myself a mental reminder about any longer. (I continue to use Lose It!, the food- and exercise-tracking iPhone app that helped me get down to this weight, in order to alert me to any upticks in my weight so I can correct the problem before it gets bigger.) But I still have some running and nonrunning health-related goals:

Blog on ReasonPharm at least once a week. My temperament is very much fits-and-starts; I often work obsessively on a project for weeks, then abandon it for weeks, then return to it. You can see it in my 2010 posting pattern, where I'd post every day, sometimes twice a day, for a few weeks, then fail to post for a couple of months. This is not how to keep readers coming back, duh! I am capable of disciplining myself to do a thing regularly, as I've shown with my ability to maintain a running schedule of 4-5 days a week for four years now. (I don't reduce frequency in the off-season, just mileage.)

Give CrossFit a try. Endurance is, obviously, not a problem for me. Strength, however, is. I've never in my life been able to do a single unassisted pull-up. I would like that to change, and I've heard nothing but positives about CrossFit from fellow Objectivists. I'm planning to attend a teaser class at CrossFit South Brooklyn, which is a quick jog away from my apartment, in January, and probably sign up for private Foundations training (basically the onboarding stuff where they show you how to do the moves) after that. Assuming all goes well, I'll be able to attend classes after Foundations are done. I'm excited, and a little scared -- my typical workouts as a distance runner are long and work me somewhat hard, but rarely to a very high level of intensity. Am I going to be able to hang with the tough guys? I hope so!

Pick a really damn cool marathon to run. I have now set a personal record every time I've run the marathon. I certainly wouldn't mind doing so again (and running a 4:22:35 PR in 88-degree weather begs the question of what I could do if the conditions were better), but chasing PRs is no longer my primary goal. My husband and I may want to have a child in the next three to five years, and once that happens, I am probably going to have to give up marathoning. I won't give up running, but maintaining the mileage load I need to run a successful marathon doesn't really go with the time and energy needed to raise a child. Which means I can count the number of marathons I have left in my lifetime on one hand (since I don't plan on running more than one a year, and can't necessarily count on getting back into marathoning once any children are older). That means I want every race I have left to be a special experience. Right now option one is Berlin, which is a city I've desperately wanted to see again ever since I visited ever so briefly in 1999. It's an enormous race -- one of the five World Marathon Majors -- and would thus have great crowd support. Plus, it's a nice flat course, so I could chase another PR. Other possibilities: San Francisco (for a serious challenge) or Marine Corps, which I might be able to run with a friend, something I've never done before.

And that's about it!

Aaaaand it's price control time!

2010-12-22T16:40:00.002-05:00

Really, is anybody surprised? Of course, the White House won't come out and say that the government is imposing price controls on the health insurance industry. But now that insurers are responding to all the extra benefits they need to cover (not to mention all the sick people who'll be buying "insurance" for chronic conditions -- particularly the ones who, now that the individual mandate is in trouble, are going to wait until they have an acute problem to purchase their policies) by raising prices, Obama and Sebelius are stomping their feet, crying "Boo, hiss, reality!" and telling insurers they're going to have to present justification for any rate increases of more than 10%. It's not a very long step from there from the government ordering insurers not to sell any policies at prices it deems "unreasonable."

"Karen M. Ignagni, president of America's Health Insurance Plans, a trade group, said that in their zeal to review premiums, 'the administration and Congress have largely ignored factors driving up the cost of coverage.'"

I don't feel sorry for the beating Ignagni and her ilk are taking. AHIP got behind ObamaCare when the President was trying to garner support for the bill; AHIP was hoping that it could grab a huge share of loot by forcing Americans to buy coverage they don't want or can't afford. But now the scheme is blowing up in the industry's face. Big shocker: when the nanny state giveth, the nanny state decideth how much things should cost.

Goals for 2010: How'd I do?

2010-12-21T19:03:00.004-05:00

Now that year's end is approaching, time to see how I did, as I set up my goals for next year.

First, my 2010 goals:

Maintain weight at 135 pounds. Done, and without a whole lot of difficulty. I've replaced just about my entire wardrobe -- it's such fun buying size sixes instead of tens and twelves. Also my husband brags about the fact that although the cliche is that a woman lets herself go after marriage, I look better than I did on our wedding day. Hah!
Beat my personal record in the marathon. Also done, although in retrospect I should always have qualified this goal with "weather permitting." I sliced six minutes off my PR, but I did so on an 88-degree day in Chicago, at the cost of fainting from dehydration a few days later. Was it worth the medical emergency? Probably not, since next year I can try again. Then again, it was so hot that I'm not sure going out more conservatively would have saved me.
Run a 5K. Done...twice! As expected, I slashed my previous PR (set before I started seriously running and before I pared my weight down to 135) from 26:47 to 24:09.
Improve core strength. This is the one area in which I've failed miserably, mostly because I haven't held this goal in mind all year. I'll address this in my 2011 goals.
Go injury-free. Hmm. On the one hand, I didn't injure any body parts. On the other hand, can we call a year in which I fainted from dehydration "injury-free"? In any case, the circumstances surrounding Chicago were pretty extreme, and it's unlikely I'll ever again be faced with running a marathon in such difficult conditions, so I do give myself credit for knowing this year when to stretch, when to lay off a prescribed day's training because of illness, etc.

Soon to come: Next year's goals!

Freedom of speech? Good luck with that one.

2010-12-21T16:23:00.004-05:00

Medical Marketing & Media reports that a Jazz Pharmaceuticals drug rep is suing the federal government for the right to speak about so-called "off-label" use of Xyrem, the drug he represents, citing his First Amendment right to free speech.

I wish that statement didn't have to be qualified. I wish some drug company would have the cojones to flat out state, once and for all, that the muzzle the FDA puts on every pharmaceutical company that does business in America, is unconstitutional and a violation of rights.

The rep's argument, though, is that he should have been allowed to speak about this particular off-label use because the manufacturer had already submitted data to the FDA for approval of that use. FDA's rationale for violating manufacturers' rights is to say that, if it allowed off-label promotion, manufacturers would have no incentive to conduct clinical trials to provide evidence to support new uses of their drugs. The Jazz rep and his lawyer say that, since the trials were already conducted, there was no need to incentivize Jazz to perform more trials, and therefore the rep's off-label speech wasn't so wrong.

FDA's counterargument is that it's not the speech that's wrong, but rather "the crime is introducing the drug into commerce." I suppose it's easier to convince Americans that governmental activity falls under the commerce clause than it is to convince them that they should sacrifice their First Amendment rights, hence the attempt to call the rep's action something other than what it is, an exercise of freedom of speech.

Where do I begin to point out all the things that are wrong here?

Why yes, FDA, you have criminalized free speech for years. As I said, I wish pharmaceutical companies had the will to stand up and say so, because from the FDA's eagerness to characterize this "crime" as one of commerce rather than speech, it's clear the enemy is a bunch of mean little men who scurry like rats when presented with the truth.
Who says pharmaceutical companies wouldn't have incentives to do clinical trials without the FDA? They certainly wouldn't need to deal with the kind of bureaucracy the FDA imposes, but that doesn't mean pharma companies wouldn't want to do trials -- precisely because lots and lots of people won't take drugs without that level of evidence that they work. In order to increase market share, then, companies have to do trials, or find some other way of showing that their products work.
Pharmaceutical companies aren't the only ones doing trials. In a free market, anyone who wants to answer a particular question about whether a drug works, is free to do so, provided he can recruit enough patients for a trial and doctors to conduct it. Even in our not-at-all-free market, plenty of nonprofit groups and individual hospitals or doctors do this. People want information. That means, in a free market, it's often profitable to be the discoverer of such information. You don't have to muzzle pharma companies to incentivize the release of data.

In any case, I highly doubt that the Jazz rep is going to win his case -- even though it's true, the FDA is violating his and his employer's rights.

St. Vincent's: first of many?

2010-10-19T19:48:00.002-04:00

New York magazine reports that although the closure of giant St. Vincent's hospital earlier this year shocked New Yorkers, the pain isn't over yet -- because the majority of the city's hospitals teeter on the edge of financial collapse. With 2% profit margins considered enviable, and losses the norm for most institutions, the city's hospitals leave the article's author searching for the why. What's killing the city's hospitals?

The author does identify some reasons specific to New York: the stranglehold that unions have on hospital labor drives up costs, the high percentage of uninsured and Medicaid- or Medicare-insured patients, the older buildings that many hospitals are forced to maintain.

But what he doesn't say is how all of these things tie together with the pressures that hospitals nationwide are facing: It's government intervention, stupid.

If hospitals weren't forced by city government to deal with unions, they could contract privately with workers willing to accept lower wages than unions demand. If the government didn't insure the poor and seniors, and if hospitals weren't forced to accept all comers (in NYC, it's not just emergency departments that have to do this; according to the article, the nonprofit status of the city's hospitals subjects them to a complex web of regulations forcing them to accept patients regardless of ability to pay), hospitals could choose to deal with patients who can pay (and accept charity patients voluntarily, if they could afford to do so). If New York weren't landmarked to death, with a ridiculous number of historical committees, neighborhood groups, and bureaucrats to please if you so much as want to change the windows on your townhouse, hospitals could build newer facilities when it makes financial sense for them to do so.

All this, on top of the pressures that hospitals all over the country face -- emergency rooms that can't turn away patients, even those who are clearly faking an illness to get a free bed for the night and who will never pay a red cent for the expensive medical care they receive; malpractice lawsuits that force enormous, often undeserved, payouts; private insurers (who would likely play a much smaller role in a fully free market) driving down reimbursement rates -- and it's no wonder New York's hospitals are in the toilet.

Add ObamaCare to the mix, and there will be even more patients clamoring for care, straining a system already at the brink of collapse.

I was fortunate, four days ago, to have a New York City hospital to go to when I had a medical emergency. I certainly hope I don't have one again for the rest of my life. Unless we turn toward a free market in health care, who knows what will be there the next time?

Lessons learned from the ER

2010-10-17T09:31:00.002-04:00

Wow, it's been a while since I've posted! Chalk it up to training for the Chicago Marathon, which I improbably ran in 4:22:35, taking six minutes off my personal record despite temperatures in the high 80s for the last several miles of the race. (If the forecast had said it was going to be that hot, I probably would not have run the race, so perhaps not knowing was better, as I would have missed out on bettering my PR!)

Unfortunately, although I was able to run 26.2 in such brutal conditions and seemed fine, if exhausted, afterward, as it turns out there were some lingering aftereffects.

On Thursday and Friday I had a pretty bad stomachache, which I attribute to the fried chicken I had for lunch on Thursday. Due to said stomachache, I did not eat much on Friday at all, and although I did drink water, I probably didn't drink enough for having run such a dehydrating marathon just a few days before. On Friday afternoon my nausea got fairly uncomfortable, so I decided to go home instead of joining friends for Objectivist happy hour.

On the subway, I really started to feel like caca. It was a crowded train and there was nowhere to sit down, so I just resolved to stick it out and put myself to bed with a glass of water the minute I got home.

Except I didn't make it home. All of a sudden I saw white lights. I remember thinking something that was complete nonsense (I can't remember what it was, just that it didn't make any damn sense) and the next thing I knew I was on the floor of the subway car. The train doors opened -- fortunately, I had fainted just as the subway had arrived at a station stop -- and some kind strangers helped me out of the train and onto a bench, where I spent the next woozy several minutes answering questions of the strangers and the paramedics they summoned. One of the strangers called my husband for me (there was no cellular reception in the station, so he stepped outside to do this) as I waited for an ambulance to arrive.

I was taken to the Brooklyn Hospital Center ER, where my husband (who arrived shortly after I did) and I spent the next six hours. The medical staff gave me IV hydration, some drugs for the nausea, an EKG, and a chest X-ray; this being an ER, I waited hours between tests. (Not that I fault Brooklyn Hospital Center, for reasons to be stated below.) I was so ready to leave by the end of it! The resident who had been seeing me finally told me that it was probably just dehydration, but that I should follow up with a cardiologist, and that I was free to go once I finished at least half of another IV bag. (My husband says it was a bit of a relief to see me watching the IV bag with obvious impatience, because it was better to see me bored and restless than fatigued and out of it, as I had been for the first few hours we were in the ER.)

End of story: Please don't worry about me, I am doing fine (and I don't intend to stop running marathons, as I have run three of them before with no such issues), although I do have a fat lip from where I hit the floor of the subway car when I passed out.

