Archive for the 'healthcare' Category


Obamacare opinion

I read through the Obamacare opinion and wrote this little diddy.


What is killing us?

This is interactive graph put together by a study in the NEJM is really cool. It shows that the percentage of yearly total deaths arising from heart attacks and cancer has risen and that they have also risen in absolute numbers, I think because population has increased (right?).

As many have noted, the fact that more people die now from cancer and heart attacks (as a percentage of all deaths) is progress because people are living long enough to die from these diseases rathe than childhood killers like the flu, pneumonia, and smallpox.

What I found particularly interesting though was that heart disease was killing the largest percentage of people who were dying in the 60s and 70s. Medical advancement has moved that number down, but it likely would be having an even greater effect if we were able to improve diets at a society wide level and to reduce obesity. In fact, percentage of deaths from heart disease is close to the rates they were at at the turn of the century.

Cancer death percentages grew since the turn of the century, but there is an apparent inflection point around 1995.

Also, future rates might change again. Since kids are obese at a greater rate than ever before, we may witness a bumper crop of heart-disease related deaths in twenty or thirty years.

Of course, as medical technology improves again and we get rid of what ails us now, the future causes of death could be dominated by homicide (as natural causes become almost unheard of). Not saying that’s likely, but it could happen. Also, if the earth becomes really crowded and no one is dying from