End of story, beginning of thoughts about story:

Objectivism is perfectly compatible with kindness to strangers. I know a lot of people who, if they heard this story, would respond with, "See? Those strangers were nice to you. Doesn't your philosophy mean that you'd just keep on walking if you saw someone pass out on the subway? That's horrible!" Not true. Objectivists recognize that other people can be a huge value -- and sometimes, the benevolent attitude that results from that realization means that helping a stranger is more valuable than whatever it is you would have been doing with those few minutes of your life. If a stranger near me were in an emergency situation, and there were little or no risk to me, of course I would offer whatever help I could. (Example: I would certainly call paramedics if I saw someone having a medical emergency, and wait until help arrived; I would not, however, jump into a lake to save a drowning man, knowing that my own swimming skills are not great and that I would likely imperil my own life without saving his.) I want to live in a world where, in the rare case that I cannot help myself -- like when I lose consciousness on a subway train -- someone will help me. So I ought to help create that kind of world, by helping out when I see an emergency.
This does not mean I owe health care to every Tom, Dick, and Harry. A coworker once challenged me, "You mean if you saw a guy having a heart attack on the street in front of you, you wouldn't help him?" when I said I was against universal health care. Well, just because I would help the man having a heart attack doesn't mean I need to help everybody else pay for health care that they can't or won't pay for themselves. Helping strangers comes out of a sense of benevolence, not one of duty. I'd do it out of the selfish recognition that self-sufficient people -- myself included -- are, in rare emergencies, not able to help themselves, and that I selfishly want to help such people, knowing that the cost to me is almost nothing and the benefit of living in a world where people show kindness to strangers in emergencies is great. This is not the case for my being taxed to pay for health care for retirees who can afford to take Florida vacations because Medicare pays for their doctor visits, or "poor" Americans who claim they can't afford health care but they can pay for a cell phone. The cost to me is great (just the Medicare tax my employer and I pay on my salary, let alone all the other entitlements I pay for, could have made a nice chunk for my husband's and my down payment fund), and the benefit to me is zero (because I'm not interested in living in a world where the able and the frugal are constantly forced to prop up the unable and the spendthrifts).
EMTALA needs to go. Right now. For those who don't know, EMTALA (the Emergency Medical Treatment and Labor Act) is a law that forces ERs to treat anyone who comes near them, meaning that plenty of people who "can't afford" to see a doctor use the ER when they get the sniffles, and others who just want a warm bed for the night will make up symptoms, knowing the ER can't kick them out until they've run a bunch of tests, which takes hours. The patient in the bed next to me was like this; I heard him arguing with the doctor on duty that he felt like he was going to have another seizure (she told him there was no evidence that he'd even had one in the first place, and that Medicaid would not cover his stay there, so he'd have to be discharged) and that if he were out on the street that night and had a seizure, it would be on her head. It was so obvious that the guy was making up a story to get a free bed for the night. With patients like these clogging emergency rooms, driving up wait times for patients who truly are in emergency situations and making it harder for doctors to get paid, is it any wonder hospitals are closing their emergency departments and more and more doctors are choosing to leave emergency medicine? Check out the M.D.O.D. blog for story after story of doctors forced to serve deadbeats, getting fed up with the mess, and quitting. I want to live in a world where emergency care is available if I need it -- and I am willing to pay for it. EMTALA has got to go -- because EMTALA destroys that world.

Good for you, Tim Pawlenty!

2010-09-09T13:57:00.003-04:00

Here's something I didn't know about ObamaCare, but that is utterly unsurprising to me: The bill contains a raft of programs to be "piloted" by the states, with federal money to support them...at first. Then, in a few years, the federal money disappears, and state governors are left picking up the tab for a program controlled by the federal government. D,C. Democrats get to pretend that the federal government comes out on top of the balance sheets, but it's a sham that we'll all pay for with higher state taxes.

Minnesota governor Tim Pawlenty has seen through the trap, and has forbidden any agency in his state from applying for any grant money or pilot programs offered by ObamaCare without his direct permission. As he wisely points out, "It's like the Hotel California. You can never check out." (Well, actually, you could check out but you could never leave, but you get the idea.)

Kudos to Governor Pawlenty for recognizing the trap federal lawmakers are trying to set for state governments, and for refusing to fall for it.

Really, FDA? REALLY?!

2010-08-13T17:32:00.003-04:00

I've known for a long time that the Red Cross doesn't accept blood donations from men who have had sex with another man, even once. I had thought that this was because the Red Cross wanted to be especially cautious about the possibility of transmitting HIV to recipients of donated blood; statistically speaking, male-male sex carries a higher rate of transmission than heterosexual sex or female-female sex, so I figured the Red Cross was simply choosing to eliminate a group of people it deemed too risky.

It wasn't until today, through a pair of letters to the New York Times, that I learned two things: 1) the Red Cross and other collectors of donated blood didn't choose this ban, it was imposed on them by the FDA; and 2) that ban extends to bone marrow.

As one of the letters puts it, "It’s rare that patients are unable to get the blood type they need, but the stakes are much higher when a marrow transplant may be the only way to save a cancer patient’s life. Finding a well-matched marrow donor is much more difficult. If I had leukemia and my only chance for a cure was a gay man’s bone marrow, I’d take that chance — and I think anyone else would, too." No kidding!

But the FDA won't allow you that choice. It won't allow you to say, "Yes, I recognize that if I take this donated marrow, there is a slightly increased risk to my life because of the possibility of HIV, but I also recognize that there is an immediate and known threat to my life from cancer, and it's obviously to my benefit to take the marrow." The same is true of blood donation; although the threat to one's life of not receiving a gay man's donation may be less than with a bone marrow transplant, it should still be a patient's own decision, after a careful consideration of the risks and benefits.

FDA: Butt out. It's every individual's sovereign right to decide what will and will not go into his own body, by his own judgment and not some bureaucrat's.

On how Objectivists aren't self-absorbed egomaniacs

2010-08-10T10:23:00.002-04:00

First, I'll disclaim by saying this post is off-topic...at best, it's super-tangentially related to health, since it's not about running marathons, but about volunteering for them. But I'd like to speak up against one of the most common misconceptions about Objectivists -- that being selfish means being a self-absorbed, insufferable twit who thinks only of oneself.

Not true. In fact, the self-absorbed jerk who tramples over other people is not the least rationally selfish. He's not considering that other people can be a huge value -- and that other people are not required to serve his interests, so if he wants to gain values from other people, he needs to offer value in return.

What, though, about volunteering? On the surface, volunteering looks like it has no clear selfish benefit. If, say, I hammer some nails for Habitat for Humanity, I'll likely never meet the family that moves into the house I helped build; I stand no chance of gaining a value from them. Altruists would say that that doesn't matter; I ought to volunteer, if not for Habitat, for some other charity, out of duty to other people. Most altruists I know would consider volunteering just about as foreign an activity to Objectivists as possible; why would we want to give?

As a matter of fact, I don't want to give when I receive no or little value in return -- and that's why I won't be volunteering for Habitat or a soup kitchen any time soon. I will, however, be volunteering in the 2010 New York City Marathon, handing water to thirsty runners.

Why am I doing this? Out of the forty thousand runners racing this year, I'll know just one, and I'm not likely to see her as the flood of people passes by the water station. What value am I getting out of helping this sea of strangers?

Well, you see, I'm a marathon runner, too. (My race this year is Chicago, so I'll be free to dish out the H20 in Gotham.) In three marathons, plus half-marathons and innumerable shorter races, I have depended on the kindness of volunteers who were strangers to me. Those people ushered me to start lines, kept me hydrated and fed, handed me medals at finish lines, were around to provide medical aid in case of an emergency.

I, selfishly, want to live in a world in which volunteers continue to support races. If all those who helped at races were paid, the price of entry would be prohibitively expensive. And if I want to live in the kind of world in which volunteers help runners, I need to help create that world -- by helping other runners myself. Besides, as a runner, I'm predisposed to be benevolent to other runners. It makes me happy to help them out. Thus, volunteering is not something I do out of duty to others, but out of selfish pleasure and a genuine desire to do for other runners what others have done for me.

Government food ratings get an F

2010-08-09T12:44:00.003-04:00

New York City, whose Department of Health has meddled with food producers' business for years, has recently begun issuing letter grades to restaurants based on the results of unannounced inspections. And, apparently, although keeping smoked fish at a temperature deemed too warm by the bureaucrats is enough to get a restaurant a C rating, you can have mouse poo on the floor and still get an A.

Food writer Kat Odell, based in Los Angeles (a city that has issued letter grades for years), advises New Yorkers to look past the grades. As Odell writes, a pileup of minor infractions that won't actually hurt anybody (such as mislabeling of food containers or cracked tiles in the floor) can get a restaurant slapped with a C, whereas real threats to health, if isolated, can be glossed over with an A. Not to mention that, in many cases, what is safest by a bureaucrat's judgment isn't always what tastes best. The USDA has been urging us to overcook our steaks for years, and city health department officials are no different; they'd like us to have dumplings steamed in metal, rather than bamboo, containers, even if this cooking method affects their taste; they'd like us to eat our smoked fish ice-cold, even if eating it a little warmer brings out its flavor better.

This is what comes of substituting a bureaucrat's judgment for your own. In a free market, consumers could decide on their own whether, for example, having your dumplings steamed in the most perfectly sanitary way possible is more important, or whether it's better to enjoy a dumpling at its tastiest, with a small risk of bacteria from the bamboo. I know which one I would pick. But in our era of city health department dictators, restaurants are pressured to sacrifice taste in the name of risk avoidance.

I, for one, plan to follow Kat Odell's advice of ignoring the letter grades and finding out for myself whether the restaurants I patronize are clean and sanitary enough for my purposes -- not for some bureaucrat's.

I'm not dead...

2010-08-05T13:54:00.002-04:00

...I'm just moving! I can't wait -- Dave's and my new digs in Brooklyn will be literally double the size of the eensy beansy Upper East Side one-bedroom we live in now. Between hunting for apartments, arranging movers, starting to change addresses on about a zillion different accounts, and going through our stuff to weed out things that don't need to come with us, I've had little time or inclination to write here. (Not to mention I'm running 30-40 miles a week as the marathon draws closer!)

I'm also wrapping up (at least, I hope I'm wrapping up) the editing process on an article for The Objective Standard on how a free market would improve health care. I'm really looking forward to seeing it in print!

Peikoff's podcast on fetal damage

2010-07-12T15:49:00.004-04:00

In today's podcast, Leonard Peikoff says that, under a proper legal system, one would not be able to charge a mother with child endangerment if she does something while she is pregnant that results in the child being born with a deformity. The reason Dr. Peikoff gives is that the damage happened while the fetus was still a potential, and not an actual, human being, and although such a mother would be immoral, her actions must not be deemed illegal because she did not harm an actual human. He goes on to say: If we deem it illegal for a mother to, say, smoke during pregnancy, then can't the state also step in and regulate how much sugar she eats while pregnant, in order to give the fetus the best chance in life? Whose sperm should be combined with her eggs in order to give the fetus the best chance of being an intelligent, healthy adult? And then we're starting to sound an awful lot like Adolf Hitler.

Here's the problem I have: once the child is born, an actual human being has been harmed by the actions of its mother. Suppose, say, a woman were being treated for multiple myeloma, a form of blood cancer, with thalidomide. (Yes, that thalidomide, the stuff that caused babies to be born with grotesque deformities in the '60s -- it also works against certain types of cancer.) Suppose further that she's of the right age to get pregnant and she ignores her doctor's warnings about the risk of birth defects. Nine months later, she gives birth to a baby with no arms. In that, case, it was the woman's action that directly caused an actual human being to have no arms. According to Dr. Peikoff, such an action would be monstrous and immoral (agreed!) but shouldn't be legally punishable (here's where I'm not sure).

I certainly recognize the validity of the points Dr. Peikoff makes:

If we criminalize the harming of a fetus, we are placing the potential above the actual.
The state must not be allowed to regulate a woman's pregnancy by telling her what she can and cannot eat, who she should have the baby with, etc.

But, to me that's a case for why the state must leave a woman alone during her pregnancy (that is, they cannot ban smoking, or place impediments in her way to taking drugs like thalidomide, as the FDA currently does), and must not punish her if, say, she smokes during her pregnancy and gives birth to a perfectly healthy baby. Nor is it any of the state's business if she gets pregnant while taking a birth-defect-causing drug and aborts the pregnancy. However, if she takes a particular drug during her pregnancy and it can be proven after the child is born that her actions caused it irreparable harm, I maintain that a crime has been committed.

I'd like some insight, dear readers. What say you?

Medicine by averages

2010-06-23T10:21:00.002-04:00

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

2010-06-22T12:07:00.003-04:00

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

2010-06-21T14:25:00.003-04:00

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

2010-06-15T16:12:00.002-04:00

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

2010-06-14T14:31:00.002-04:00

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!

2010-06-10T16:53:00.003-04:00

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"

2010-06-02T18:50:00.002-04:00

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.

The "never event"

2010-05-27T15:10:00.002-04:00

Dr. Pauline Chen writes in today's New York Times that Medicare's and Medicaid's (and, consequently, private insurers') refusal to pay for so-called "never events" -- complications caused by egregious physician errors -- could lead to denial of care to the sickest patients.

On the surface, refusing to pay for a "never event" makes sense. As John Galt puts it after his capture by a totalitarian government, you wouldn't pay a doctor to set your leg if he were the man who broke it. If a surgeon leaves his scissors in a patient's body after an operation and the patient needs additional surgery and hospital care to remove the scissors, the patient obviously should not have to pay. If a patient is given an oxygen mask that has been inadvertently hooked up to a container of another gas, and the patient suffers poisoning as a result, he should not have to pay for the care required to correct the poisoning. Indeed, in cases like these, the patient probably has grounds for a lawsuit, if the damage is permanent.

But, as Dr. Chen shows, Medicare, Medicaid, and private insurers have expanded the definition of "never events" to include many medical "mistakes" that are not the doctor's fault. If a patient picks up an infection after having surgery, is it the fault of the medical staff? Maybe -- but it's also possible that the patient has an underlying condition, like diabetes, that makes him more susceptible to infections than other patients in the hospital. Cases like these do not represent egregious errors on the doctor's part, but rather the expected risks of caring for sicker patients. If a doctor knows ahead of time that he's not going to be paid if a sicker patient has complications that an insurer deems are the doctor's fault, he'll respond by turning those sicker patients away -- "cherry-picking" the healthiest patients and leaving the sickest without any care at all.

In a free market, doctors would be able to work out payment on a case-by-case basis. If a doctor's egregious error on one surgery led to the need for extra care for Joe, but Jerry needed similar "extra" care after the same surgery because he has a comorbid condition, the doctor can waive fees for Joe and charge them to Jerry, explaining to each the reasons for the charges or lack thereof. In fact, the doctor can explain to Jerry beforehand that his surgery carries a higher risk of complications than it does for most patients, and that X, Y, and Z might happen, and does Jerry still want to go through with the procedure?

When the government pays for medical care, it has to do so by statistical averages to determine what should and should not happen in a medical practice; private insurers follow suit. In a free market, where more of us would pay out-of-pocket for most of our medical care, we'd be more likely to have individual conversations that reflect the particular risks of a given procedure for the patient on whom it's being performed -- and doctors wouldn't need to avoid the sick for fear that their work will be deemed a mistake.

"Caloric extremism"

2010-05-25T17:34:00.002-04:00

Michael Jacobson, executive director of the Center for Science in the Public Interest, isn't happy that laws forcing restaurants to post calorie counts haven't induced the restaurateurs to cut high-calorie offerings from their menu. As Reuters reports, Jacobson complains that "[chain restaurants] practice caloric extremism, and they're helping make modern-day Americans become the most obese people ever to walk the Earth."

Mr. Jacobson: If you'd like Americans to slim down, you have every right to build a website denouncing high-calorie offerings at restaurants, or to publish pamphlets about the health risks of obesity, or to give a television interview stating your point of view. But if that doesn't work -- if Americans still make crappy food choices despite all the messages they get about how obesity is a bad thing -- you do not get to lobby the government to force restaurateurs to post calorie counts (nor, as is strongly implied, to force them to remove the offending items from the menu). Not in a proper society, anyway.

If you can't persuade people to eat right, you have no right to make them do it at the point of a gun.

A sale would be cleaner

2010-05-24T16:25:00.003-04:00

In this week's Ethicist column of the New York Times, a woman whose husband benefited from a stranger's donated kidney asks whether she has a moral obligation to help the stranger, now that the stranger is in financial trouble and has written to ask for help. The writer says, "I wish it were legal to sell organs; it would be much cleaner in many ways."

So true. If selling organs were legal, then the stranger could have asked a substantial price for her kidney, and both parties would have benefited -- the stranger, by earning money she could then use to keep her home, and the donee and his wife, by purchasing an extension of his life.

Instead, the stranger could only choose to give up one of her kidneys out of altruism. For the benefit of a person she had never met -- who could have been a creep for all she knew! -- she gave up an enormous value, part of her own body! This is the kind of transaction altruism demands of people -- sacrificing a great value for the sake of a lesser one.

If the woman had been allowed to sell her kidney, the patient could have purchased it and continued his life with no further obligation to her. Instead, he accepted a gift far beyond what anyone can possibly earn from a stranger, and now has to decide whether he owes her, and how much.

I do think, were I in the donee's situation, that I would want to offer the donor at least some money, in recognition of the great value she provided. On the other hand, we don't know how much the donor has asked for, whether it's an amount the couple can afford to pay, and whether it's more than they would have paid for a kidney if there were a free market. Not only that, but if they give her money, will the donor then feel emboldened to ask for more any time she is in need?

The writer of the letter is correct: Allowing organ sales would make such transactions far cleaner, because there would be no moral blank check, real or implied, held by a donor. And such lifesaving transactions would be more frequent, as well, because people who (correctly!) aren't motivated by brother-love alone to make so enormous a gift as an organ might give one up if they receive commensurate value in return.

Not just a "simple swab"

2010-05-20T15:19:00.002-04:00

The New York Times says "a simple swab can make you a lifesaver" -- that is, if a swab of the DNA in your cheeks shows that you're a match to donate bone marrow to a patient with a blood disease.

The article's strong implication is that everybody should do this. After all, this little thing could be such a big thing for a sick person, right?

Well, no. If you're a match, you won't necessarily, as the Times reports, have to go through the severe pain of a long needle being stuck into your bone, as was always the case earlier. (Some patients still need marrow harvested by the more painful and invasive method, which the Times does not mention.) But you'll still have to stick yourself with a needle for five days, taking a drug that can cause pain in your bones, and undergo a two- to four-hour procedure to have your blood cells harvested -- all for a complete stranger whom you know nothing about.

I don't know about you, but I wouldn't do that for just anyone. I'd do it for someone I loved, certainly -- probably even for someone I like and respect. But I wouldn't do it for a stranger. It's not "just a swab," and I dislike the implication that it's a moral obligation to make part of my body available just in case a random stranger needs it.

Dr. Stasi

2010-05-12T13:05:00.003-04:00

Remember how the White House wanted Americans to tell it about any "fishy" health care information they heard? Well, the government's push to turn us all into informants in medicine doesn't stop there. The FDA would like your doctor to rat out those evil pharma companies as part of its new "Bad Ad" campaign. If a doctor sees a campaign that violates FDA's (vague, nonobjective) guidelines, he is supposed to play informant by calling the FDA's hotline or emailing badad@fda.gov.

In Communist East Germany, the Ministry for State Security, better known as the Stasi, destroyed the lives of untold numbers of Germans by snooping into every aspect of citizens' lives and hauling them in for punishment for the least infraction. More than one hundred thousand full-time agents (for a population of 17 million -- that's one agent for every 166 Germans, far more than the Gestapo had in Nazi Germany!) were supported by part-time citizen-informers, for a final ratio of one informer per 6.5 Germans! So imagine -- if you lived in East Germany during the Communist regime and had a simple family gathering, chances are you were hosting a Stasi rat.

We aren't there yet in America, but programs like the White House's "report fishy information" blog post and now the FDA's "Bad Ad" campaign are pushing us in that direction, and that is a scary thought indeed.

When the White House put up its "report 'fishy' information" blog post, many of us responded by "turning ourselves in" to the flag@whitehouse.gov email address. I, for one, plan to send some inbox-clogging fodder to badad@fda.gov -- perhaps reporting the FDA's own website for misleading information. Who's with me?

Learning to listen

2010-05-10T11:13:00.002-04:00

Most people I know have the opposite problem that I do with exercise: They profess a desire to work out regularly, and can't seem to make themselves do it.

My problem, which is a pretty common one among runners (and I suspect anyone who has gotten good at disciplined practice of a particular athletic activity), is that I have a training plan, and it's really hard to make myself not stick to it. Yes, that is a problem -- occasionally, as it is right now that I'm battling a head cold. Whereas most people would wake up with a sniffle and decide that's a free pass to stay in bed, I often make myself work out anyway. This is sometimes okay if not fun, and sometimes disastrous -- yesterday I completed a six-mile run (fretting all the while that I was supposed to be running eight) and spent most of the rest of the day in bed with chills and an intense fatigue that I can only attribute to overtaxing my body when it needs to repair itself.

In my OAC class, we've been discussing the importance of context -- that dropping the context of a concept or idea can destroy its meaning and lead to faulty thinking. That's exactly the mistake I've made. The training plan I am using was created using a certain context -- for a runner with a certain amount of prior experience (check), with a certain level of baseline fitness (check), and who is in good health -- oh, wait, NOT check! Now that the context has changed, to follow exactly a training program that was created for a healthy runner is not a good idea -- it's a terrible idea. I learned that one the hard way yesterday.

So this morning I skipped my normal Monday workout in favor of an extra hour of sleep. It was hard to do. The disciplined runner in me was screaming, "Don't skip another workout!" (I skipped one last week, when I first started to feel ill) and "It's just three miles, that's nothing!"

Nonetheless, given the current context -- how bad I felt yesterday after running when I shouldn't have, how I need not to sap my energy given that my choir is singing a concert tonight (great timing, no?) -- it was the right choice. I need to listen to my body, not just the drill sergeant in my mind.

Happy birthday to the Pill!

2010-05-07T12:46:00.003-04:00

Although I don't agree with choosing a drug's "birthday" by its FDA approval date (the lifesaving idea was developed much earlier, and why give FDA the credit for the innovation?), many news outlets are using that determination to say that hormonal birth control is turning 50 this month.

Says the AP article: "In the 1960s, anthropologist Ashley Montagu thought the birth control pill was as important as the discovery of fire. Turns out it wasn't the answer to overpopulation, war and poverty, as some of its early advocates had hoped. Nor did it universally save marriages."

Well, no. Man has volition. The mere appearance of a new, more effective method of contraception is no guarantee that people will use it, nor of which people will use it (wealthy couples who could support a child if they had one? poor couples who hope that a large family might support them later in life?). It doesn't cause men to choose a life of production over a life of aggression or one of idleness, and it doesn't cause married people to communicate with each other, stay faithful to each other, or any of the other choices that keep a marriage strong.

But although the Pill can't stop man from making poor choices, it is tremendously good. Why? Because sex is good. Sex is pleasure, and sex can lead to babies. Sometimes -- in fact, a lot of the time -- man wants the pleasure without the tremendous responsibility of the babies. There's nothing wrong with that. What the Pill has done is to make it easier for men and women to enjoy the pleasure of sex without the worry of being condemned to nine months of pregnancy and eighteen years of raising an unwanted child. I'm glad that my husband and I have grown up in a world where that's possible; I'm glad that we can enjoy just being husband and wife, without having to think about being Daddy and Mommy just yet.

Happy birthday, birth control!

A taste of what's coming for doctors

2010-05-05T15:38:00.002-04:00

Dr. Jane Orient, author of Your Doctor Is Not In, tells us why she won't take government money for her services: because she understands that having the government as a customer is inherently dangerous. If a patient who pays with his own money thinks Dr. Orient is charging too much for her services, he can try to negotiate payment with her or look for another doctor. But if the government decides her profits are "too high," she can be fined, forced to pay treble damages, or even jailed. Think about what this means:

If a doctor is making X dollars in profit but the government says he's making X times 2, the government has the power to insist that its numbers are right, and that the doctor must refund the difference and pay punitive damages -- even if that means the doctor loses money practicing medicine. (See Dr. Orient's example of the plumber who was forced to pay rebates even though his business had met the pricing on the bid it originally made to the government, and actually lost money for the year as a whole.)
If a doctor finds ways to make his processes more efficient, so that he's still able to make a profit even as reimbursement rates are being cut, the government can point to him and say, "He's making too much. He needs to be punished." So instead of being rewarded for doing things more efficiently, a doctor can be punished. The hell?

ObamaCare will only make this situation worse, even though it will nominally be private insurers who are paying for the care of Americans who buy health insurance because of the law. Don't be shocked if those insurers, as costs continue to rise, try to get the strong arm of the government to punish doctors who have the audacity to try and make a profit by providing lifesaving and life-enhancing services.

The question nobody asks

2010-05-04T13:25:00.002-04:00

In the American health care system, where so many goods and services are paid for indirectly, through a third-party insurer, patients learn to ask for champagne even if they should really be on an iced-tea budget. But I'd never thought about how doctors' thinking, too, is so different from what it would be in a free market, until I read this New York Times article.

A doctor's education is devoid, with rare exceptions, of consideration of the costs of the services they provide. Think the patient might need a colonoscopy? Just order one, without thinking about how much it costs and what kind of money your patient makes. Prescribe a drug that's five percent more efficacious than its competitors, but costs three times as much; your only concern is the efficacy, right?

Prior to the rise of employer-paid health insurance, doctors thought about cost, and patients asked. As blogger Dr. David Thomas put it, doctors tried to "save the widow the farm" -- to consider all of the requirements of his patient's life, not just the medical ones. They would think about the fact that an expensive treatment that bought the patient only a few extra, painful months of life, might not be worth bankrupting the patient and forcing his family to pay the bills long after his death. They might decide, with their patients, that the little bit of extra relief Drug X gives is not worth the steep price relative to Drug Y, and so on and so forth.

The fact that patients and doctors no longer think this way is why the cost of medical care continues to climb without a corresponding increase in breakthroughs, unlike freer sectors of the market, like electronics, where prices drop and innovations flourish.

No, Princeton, I will not give you money.

2010-04-30T13:49:00.005-04:00

My ten-year college reunion is coming up. (Gulp.) That means even more than the usual stream of pleas from Princeton that I send along some moolah. (Five years ago, I wisely decided to remove my phone number from the alumni directory, after my then-roommate informed me that "a friend from school" had called and asked me to call her back -- the "friend" was someone I'd never met who was working for the annual giving campaign. But I still get plenty of emails and snail mail.)

I refuse to give one cent to Princeton.

I had, in many ways, a very good experience there -- in particular, my thesis advisor, Dr. Robert Cava, and my German professor, Jamie Rankin, were among two of the best teachers one could hope to encounter in one's life. So why won't I fork over the cash?

Reason number one: Paul Krugman, a professor of economics who doesn't understand that a massive government entitlement cannot possibly reduce the national deficit (blithely ignoring all of the funny math Democrats used to pretend that it will), among other basic principles that even I, who switched my grading option in Princeton's Economics 101 class to pass/fail to avoid getting a C on my transcript, understand. Reason number two: Peter Singer, a professor of ethics who thinks that being moral consists of making sacrifices, that anybody in need has a right to what you have earned, precisely because you have earned it and he hasn't.

Both of these men have a base to spread their poisonous ideas in large part because Princeton employs them. I will happily -- and selfishly -- give to organizations whose work supports my life. But to support an institution that employs these men, who are working so hard to undermine my life? Hell, no.

ObamaCare adds headaches to doctors' days

2010-04-19T13:52:00.002-04:00

ObamaCare will do much worse than cause doctors headaches as its provisions take effect, but right now, the New York Times reports that physicians are having to spend significant amounts of time answering patients' questions about the law.

Why should your physician have all the answers here? After all, I would bet nontrivial sums of money that most of the idiots who voted for the bill's passage have read a tenth of the bill, much less its entire 2,409-page text. I feel sorry for America's doctors, who on top of the massive injustice already done them by passing a bill that threatens to enslave them even more than they are already, now have to take extra time out of their days explaining the mess that has been foisted upon them and their patients. That's time they could be spending on patient care, on leisure activities, on all manner of productive pursuits.

If you have a question about the health-care bill, demand an answer from your congressional representatives. Let's make them spend hours trying to explain the unjustifiable thing they have done.

A nation of averages

2010-04-16T15:19:00.002-04:00

In "Government-Run Health Care vs. the Hippocratic Oath," Paul Hsieh argues that government control of care subverts your doctor's judgment -- and undermines your ability to trust your doctor. One of the ways in which this happens is that bureaucrats inherently make rules based on averages. Instead of deciding how much and what kind of care a patient needs based on that patient's individual symptoms, overall health status, and general situation, as a doctor who has direct contact with a patient can do, bureaucrats look at the average level of care required by a patient with a particular condition, based on data from a large group of such patients. Then they condemn a doctor giving more care than the average as an "outlier" who is using "unnecessary resources," even if the patient's health situation makes that care all too necessary. An average, after all, is a calculation that includes both patients who need less care and patients who need more. In a free market, patients who need more than the average amount of care can seek it, and pay for it. In a government-controlled market, such patients are deemed "outliers," and to put it bluntly, they're screwed.

But payments to doctors aren't the only way in which government-run health care imposes an average to the detriment of anyone who happens to be "above average" in their need for care. The New York Times reports that the health care "reform" bill is capping the annual limit of money that can be put into a tax-free health-care flexible spending account at $2,500, starting in 2013. Proponents of the limit argue that the average amount put into such accounts is much less than that -- only $1,400 (of course, I'm sure people would put more money in if it could be rolled over from year to year and thus used to insure against serious, unforeseen events). So who are we really hurting by imposing it?

Those with chronic conditions, that's who. The article cites a Florida couple who spend $350 per month just on their co-pays for prescription drugs for heart disease, diabetes, and Crohn's disease -- let alone any money they spend on over-the-counter meds, which won't be allowed reimbursement from an HSA starting next year. They are hardly the only Americans who take multiple medications, or who have children who need orthodontic work, or who would simply prefer paying for their health care out of pocket rather than buying an expensive comprehensive insurance plan that doesn't deliver the value paid for. Such people will now have to pay for those expenses with post-tax, not pre-tax, dollars.

Just another way in which letting the government take over health care will screw you if you're "above average" in any way...

New law will create a shortage of health screenings

2010-04-09T15:33:00.003-04:00

That's what the New York Times should have titled its blog post "New Law Will Require Free Health Screenings."

After all, if you force insurance companies to let patients completely ignore the cost of preventive care, they'll demand even more of it than they do when they have to fork over a co-pay. But there won't be a magical increase in the number of new physicians to perform all of these physicals, mammograms, and other procedures deemed to be preventive care. In fact, we can bank on fewer good doctors in the future than we have now, thanks to falling reimbursements and the soul-killing paperwork they increasingly have to spend their time doing.

Let's call a spade a spade: "Free health screenings" really means "health screening shortage."

The insidious bracket creep

2010-04-05T14:13:00.003-04:00

One of the provisions in the health care "reform" bill is a tax on so-called "Cadillac" insurance plans -- those that cost more than $27,500 for a family or $10,200 for an individual. (So, in the name of egalitarianism, we are not only supposed to feed the short poppies but cut off all the tall ones.) This is supposed to get the "rich" to pay "their fair share" of others' health costs.

As the Boston Globe points out, many Massachusetts residents who don't consider themselves "rich" but nonetheless are covered under expensive health plans -- their high prices themselves the result of Massachusetts regulations that force patients to purchase coverage for more services than they may want or need -- stand to be hit by the "Cadillac" tax. And that's at current insurance plan rates -- in 2018, when the tax sets in, don't be surprised when health care "reform" has pushed premiums so high that many more Americans get taxed.

Unfair? Hell, yes.

Recipes for the paleo-minded

2010-04-03T16:58:00.002-04:00

As I mentioned back in my Goals for 2010 post, I have not gone paleo as many of my Objectivist friends have, but I have reduced my carb consumption quite a bit. Where I used to eat cereal for breakfast, now I have salami and cheese; where I used to load up my plate with rice or couscous to go with whatever meat and vegetable I was having, I now limit the grain portion to no more than half a cup, or skip the grain altogether. I've found that I get fewer hunger spikes this way, and maintaining the weight loss I achieved last year has been no problem. I still have a deep love of distinctly non-paleo desserts, particularly cake and pastries, but even those I have less often in favor of chocolate-covered almonds or a rich chocolate ice cream (Ronnybrook Farm's Chocolate Silk is pretty damn awesome).

I'm not interested in using this post to persuade others who haven't adopted paleo at any level to do what I have done, nor to be persuaded to go whole hog (pun intended) by those who are full-on paleo purists. Rather, because I love to cook, I wanted to share a few of my favorite full-on paleo and paleo-friendly recipes that I've discovered since switching to a less carb-heavy lifestyle. Here we go -- and I'll post more as I find them!

Salmon fillet en papillote with julienned vegetables, by Alton Brown. This recipe makes use of a method that paleo man most certainly did not have at his disposal -- the microwave! If you're thinking, "I can make a tasty dinner in the MICROWAVE? Yeah, right!" I implore you to give it a shot, because in terms of flavor vs effort, this is just about one of the highest bang-for-your-buck recipes I can think of. Basically, you chop some vegetables, put 'em on a piece of parchment, season, throw some fish on top, season that, throw some oranges and a little vermouth on, and toss that baby in the nuke machine and you have dinner. To those purists who do not eat snow peas, it's easy enough to julienne something else, like broccoli stems or asparagus, in their place. The recipe also works for fish other than salmon -- I made it last night with wild striped bass with excellent results (just be aware that you may have to adjust cooking time).

Chicken drumsticks with muhammara sauce, from Epicurious. This is a theme: simply cooked meat with an amazing pureed vegetable-based sauce. Purists should of course omit the bread crumbs from the sauce. Again, an incredibly easy-to-make dish, and very flavorful indeed.

Skirt steak with cilantro-garlic sauce, from Epicurious. See above re: yummy pureed sauces, although this is herb- rather than veggie-based. No need to modify, it's paleo as is!

Entitlements 1,000,000,000,000,000,000,000, Freedom 0

2010-03-31T10:25:00.002-04:00

It is telling that a White House staffer tweeted, in response to insurance companies' caving to White House demands to cover children's preexisting conditions despite a potential loophole in ObamaCare that might let them get out of it...

..."Kids 1, insurance 0."

So the Democrats think of health care only in terms of winners and losers. In order for patients to win, insurance companies must lose. Gains by one group must always be made at the expense of another group.

But this is not the way it has to be. In a free market, decisions about health care would be made voluntarily -- by mutual trade, to mutual benefit. A child would not get health insurance at the expense of the insurer -- his parents would decide that they valued their child's being insured more than they valued the money it cost them, whereas the insurance company would value the money more than it values the service it is providing to the child's parents. Both parties would be trading something they valued less and getting something they valued more. In that case, the score is a win for both sides. Isn't that the kind of world we want -- not the kind where we cannibalize each other?

We're all vicious, therefore we should all pay?

2010-03-30T14:50:00.003-04:00

Sandeep Jauhar, a doctor, writes for the New York Times that healthcare "reform" will require people with good habits to subsidize people with bad ones, because if determining the price of an insurance policy by risk is outlawed, then those of us who pursue healthy lifestyles will be paying more so that those who don't can pay less. Dr. Jauhar is right, of course, but he goes on to imply that that's not such a bad thing.

Dr. Jauhar's argument: We all have bad habits that "society," in some form or another, has to pay for. He says, "But then I remind myself that we all engage in socially irresponsible behavior that others pay for. I try to eat right and get enough exercise. But then I also sometimes send text messages when I drive." He doesn't come out and say "who are we to judge?" but he strongly implies it, with his tale of a patient who didn't care for himself very well and then was denied care by a doctor who told him he needed to learn personal responsibility. He doesn't come out and say, "we're all bad, so we should all pay," but that's what he means.

What an abysmal view of human nature -- that we are all flawed, and that rather than try to make ourselves better, we should simply accept that we are flawed and help each other pay for the wrecks our foibles cause.

Ayn Rand offered a very different view of human nature -- in which pride, or moral ambition, is a virtue. Man is fallible, he can make mistakes -- so he isn't automatically perfect in his knowledge or his decisions, but he can strive to be morally perfect. He can, no matter what the situation, apply his reasoning mind, and he can refuse to tolerate moral laziness or weakness in himself.

That is how I want to view man -- as a being capable of finding out what steps he should take to sustain his life, and once he knows what those steps are, he is a being capable of acting on his judgment. Man is not a creature of his fatal flaws, and what flaws he does allow himself impose no obligation on others.

This breaks my heart.

2010-03-29T11:17:00.002-04:00

Paul Hsieh posted a letter written to him by a bright sixteen-year-old girl who had been dreaming about a future in medicine, but who is now wondering if she should reconsider her choice, given that ObamaCare will make slaves out of doctors. And she does not want to be a slave. "How can you now lay claim to my hard work and future talents?" she asks. "I now feel that if I choose the medical profession I would become a second class citizen."

She's right, and it breaks my heart. Most of the discussions I've had about health care reform have made me angry -- at people who can't or won't analyze the facts and see the principles that make government intervention in health care an evil idea that can only lead to misery. But this letter makes me sad.

The only thing I could think about while reading it is my fifteen-year-old niece, who, like the author of the letter, is a bright young lady who wants to be a doctor. When she was little, my niece broke her arm at a school playground, badly enough to need traction and surgery. The expert care she received at the hospital inspired her to want to become a doctor just like the ones who had treated her.

I've always encouraged my niece's dreams. But now, I can only do so with a heavy heart. If she continues in her path to become a doctor, she's setting herself up to spend at least as much time dealing with insurance company employees and government bureaucrats as she spends working with patients -- to have to subdue the judgment of her own mind to that of some bureaucrat who doesn't have a medical degree -- to have her pay dictated, not by the best her ability can command, but by some apparatchik who thinks that, because her services are needed, she has to offer them at low cost to all comers.

It breaks my heart to think of my beautiful, carefree niece consigned to that kind of life. It breaks my heart to think of how some of our best and brightest students, instead of looking forward to a life in which their fortunes are limited only by the best their ability can be and in which their minds will be the guide of their work, will decide instead to do something that they don't quite feel as passionate about -- but that won't shackle their minds the way government-regulated medicine will.

We'll never know how many bright young minds like these ObamaCare will crush.

Back in the fight

2010-03-26T08:05:00.002-04:00

I've posted nothing since Washington committed its crime on Sunday night. I have to admit, it was demoralizing.

But, I have a liberal commenter who likes to think he's a smartass. See the comments here, where he (I think it's a he) began with, "Eat your heart out about the health care bill passage, sweetie."

No. No, I won't. I'll join the many others who continue to fight the good fight, because it's my life and the lives of those I love at stake -- the fruits of my productive ability that the Democrats want to take to pay for other people's care, the advanced health care that won't be available to any but the politically connected by the time I need it, the bureaucratic misery that awaits my beloved niece if she follows her dream of becoming a neurologist.

So, Rye Parrish, know that your little dig has actually reinvigorated me to fight this evil legislation. Here's what will be my biggest contribution: an article for The Objective Standard showing why a free market would make better quality health care available -- and make it more available, because it will be cheaper.

LTE in the NYT!

2010-03-18T07:15:00.003-04:00

For a while I had given up on writing letters to the editor of the New York Times -- it seemed like they only published letters from loony leftists. But, given that we are in a healthcare endgame, I had to try again -- and my letter appears in today's paper.

http://www.nytimes.com/2010/03/18/opinion/l18health.html

I'm glad I took the time out to write it. Notice that it appears alongside two letters from leftists who want ObamaCare passed, and one from the president of the AMA, who doesn't understand the trouble government intervention has gotten doctors into or how to get out of it. I'm glad there's a free-market voice on the page to counter them!

Emotionalism doesn't belong in the health care debate

2010-03-16T13:13:00.004-04:00

Advocates of healthcare "reform" love to trot out stories like President Obama's of a self-employed cleaning lady who dropped her insurance, then got leukemia. One is supposed to feel sorry for her, and then because one feels sorry for her, swallow ObamaCare, with its massive increase in government controls and taxes, whole. Obama asserts that "every argument has been made," and now it's time to show the real impact of not following his plan.

Well, yes, an awful lot of arguments have been made -- but the good ones haven't been answered. How can forcing insurers to cover anybody and everybody while limiting the price they can charge, do anything but steal from the young and healthy to pay for the old and sick? Why, when insurance mandates have failed spectacularly in Massachusetts, are they going to do better multiplied by fifty? How can one justify violating individual rights on an even grander scale than they already are?

Obama is trying to bypass logic and facts -- because they aren't on his side -- and go straight for feelings. Isn't it awful to see a hard-working human being who, because she could no longer afford insurance, now has a life-threatening condition and no way to pay for her treatment?

Yes. Yes, it is, and I do feel sorry for Natoma Canfield, the woman of the president's example. But it does not follow from that emotion that we must place health care under government control.

Emotions, as I'm learning in my OAC readings, are not tools of cognition. You can't just go from "I feel X" to "we need to do Y." You have to unravel all of the ideas that got you to that emotional reaction, because some of them may be true and some may be false -- and you have to act on your best rational assessment of the facts, not on that initial emotion.

Your average American, indoctrinated by altruism as we are, hearing about Natoma Canfield probably feels sorry for her out of a sense of benevolence (she's another human being; even strangers are of potential value to us because of that) and guilt (we are supposed to help others; I should do my part and help her), and Barack Obama can play on that unearned guilt to buy the federal government an unprecedented control over the U.S. economy.

I feel sorry for her out of benevolence to other human beings -- and because the very reason a self-employed person like her can't afford insurance coverage for catastrophic conditions like cancer is because government controls have priced her out of the market. My emotion of feeling sorry for Natoma Canfield will not lead me to support ObamaCare, not one whit -- because I understand that there are principles involved, and that the facts are what they are regardless of what I feel. In fact, my feeling sorry for her is a reminder to me of the fact that government intervention caused her desperate situation, and that we must fight against government intervention to prevent more cases like hers.

Don't let the president bamboozle you with sad stories. It's fine to feel sad for people like Natoma Canfield -- but then think about why she is in the situation she's in, and you'll come to a far different conclusion than Obama. Feel what you feel -- but act on the facts.

"Too much" care

2010-03-15T15:22:00.002-04:00

The AP reports that Americans, including the President himself, may be getting "too much" health care -- as in tests deemed unnecessary:

[T]he colon exam exposed [Obama] to radiation "while likely providing no benefit to his care," [cardiologist and healthcare policy analyst Dr. Rita Redberg] wrote in an editorial in the medical journal. Obama's experience "is multiplied many times over" at a huge financial cost to society, and to patients exposed to potential harms but no benefits.

Well, why "at a huge financial cost to society"? That's only because the government pays for so much health care. If I'm not paying for it, I don't give a rap whether my neighbor wants a colonoscopy at age 45 for his peace of mind. It's only when the government gets involved that we start turning a suspicious eye on each other to see if we can castigate others for their "frivolous" biopsies or "unnecessary" screenings.

In a free market, most of us wouldn't buy insurance that covers every test under the sun -- because it wouldn't make financial sense to do so. And if I pay for my tests out of pocket, you can be damn sure I'm going to ask: Do I need it? Are there risks associated with my getting the test? What are the risks if I don't have it? And then I, taking the expert medical advice of my doctor as well as my financial situation and the other things I want and need in life into account, will decide whether or not to have that test. I, and I alone, would decide, in the context of my life, whether that test was necessary or not, and nobody else would have any business enforcing their view on me.

Do you want third parties -- whether the government or private insurers -- telling you that the care you want is "too much"? Only a free market in health care will let you make the final choice.

To Carolyn Maloney

2010-03-15T11:15:00.002-04:00

I live in NYC, so my representative is a loony liberal, unsurprisingly. (Last year, she sent me this awful form letter in response to my letter to her urging her to vote no on the House healthcare bill.)

Nonetheless, we are at another critical point in the push against ObamaCare, and I have to at least try to stop it. I sent her the following:

Representative Maloney:

Your voting record on health care is well known. However, I must urge you to do the right thing the only way I know how.

If you vote for ObamaCare, I will make sure I get to the polls next election to vote against your continued presence in the House of Representatives.

America needs a total dismantling of government intervention in health care, not an increase in the crippling burden of regulations and taxes that we already bear.

Sincerely,
Stella Zawistowski

Write your representative, too! If ObamaCare passes, it will be even more difficult to get it repealed than to prevent it from passing.

Really, NYC?

2010-03-15T11:04:00.002-04:00

Really? You have nothing better to do than try to shut down clubs that secretly allow smoking?

How about, instead, with all the tax dollars you've stolen from me and other New Yorkers, you spend some time thinking about how to reduce your intrusion into our lives, not increase it?

Funny how that works, Mr. President...

2010-03-11T15:19:00.003-05:00

Obama is "tired of talking about" health care.

Well, boo hoo hoo, Mr. President. That is the whining of a petulant child. If he had been able to answer the many rational objections to massively increasing government intervention in health care, and found his well-reasoned rebuttals falling on deaf ears, then he would be justified in saying that he's sick of the discussion. But that is emphatically not the case. Obama has failed to answer objections with anything more than a lame "because it's right," which means "because I feel it's right," not "because the facts show that it's right." That's because he can't. He can't use logic and facts to support what he wants because logic and the facts support a completely opposite conclusion: that what we need in health care is a fully free market.

So, Obama has no right to demand an end to the debate and the execution of his whims just because he's tired of talking about health care. Guess what, Mr. President? I'm tired of talking about it, too. I'm tired of having to argue, over and over again, that health care is not a right -- that the high cost of so many healthcare goods and services is because of, not in spite of, government regulation -- that neither insurers nor doctors nor patients should be enslaved by the government in the name of universal health care.

I'm tired of talking about it, but I will continue to do so, because I value my life and I don't want the government messing with my health care even more than it already has.

You, Mr. President, do not have the luxury of throwing a tantrum and saying that we Americans need to stop talking about health care and just do what you want. If you'd like to stop talking about it, please do shut your pie hole, learn some basic laws of economics, and start defending individual rights the way you're supposed to -- by dropping all talk of healthcare "reform" via government controls, and talking about a free market instead.

Oh yeah, that's insane, all right.

2010-03-10T15:04:00.003-05:00

New York magazine's Grub Street blog reports that state assemblyman Felix Ortiz has proposed a salt ban in restaurants. Not just a restriction, a BAN. On any use of salt in any form in the preparation of food in restaurants! Grub Street quite correctly calls the bill "insane."

Grub Street is reacting so strongly, though, for the wrong reasons. It's true, so much of a meal's flavor derives from its being properly seasoned that a salt ban would turn the state's restaurants into a bland mess of awful -- and that thought sends the columnist (and me) into paroxysms of horror.

But that's not the worst of it. The truly unpalatable problem is that New York's lawmakers think it's perfectly all right to trample on individual rights -- the right to eat as much salt as one damn well pleases, and take the consequences for it. That is what Grub Street ought to be calling "insane."

By the way...it was only a matter of time from when Bloomberg and his talk of "encouraging" "voluntary" salt restrictions in the city until someone in the nanny state tried to make it a law. Until and unless there is widespread opposition to these laws on moral grounds, we are just going to be having a debate on how much salt should be restricted, how much of a tax to put on sodas, and so on and so forth.

2010 goals: Progress

2010-03-09T13:54:00.003-05:00

Now that we're almost a third of the way through the year (!) I'm checking my progress on my health-related goals:

Maintain weight at 135 pounds. Check. I have not been above 137.5 since the start of the year. Continuing to use Lose It! as a check on myself (it automatically cuts your calorie count once you enter a weight above your goal weight, even if it's only by half a pound) has kept me from slipping.

Beat my personal record in the marathon. I've signed up to run Chicago in October, and have put together my training plan for the year. I begin next week with twelve weeks of speed-building, including fartleks, tempo runs, hill training, and intervals. The twelve-week spring training program is followed by 18 weeks in which the focus shifts to building mileage. I'm choosing a slightly more difficult plan than I've followed in my past two marathons, in the hopes that increasing my weekly mileage by about 10% as compared with last year will improve my endurance.

Run a 5K. Did that on Sunday morning. My time was 25:09 -- a little slower than I wanted, but then I had no idea I was going to be running on a course loaded with hills. Note to self: Know thy course! If I'd done a little research ahead of time, I would have known to expect that, and thus not to expect a sub-25-minute time (as well as to do more hill training in the weeks before the race). If I can find one (5Ks are oddly hard to come by in NYC), I'll try running a flatter 5K before the summer is over, so that I can see what my time on a less roller-coaster-like course would be.

Improve core strength. I haven't been perfect on this one. I find it easy to throw in ab work at the end of a treadmill session, when I'm at the gym and there's an ab mat right there. But when I run outside (as I've been much better about doing this winter than in previous years), I almost never do ab work when I get home, usually because I just want to get into the shower and de-stink myself. So I think I need to figure out other ways to get ab work at home into my day, especially since I'll be running outdoors even more now that the weather is finally getting springy.

Go injury-free. Thus far, nothing worse than an annoying plantar wart!

Stossel on health care

2010-02-24T04:39:00.003-05:00

Tomorrow night, Stossel on Fox Business will be featuring a segment on the nanny state's intrusion into medical decisions that ought to be between an individual and his doctor. Here's a teaser link.

President's plan closes down on innovation, violates rights

2010-02-23T15:26:00.002-05:00

That's what this article from Medical Marketing & Media should have been titled (its given title is "President's plan closes doughnut hole, bans 'pay for delay'")

What does Obama think piling huge fees on pharmaceutical companies and medical device manufacturers is going to do? It's going to kill innovation and drive up the price of health care...duh?

Remember that Nails song...

2010-02-05T14:43:00.002-05:00

..."Head Like a Hole"?

Specifically, as I read this excellent Wall Street Journal op-ed, I thought of the lines, "Bow down before the one you serve. You're going to get what you deserve."

Big Pharma bowed down to the government, hoping that by playing nice with the bullies, they would get huge profits out of a sweeping healthcare bill that would force more Americans to carry insurance, thus turning more Americans into consumers of medications. Now that ObamaCare is in a shambles, Democrats look likely to turn to the strategy of passing multiple smaller, less controversial bills so they can still say they "did something" about health care.

So now, Big Pharma might just get what it deserves for having worked with Congress instead of proudly standing against it...because you know what's less controversial than a giant bill that involves lots of new taxes and requirements that affect Everyman? Smaller proposals like putting price controls on Medicare-purchased drugs, allowing reimportation of prescription drugs from countries whose governments control drug prices, and cutting into drug companies' patent exclusivity on biologics.

The pharmaceutical industry can't protest that such measures would be a violation of their rights to charge what they please for their medicines without direct intervention from the American government or indirect intervention from a foreign one (which is what reimportation is). They gave up any pretense of caring about rights when they tried to help Congress hog-tie insurance companies to get a share of the loot.

As the author of the op-ed says, "There's a lesson here for corporate America. Try standing up for the free markets and limited government that have always been the foundation of U.S. business."

We know better. We're the government.

2010-02-02T19:22:00.003-05:00

Florida dermatologist Dr. Leslie Baumann, who was the lead investigator on clinical trials of Dysport, an antiwrinkle treatment that was approved by the FDA last April, has received a warning from that agency for remarks she made to the media about the drug before it was approved. Pharmaceutical companies are not permitted to promote the use of a drug before the FDA approves it (and they are not allowed to promote it for uses other than those approved by the FDA, even after approval is obtained), and that includes the doctors who run their trials, even if those doctors aren't directly employed by the drug company.

Does anyone else notice how ASININE that is?

Who in hell would know more about how good a drug is than the chief investigator of the clinical trial? Dr. Baumann has direct experience with the drug, which is more than any government paper-pusher can say.

The New York Times paraphrases Thomas W. Abrams, head of DDMAC (the division of the FDA that monitors drug advertising and marketing):

But an investigator should not promote any unapproved prescription drug — or an unapproved use of an already approved drug — as being safe or effective if the agency has not yet deemed it to be so, he said.

Right. Because the opinion of someone who has seen firsthand what the drug can do doesn't count, but the opinion of bureaucrats who have never worked with the drug does.

The Supreme Court may have given us a victory for freedom of speech last month, but let's not forget how the muzzle on talking about drugs is getting tighter and tighter. Doctors and pharmaceutical companies have just as much right to speak freely about drugs as unions and corporations have to speak about politics.

Review: Extraordinary Measures

2010-01-27T15:55:00.003-05:00

I'm swamped at work, but just wanted to point out the new Brendan Fraser/Harrison Ford movie, Extraordinary Measures. (Warning: somewhat spoilerish.)

I had a mixed reaction to the film, which is about a father of three children, two of whom have a life-threatening and degenerative disease, who teams with a maverick scientist to look for a treatment that could save his kids' lives. But the mixed reaction was not because the film was half bad and half good. In fact, there was a lot of good: the father's willingness to do anything to achieve his values, the scientist's dedication to truth, the fact that the filmmakers didn't present the children's situation as the fault of Big Pharma, but rather presenting the metaphysically given difficulty of translating theoretical research into a usable pharmaceutical. I really enjoyed the heroic actions of and the interplay between the two main characters.

What made me truly, truly angry about this movie is that it's too kind to the government.

The story of a father and a scientist bringing their minds to bear on a difficult problem and making a breakthrough in medicine made me angry...because I am convinced that in the world we actually live in, the FDA would not let such a thing happen. The children in the film would have been dead before the government decided that a new treatment was safe enough to be tested in humans -- just ask the families of Anna Tomalis or Abigail Burroughs. Government officials think they are more qualified to decide whether the benefits of a new drug are worth the risk than the patients who will die without those drugs. Maybe they'll die with the drugs -- but if you were a dying patient -- or the parent of a dying child -- wouldn't you want to be the one who decides whether or not to take a chance?

Go see Extraordinary Measures, but know that there's a villain in the real world who doesn't show up in the movie -- and that villain must be destroyed.

Reasons to be wary, and reasons to be excited

2010-01-20T12:30:00.004-05:00

Scott Brown, soon to be senator of the bluest of blue states. Bless you, Massachusetts voters!

It's not a total victory. Here's why:

I didn't know until today that Brown voted for RomneyCare in Massachusetts. This guy doesn't want to be the forty-first vote for the sake of defending individual rights in medicine. He wants to be the forty-first vote so that he can block the Democrats from being able to take credit for any action, and perhaps so that Republicans can propose their own bad healthcare policies.
As other astute Objectivist bloggers have observed, we're still not having a debate in terms of principles. It is only ObamaCare vs. the current system, which is a false dichotomy. The question should not be "our current set of controls, taxes, and entitlements" vs. "even more controls, taxes, and entitlements." The question should be: A free market in health care, or continued tyranny?

But here's why I am excited:

The people of Massachusetts have bought us time -- time to turn the debate toward one of principles, time to spread the idea that health care is not a right, and that doctors, pharmaceutical companies, and insurers are not slaves to be chained for the purpose of churning out care for everyone, regardless of whether or not he has earned it.
There's been talk of what would happen in midterm elections if healthcare "reform" was passed over the protests of the American people...but now politicians facing election this year have a concrete example staring them right in the face of what happens when you run roughshod over your constituents. And that, I hope, will scare them out of marching in lockstep with Obama's demands.

I had been discouraged by the House and Senate passages of "reform" bills and hadn't written a letter to the editor or even posted to this blog much for a while. But now I'm reenergized for activism. I thank the people of Massachusetts for that!

Screw you, Nancy Pelosi.

2010-01-19T13:35:00.003-05:00

"Let's remove all doubt," she says. "We will have health care one way or another."

You mean, you'll have it regardless of whether or not the American people want socialized medicine, and regardless of whether it's right?

Mrs. Pelosi and her power-lusting ilk need to be stopped. As much as I'd love to see Scott Brown win today's election, it won't be enough. Even if he wins and the Democrats don't get away with their slimy plan to pass the Senate bill in the House without amendments, defeating health care "reform" this year is only a Band-Aid. Remember, HillaryCare got killed too. What we have to fight is the idea that people have a right to health care or any other of thousands of services our bloated government currently provides using money expropriated from Americans. That will take much more than a single election in Massachusetts.

Asthma asininity

2010-01-18T16:07:00.003-05:00

My husband has asthma. It's a chronic condition. He's had it since he was a child, and he takes two different inhaled daily medications for it. Barring some extraordinary development that has yet to occur, neither his asthma nor the medications he takes for it are going to change.

Nobody in government seems to have figured out that conditions like this exist, though. Both of my husband's medications can only be obtained by prescription. His doctor is usually happy to write a script with several refills on it, but when he runs out, he has to go back to the doctor and get another script. Never mind that nothing has changed since he got the last script. Never mind that asthma inhalers have a pretty low potential for abuse. Never mind that if he wanted to act like a fourteen-year-old and use his inhaler to get high, it would be his right to do so.

Never mind any of that. He needs a prescription when his inhalers run out. Guess what? His inhaler ran out...and because today is a holiday, no one will write him a prescription. He keeps getting voicemail from his primary care doctor, and when he calls anyone else, they tell him, "We're closed, so you should call your primary care doctor," or "Wait until tomorrow." He won't die if he waits until tomorrow, but he'll be pretty damn uncomfortable...for no good reason.

Luckily, I remembered that a drugstore near us has a walk-in clinic whose nurse practitioner can write him a script, so my husband can breathe easier today. But this example is illustrative of how asinine the prescription drug requirement can be. Same for me -- I have to go back to my gynecologist once a year to get his signoff on my birth control pills, even though the way to prevent oneself from having a baby has not changed in any substantial way in the more than ten years since I started taking birth control pills. Why? Because bureaucrats at the FDA won't allow me to purchase them over the counter, and bureaucrats in New York State won't allow my doctor to prescribe me more than a year's supply at a time. (For many drugs, the allowed supply is far lower -- try getting more than a month's worth of Ritalin at a time.)

In all the talk of what dissatisfies Americans about our healthcare system, I never hear the prescription requirement mentioned. But the government telling you that you can't get drugs without a doctor's approval is just as evil as the government taking your money to pay for other people's health care, regulating insurance companies, and all the rest. It's your body -- it's your right to put anything you like into it, and your responsibility to bear the consequences of doing so.

Experimentation

2010-01-14T15:42:00.004-05:00

Although I managed to get through the holidays without gaining weight, I've slipped a little bit off the wagon in early January. As a result, I started this week closer to 140 pounds than 135. Not a huge increase, but the way five pounds turns into ten and then into twenty is by not paying attention. So I've been following a 1500-calorie-per-day diet (plus more on days that I work out) this week.

I went into this week thinking, "I hate salad." But eating fresh, relatively unadorned vegetables gets you a lot of nutritional impact for very few calories, so I decided to suck it up.

After four days of this, I think it's not that I hate salad. I just hate bad salad, and there's a lot of it out there. You know what I'm talking about: soggy yellowish lettuce, tomatoes that aren't even close to bright red, gloppy dressing applied in mass quantities to hide the fact that the vegetables are no good.

Instead, I've eaten several times at Mooncake Foods, a great little Asian fusion restaurant near my office, for lunch. On Monday I had their chicken sausage/Asian pear salad. Wow! So much better than what I usually think of when I think of salad. The greens were actually green, the chicken sausage popped with flavor, and the pear added crunch and sweetness without a ton of extra calories.

After having a bad salad the next day, I went back to Mooncake yesterday and today -- yesterday, for the lemongrass shrimp with greens and today for steak with cilantro pesto and greens. (Each dish came with rice, of which I kept my consumption to 1/2 cup or so.) And you know what? I always thought 1500 calories for a day was practically nothing, but when you eat meat and greens, it isn't! I've had plenty of leftover calories to spend on snacks, which I've mostly been using on the delectable dark chocolate-covered almonds sold in one of the office vending machines. And I've lost two pounds.

This is not to say that I'm going to quit having quesadillas from Calexico for lunch (ZOMG AWESOME) once the weight comes off, but I suppose being more paleo at lunchtime wouldn't hurt.

Also, if you live in NYC...Mooncake Foods RULES. None of the dishes I've mentioned costs more than $10!

Nanny city: A salt on our rights

2010-01-12T15:01:00.004-05:00

Not satisfied with having violated rights and gotten a trans fat ban and calorie count posting mandates in NYC, Mayor Bloomberg is now talking about getting New Yorkers to cut their sodium intake by "encouraging" food manufacturers to reduce the amount of salt in their products. He claims he won't legislate salt reductions, but a) that's only because they'd be nearly impossible to enforce (what food manufacturer is going to come up with salt-free products just for the NYC market?) and b) the city first started out saying it wanted voluntary participation in trans fat reduction and calorie count postings, too. And when "encouragement" didn't work, the city turned to force.

What's to say Bloomie won't try to get as much of a salt ban as he can? He'll probably do it the same way the calorie-count postings and the trans-fat ban were done: by imposing salt restrictions on restaurants. NYC can't force manufacturers of packaged foods to toe the line -- most would just quit doing business in the city rather than revamp their recipes and factories to suit the demands of one market's bureaucrats. But it can tell restaurants to change their in-city operations...or else.

This type of regulation hits chain restaurants hardest. In NYC, calorie-count postings are mandated only for restaurants with 10 or more locations in the city; the majority of city restaurants have only a single location, so the onus falls mostly on fast-food chains. I'm sure our city nanny realizes that if he tries to impose salt restrictions on all restaurants, he'd have a revolt on his hands; in fact, city chefs are already speaking out against Bloomie's sure-to-later-be-backed-by-force "request." But he can demonize McDonald's, Wendy's, Starbucks, et al., and those chains will likely meekly change their NYC operations if ordered to do so.

They shouldn't. If individuals want to eat more salt than is good for them, that's their right, and it's the right of restaurants to flavor their foods in any way they please. It's the market, not Nanny Bloomberg, that should decide how much salt is in our food.

Schumer: It's government intervention, stupid

2010-01-11T12:54:00.002-05:00

Even as the pharmaceutical industry has been colluding with Washington in hopes of having healthcare "reform" be favorable to its bottom line, Congress has been investigating the industry's pricing practices -- and politicians don't like what they see. They're upset that certain drugs -- those that are sold to smaller numbers of patients than, say, a blockbuster like Lipitor, but that are no less important to the patients who need them -- have had huge price increases over the past decade, whereas "bigger" drugs have had smaller increases.

As the New York Times explains, sometimes these price increases happen when larger pharmaceutical companies sell off the smaller-market drugs in their portfolio, and the smaller drugmaker that purchases the drug immediately raises the price in order to profit from its investment. Or the price increase happens via a third-party distributor who purchases the drug from a pharmaceutical company and then resells it to hospitals and pharmacies. Or, the original maker of the drug might have raised the price.

Chuck Schumer, who I'm disgusted to say represents my state, exhibited the typical attitude when he said, “It is hard to find a good-faith explanation for why drug prices could go up this much. This report will lead to a strong demand for action by Congress.”

By "good-faith" he means altruistic; he means that pharmaceutical companies should continue to innovate and produce drugs, not out of pursuit of profits, but out of brother-love for anybody with a medical condition. But don't expect the kind of great minds that are needed for drug development to work as slaves or to allow themselves to be punished because their work is more vital to man's survival than others'.

In fact, although Schumer would like to blast the pharmaceutical industry for seeking "excessive" profits, there's a much more obvious explanation for why the industry has raised prices, and it's Washington that is abased thereby, not the pharmaceutical industry.

As the article points out, "drug makers’ labs have been unusually barren, and...without new products, drug makers view price increases as among the only ways to reliably increase profits." That is, drug companies need to increase prices on the products they have in order to stay afloat despite meager pipelines...but why are those pipelines so meager? You can thank the FDA for that -- see my article from the Fall 2008 Objective Standard for details on how the FDA kills innovation.

Senator Schumer, the solution is not action from Congress -- unless by "action" you mean action to remove your bureaucratic tentacles from medicine!

One good point, and a lot of bad ones

2010-01-05T13:59:00.003-05:00

Food Rules author Michael Pollan appeared on the Daily Show last night to plug his book -- and to comment on how healthcare "reform" could impact America's diet.

In the linked clip, Pollan correctly states that once insurance companies are forced to cover everyone, regardless of preexisting conditions, it's going to be in their interest to prod you toward a healthier lifestyle so they have fewer payouts to make. This could lead to insurers offering price breaks to customers who can demonstrate that they are maintaining a healthy weight, say, or more coercive measures that Pollan hints at -- say, insurers pressing the government to tax foods deemed unhealthy.

The one good point that Pollan makes is that we need to quit subsidizing the production of high-fructose corn syrup (a product that, according to Pollan, makes up 20% of Americans' caloric consumption!). Pollan thinks the government shouldn't be propping up a food that's basically empty calories. True -- because the government shouldn't be subsidizing any foods at all.

But Pollan then goes on to ask: What's wrong with the government encouraging healthier behavior? Why, he asks, do we get up in arms about a soda tax, but don't bat an eyelash if a doctor says we need to take drugs or undergo uncomfortable medical procedures because of our weight?

Pollan is wrong to think the two are equal. In fact, one is objectionable and the other is not. Government "encouragement" of healthy behavior is a violation of rights, whereas a doctor's prescription of statin pills or bariatric surgery is merely the consequence of an individual's own choices. The former is correctly repudiated; the latter, although unpleasant for the individual who experiences it, is the way things should work. The former punishes all Americans because some Americans overeat; the latter is simply the consequences of an individual's actions visited upon that individual, and no one else.

Gah! The double-talk!

2010-01-05T11:38:00.005-05:00

So out of one side of their mouths, healthcare "reform" advocates bemoan the fact that health care is a limited resource. They cry because everybody can't get all the health care they need, whenever they want it, regardless of whether or not they can pay for it.

But then White House spokesman Robert Gibbs came out with this gem, calling some insurance plans "far too generous":

"The best way to bend that cost curve is to go after and work on eliminating excessive Cadillac plans that people at Goldman Sachs and big bankers might get," he said on NBC's "Meet the Press." "That's what the focus will be in this. I think the president believes that we can work out a solution."

So which is it? Everybody should get all the health care they want, or some people get too much and THAT has to stop? (Never mind the irony of the fact that so many of those who get so-called "Cadillac" plans are union workers in high-risk jobs, whom Democrats usually tiptoe around, unlike the "big bankers" they love to hate.)

Goals for 2010

2010-01-04T13:48:00.004-05:00

I can't think of any frustration to express with the Senate's "reform" vote that I haven't expressed already, so instead I'm going to go in a more positive direction: my health- and fitness-related goals for 2010.

First, I want to brag that I was very successful in 2009. Thanks to my favorite iPhone app, Lose It!, I went beyond my original goal of losing 15 pounds. I went from 157 pounds to 135, the same as I weighed as a senior in high school (and I'm in much better shape than I was back then), and I've maintained that weight for 6 months.

Lots of people assumed I lost the weight for my wedding. Not true; if that were my goal, my weight loss was too much and my dress was enormous! In fact, I wanted to take the pounds off so as to run a faster, stronger marathon. And I did -- by more than 17 minutes, despite running a hillier course than the one on which I set my previous personal record.

I've investigated a bit into the paleo-eating trend that a lot of Objectivists have embraced. My personal conclusion is that I'm not willing to cut out refined sugars and starches altogether, but I do feel better when I reduce my consumption. So, in the second half of 2009, I made subtle changes like treating corn as a grain, not a vegetable (my husband and I had always been in the habit of including a vegetable with every home-cooked meal, but now I don't put corn in that slot), replacing cereal with apples and almond butter or with salami and ricotta, and cutting down portion sizes of starchy foods. Also, I've tried to be more mindful of the starchy and sugary foods that I do eat. I don't waste my time with, say, Little Debbie snack cakes any more; if I'm going to have junk food, I make it the best-quality junk food I can find -- say, homemade brioche bread pudding from my favorite Brooklyn bakery. (I also don't carbo-load before long runs any more -- I find that a meal of fish or chicken and vegetables works best for my energy levels and gastrointestinal comfort.) I like this approach -- I feel better and more energetic, but I still get to enjoy some carb-rich foods. Life without cake is life without sunshine, IMO!

So here's what I want to do, health- and fitness-wise, in 2010:

Maintain weight at 135 pounds. Even though the old pounds are gone, I continue to use the Lose It! app to keep tabs on my eating and make sure my weight doesn't fluctuate by more than a pound or two.

Beat my personal record in the marathon. I'm thinking of running Chicago this year; if I don't get in, I will probably sign up for Philadelphia again. On either of those courses, I should be able to beat my NYC time provided I maintain the high level of fitness I achieved last year.

Run a 5K. Sounds like nothing compared to the previous goal, huh? I haven't run a 5K since 2007, and I'm in much better running shape now than I was then. My previous best time was 26:47, and I'm certain I can shave that down -- so I'd like to see by how much. I'd love to get in under 25 minutes, and I'm thinking I'll try it at the Coogan's 5K in March.

Improve core strength. Although I was vigilant about running my prescribed number of miles each day last year unless I was injured or seriously ill, one area that I let slide was strength training. Stronger abs, in particular, would make me a better runner (and I'd look hotter in a bikini). I've already started adding crunches, bicycles, and other moves back to my routine. My goal for January is to do a couple of minutes of ab work at least four times a week, and I'll increase the duration and frequency from there.

Go injury-free. Other than a brief bout of shin splints, I didn't get hurt in 2009, which was really nice. I'm going to continue regular stretching to make sure I stick to that trend this year. The harder part is listening to my body. If you're a runner you'll know what I mean: your body is sending you a clear signal that you need to stop, and you want to keep going anyway to make sure you reach your mileage goal for that day/week/month. I'm not always perfect about paying attention to these signals; thus far it hasn't sidelined me, but I need to become better at discerning the "I don't wannas" from the "something is really wrong, I shouldn'ts."

Those are the goals, and if I do the work I should be even more successful this year than last year!

Free-market solutions #1: Teaching

2009-12-10T12:04:00.002-05:00

This is the first in what I hope will be a series of posts on how a free market might solve many of the problems we have with health care in America. I say "might," because I am not actually a healthcare professional; I'm sure that, free from the constraints of government interference, hospital administrators, doctors, insurers, and anyone else involved in the delivery of care would come up with solutions beyond what I can dream of. Though I do not know exactly what the forms are that improvement would take under a free market, I know that respecting individual rights by getting the government out of health care would improve the system in a big way. Here's an idea as to how that might work.

Two problems in health care: 1) It's not in limitless supply, so some people can't afford it -- even when it's a life-or-death decision. 2) Doctors have to be taught their craft. A surgeon isn't simply born with flawless technique; he has to learn it through lots and lots of practice. Often, that practice has to be done on living human beings. As Atul Gawande, a physician who has authored the books Complications and Better, points out, this can seem to create an ethical conundrum: How do we balance the need to train physicians with the patient's need for experienced care?

Under a free market, there's one solution that addresses both of these problems. The answer is that trainee physicians would likely offer lower rates for their procedures, likely done under the supervision of a more experienced doctor. The poor would be able to purchase care at a price they could afford, and the trainee would get experience -- a mutual trade to mutual benefit. Anyone who prefers the security of a more experienced doctor could pay extra for the privilege.

This system is already done at dental schools (and hair salons!) all over the country. Dental care is far less regulated in America than other medical care, so dental schools have been free to discover this solution -- their students get the training they need, and patients obtain dental care they couldn't otherwise afford. The patient voluntarily accepts the risks associated with a trainee in exchange for a lower price; the trainee offers a lower price than he will later command as a full-fledged dentist, knowing that he can build his knowledge by doing so.

Just as a relatively freer market lets people get their teeth cleaned (or their hair cut, or their makeup done) at an affordable price, so would a free market help more patients get the medical care they need -- and medical students the experience they need.

Even Oompa Loompas have rights

2009-12-09T16:21:00.002-05:00

The Senate continues to look for creative ways to rob the American people in order to finance healthcare "reform." Many big targets for taxes, like so-called "Cadillac insurance plans" (ie, plans with comprehensive coverage that cost a lot of money), have turned out to be politically contentious -- unions, whom the Democrats love, don't want the high-value plans taxed because that would affect many of their membership, for example.

So, politicians look for lower-hanging fruit. There's Bo-Tax, and now there's talk of taxing indoor tanning salons. After all, it's easier to argue that Bambi McBimbo shouldn't be able to have her new boobs or her fake-'n'-bake unless she helps everybody else get health insurance than it is to, say, argue that Grandma's Medicare coverage should be cut or that workers in high-risk professions should pay the government because they have more comprehensive coverage than Americans in lower-risk jobs. It's especially easy to argue against tanning salons because, after all, they're associated with increased cancer risk, so why shouldn't people who use them pay extra into the system, given that they'll be more likely to need medical care for cancer in the future?

But to go down that path is to violate individual rights completely. If Bambi wants plastic surgery or a bronze bod, it is her right to pay for it, without having also to pay for health care for those who cannot or will not pay for it themselves. If she wants to up her skin cancer risk, it is also her right to do so without government interference -- though she also cannot expect anyone else to cough up the cash if she gets melanoma and needs treatment.

No matter how frivolous a procedure may seem, and no matter how much others need health care and can't afford it, the need does not justify the violation of rights.

A blow to rights? I'll show you a blow to rights!

2009-12-09T11:13:00.002-05:00

Of an amendment to the House healthcare "reform" bill that would bar any insurance plan paid for with federal subsidies from covering abortion (a similar amendment is being considered by the Senate),

Representative Jan Schakowsky, Democrat of Illinois, said the restrictions were “the most crushing blow we have seen to reproductive rights since Roe v. Wade,” the 1973 Supreme Court decision that established a constitutional right to abortion.

Well, no. Rep. Schakowsky is confusing a woman's actual right -- which is to have control over her own body, and to obtain an abortion without government interference if she can afford to pay for it and a doctor is willing to provide one for her. What a woman does not have is the right to have her abortion at someone else's expense.

The real blow to rights, of course, is the healthcare "reform" proposal itself -- telling insurers what they may and may not cover instead of protecting their right to exercise their own judgment, prodding doctors to follow bureaucrat-chosen guidelines instead of protecting their right to make medical decisions according to their judgment, and so on.

Guilty until proven innocent

2009-11-30T17:34:00.002-05:00

A news release issued by the FDA on Tuesday said:

The U.S. Food and Drug Administration (FDA) is seeking a permanent injunction against Sharkco Seafood International Inc., located in Venice, La. The injunction is intended to stop the seafood processing company from distributing scombrotoxin-forming fish in interstate commerce. Consumption of scombrotoxin-forming fish that are not properly preserved or refrigeratedcan result in scombroid food poisoning, a foodborne illness that results from eating spoiled or decayed fish. Scombrotoxin-forming fish most commonly include mackerel, sardines, tuna, bluefish, and mahi mahi.

The government’s complaint, filed today by the United States Attorney’s Office for the Eastern District of Louisiana charges Sharkco Seafood and its owners, Khai Q. Nguyen and Tuan Q. Nguyen, with violating the Federal Food, Drug, and Cosmetic Act by failing to establish and implement an adequate Hazard Analysis and Critical Control Point (HACCP) plan for their scombrotoxin-forming fish. FDA requires all seafood processors and distributors to have a HACCP plan that determines and monitors food safety hazards associated with their products.

“FDA repeatedly warned and tried to work with Sharkco Seafood,” said Michael Chappell, acting associate commissioner for regulatory affairs at FDA. “The company had ample time to take correction action, which it failed to do. An effective seafood HACCP plan is critical to safeguard the health of the American people. We will take prompt action against companies whose poor business practices could jeopardize the public health.”

According to the government’s complaint, FDA inspections showed that the defendants failed to have an adequate written HACCP plan for their scombrotoxin-forming fish operation, despite numerous warnings by FDA. The formation of scombrotoxin can be adequately controlled when fish are appropriately preserved or refrigerated. Once formed, however, scombrotoxin cannot be removed or destroyed by washing, freezing, or cooking the affected fish.

No illnesses have been associated with Sharkco Seafood’s scombrotoxin-forming fish products. The company produces other seafood products, which are not affected by this action.

Note that last paragraph: No illnesses have been associated with the company's products. So the FDA isn't seeking an injunction against Sharkco as retribution for making its customers sick. It's seeking an injunction because Sharkco hasn't followed the FDA's bureaucratic requirements to prove that it won't make anyone sick. In other words, Sharkco is assumed guilty because it hasn't proven itself innocent. That's backwards.

Bo-Tax

2009-11-30T15:24:00.003-05:00

One of the Senate's creative ways to steal money to pay for healthcare "reform": A tax on plastic surgery not considered necessary to correct congenital defects, the results of an injury, or the aftermath of a disfiguring disease.

Plastic surgeons are protesting the tax, but they're going about it the wrong way. They argue that the tax is being proposed because plastic surgery patients are seen as wealthy housewives who can afford to pay a little extra, but that in truth the majority of their patients are not affluent, and that therefore this tax would hurt working-class Americans.

That's true, but it's not the argument plastic surgeons should be making. By arguing that the government shouldn't steal from their patients because they aren't rich, plastic surgeons have conceded that it's okay for the government to steal from someone, and it only remains to be seen who that someone is. And once you've made that concession, it's an awful lot easier to convince politicians that "someone" should be people who can afford mole removals and breast implants, whether or not those people had to spend years saving for the surgery, than that "someone" should be labor unions or grandmas and grandpas or any other politically savvy group. As the New York Times article states:

Dr. Teitelbaum, the Santa Monica surgeon, seconded that opinion, and called the proposed tax “cowardly.”
“You’re taxing a disorganized group that has no one of its own representing it,” he said. “There’s no American Society of Plastic Surgery Patients.”
Dr. Teitelbaum said some patients might be embarrassed to admit to having had cosmetic surgery. “They don’t want to come out and march on Capitol Hill,” he said. “You’re not going to have a million-man Botox march.”

In a system where the group with the loudest voice and the most political pull gets its way at the expense of others, the individual suffers -- particularly the individual who's afraid to speak out for his own rights.

Instead of arguing that their patients don't have the money the Senate thinks they do, surgeons should be arguing that the government has no right whatsoever to meddle with the services they offer to patients, whether by taxation, regulation, or any other means. The idle trophy wife who gets breast implants for her husband has the same right not to be taxed as the burn victim who has his destroyed skin reconstructed, even if the public may not be as sympathetic to her wish for surgery as to the burn victim's. The government should not tax plastic surgery -- not because plastic surgery is purchased by the middle-class as well as the rich, but because the government has no proper purpose in medicine.

A reminder at Thanksgiving

2009-11-24T10:49:00.003-05:00

I've been working a lot lately. A LOT. Much of this work is (no) thanks to the FDA; I can't go into details, but not only has it been long hours, but I may also have to work this weekend. For the girl who deeply enjoys preparing the Thanksgiving meal for her family, this is a severe annoyance.

Here's the thing, though...this is just one year of annoyance for me. For doctors, nurses, and other healthcare professionals, it may be EVERY year that holidays are not days spent with family, but days spent on call or working at a hospital. Emergencies don't take holidays.

Young people know this (or they should) when they choose to enter the medical profession. An ER doctor knows he'll have to trade in Mom's turkey and stuffing for a night of IVs and sutures. An obstetrician knows that, instead of flying across the country to open presents by the Christmas tree, she needs to be on call for any babies who decide to show up on December 25th. A nurse knows she may have to sign on for extra shifts in December to handle all of the ice-, snow-, and drunkenness-related injuries instead of going to holiday parties.

How many people do you think will be willing to sign up for that life when healthcare "reform" pushes healthcare professionals' salaries lower and lower, when insurance companies pay the same rate for treatment on Thanksgiving Day as they do for some random day in August, when we start paying doctors the same amount of money per patient regardless of how much care that patient gets?

No moral leg to stand on

2009-11-19T12:07:00.003-05:00

Very quick commentary, since I don't have time to write much about this:

House Democrats are accusing the pharmaceutical industry of increasing prices in anticipation of cost cuts from whatever healthcare "reform" bill passes. They haven't said what they'll do if an investigation says that the pharma companies are "price-gouging," but I wouldn't be at all shocked if antitrust proceedings and massive fines ensued.

Now, if the pharmaceutical industry hadn't been in bed with the government all along, trying to get universal health care passed (with the obvious benefit to the industry of more customers buying drugs), it could proudly say that the government has no moral right to tell companies how to price their drugs. But seeing as how the industry's leadership is trying so hard to get government force on its side, it has no moral defense against the use of force.

Going quiet for a while

2009-11-15T22:45:00.001-05:00

I probably won't post here again until after the Thanksgiving holiday. Not that there isn't PLENTY to say about health between now and then...but I'm going to be working an absurd number of hours and will have zero time to blog. Can't post the reason publicly except to say that the Food and Drug Administration is a large source of the pain. Boo, FDA!

Chopping the tallest poppies

2009-11-11T15:19:00.002-05:00

From the Boston Globe, via the New York Times, comes this little gem:

Health economists are increasingly advocating a cost-cutting method known as “bundling,’’ in which health providers receive a lump sum to care for a patient with a particular medical condition, say, diabetes or heart disease. The House bill calls for the administration to develop a plan for bundling, while the Senate Finance Committee version of the bill gives it until 2013 to create a pilot program.

This type of payment system has been proposed in Massachusetts, which is struggling under the burden of universal health care. All I can say is, if you have a medical condition, you'd better hope you're one of the easy-to-treat patients with that condition, because this payment system creates a pernicious incentive for your doctor not to treat you. If my doctor gets $20,000 to care for my heart disease whether I get $4 generic statins for it at Wal-Mart or a $25,000 bypass surgery, which one do you think he will recommend? What if the statins aren't going to cut it? Don't assume that doctors are going to take all patients and use the profits from the below-average-cost ones to pay for the above-average ones. They're simply going to refuse to treat patients who need more work than the average Joe.

This is just another way in which "universal health care" will make care less available, not more.

Guidelines for Survival Under Socialized Medicine

2009-11-09T13:10:00.003-05:00

A friend of mine and fellow Objectivist, who asks to be identified only as Christian W., posted this excellent set of advice on Facebook. With his permission, I'm sharing it here. Christian originally hails from a country in which socialized medicine is already a reality, so we can learn from his experience in the unfortunately highly likely event that that's what we get in America.

Guidelines for Survival Under Socialized Medicine
by Christian W.

Folks, socialist medicine is likely inevitable in the United States. I think that it will either be implemented by means of sweeping bills like the one now approved by the House, or by a continued gradual strangulation of freedom in healthcare. The trends towards fascism and socialism have grown increasingly stronger over generations, and little will change their essential trajectories in our lifetimes. (I hope to be proven wrong.)

I think that it is still very worthwhile to wage an intellectual battle against the collectivist juggernaut, but it is also time to consider some personal strategies for coping with the coming deterioration of healthcare in this country.

Here are few general practical guidelines for personal survival:

1) Rationing and shortages are inevitable under socialism. Therefore you must plan your life as if no healthcare will be available for you at all except in cases of acute trauma requiring ambulance transport. (There are some other exceptions, but this is the essence of health care in countries like Sweden.)

Absence of modern medical services means that you have to take meaningful steps to minimize the risk of acquiring a chronic illness or disease of aging and/or lifestyle. You will have to become your own doctor, primarily focusing on disease prevention. Special emphasis should be put on proper diet and exercise. Know these fields as if your life depends on it.

Note: Don't become overly reliant on supplements as a way to mitigate less-than-optimal dietary and lifestyle choices, because supplements that are in any way effective will gradually be outlawed, as they already are in Europe. The pharmaceutical industry lobby, in collusion with power-lusting congressmen/bureaucrats, will ensure this.

2) Treat your body as a delicate vintage automobile that you must take exquisite care of, since spare parts and/or access to a professional mechanic are either nonexistent or excruciatingly expensive. Many organs and systems of the body have good self-repair mechanisms, while others, unfortunately, have not. Thus, for example, participating in sports that may wear down joints or cause other permanent damage should be minimized. (Services like hip replacements will not be readily available.) Many health-conscious people are unaware that the modes of exercise that they are applying may have short term health benefits, but could be detrimental in the longer term. Be informed, and always apply the ancient medical maxim "First, do no harm."

3) Avoid contact with the public healthcare system as much as possible. It can be deadly to be sucked into the machinery even for a minor issue. Misdiagnosis and faulty, dangerous, treatments and medication regimens are commonplace under socialism (just as in Dark Ages "medicine"). In many areas of medicine, particularly those related to especially politicized areas like CVD and other "life-style" diseases, government-franchised practitioners are often dangerously ignorant of essential facts. Remember that the worst aspect of socialist medicine is that medicine as a rational science is epistemologically destroyed by eliminating the role of the doctor as a sovereign, independently thinking, professional. [SDZ: I consider that last point an incredibly important observation that needs to be spread widely.]

4) Don't trust at face value any pronunciation or recommendation that comes out of organizations like the FDA, USDA, NIH, American Diabetes Association, American Heart Association, the medical industry lobby, or your medical insurance company. I deliberately lump together government agencies and some influential private entities here, because these are all primarily (or, in the case of the private organizations, to a very significant degree) vehicles for dissemination of propaganda having scant to do with the furtherance of objective health information.

Obtain your health information from honest clinical practitioners with proven track records, and from primary scientific sources. The latter can be done either directly, for example, by reading research papers (if you have the time and appropriate background knowledge to do so) or by finding experts that apply sufficiently rigorous epistemological standards to interpret and explain the content of such scientific sources for the layman. (Aim to get a second opinion on all important issues.)

5) Consider becoming a "medical tourist". Medical services are already cheaper, safer, and provided with better care for the patient in many former third world countries. (Thailand comes to mind.) If you'll ever need to travel overseas to save your own life, swear to never forgive those of your countrymen who let America deteriorate to such a despicable state.

Praying won't make it so

2009-11-04T15:40:00.005-05:00

I'm a second-year student in the Objectivist Academic Center, and the class is currently working through the difference between the metaphysically given (such as the law of gravity) and the man-made (such as traffic laws). The man-made is the result of choice, and as such is subject to praise or criticism. The metaphysically given simply is what it is, and all the whining, crying, and pleading we do will not change it. Neither will praying.

What's this got to do with health? According to the Los Angeles Times, religious Congressmen have slipped into the healthcare "reform" proposal a provision that insurers be required to pay for "religious and spiritual healthcare," including "prayer treatments" offered by Christian Scientists.

If an individual believes he can deny the metaphysically given, that by praying or paying someone else to pray for him, he can kill the cancer cells growing in his body, or heal a broken bone, that is his problem. He should be left to his own devices. He can go ahead and waste his money on "treatments" that do nothing -- that can do nothing. As long as he spends his own money or money given to him voluntarily, he violates no one else's rights, and he will be the only victim of his own poor decision.

But this law would force insurers to act against their own judgment, so that some individuals can indulge their fantasies that their own wishes and prayers can change nature. Any insurer willing to examine the facts of reality -- and it had better examine them, if it wants to stay in business -- would eliminate coverage of such "treatments," knowing that they would never produce any value in return for the money paid for them. The "religious and spiritual healthcare" provision would force insurers to act against their rational judgment and pay for these services, and it would force those of us who know the difference between the metaphysically given and the man-made to pay for them, since insurers would have to distribute the cost of "prayer treatments" across all customers.

It doesn't seem like a big issue -- after all, "prayer treatments" cost an awful lot less than MRIs. But it's an illustrative one. There is no benefit -- not "prayer treatments," not in vitro fertilization, not autism therapy, not even heart transplants -- that justifies the violation of the rights of insurers to offer coverage on whatever terms they choose, nor the violation of the rights of consumers to purchase the coverage that best suits their personal needs. And that's why a mandate is so evil -- it turns decision-making about insurance from a voluntary exchange between insurer and insured into a dictate from bureaucrats and whatever special interest of the month is calling. That insurance mandates are evil is something all the prayer in the world won't change.

I rule

2009-11-03T08:38:00.003-05:00

26.2 in New York City!

It was amazing. Before this race I said NYC was something I would probably only do once, figuring that the logistics of such an enormous race would be too much of a pain to do again. I was wrong. The elation of having so many people encouraging you along those miles, the fun of seeing so many different neighborhoods, the unbelievable feeling of coming into Central Park for those last couple of miles, is worth repeating. I think I'm going to apply for Chicago next year, but another NYC run in the next five years is a definite possibility.

My weight-loss success really helped me in my goal of running a better race. My previous personal record was 4:45:58, and I cut that to 4:28:30! This, even though my old PR was set on the flat course of Philadelphia, and my new one involved running up and down a lot of damn bridges :)

I feel amazing, and will post some pictures when I get them!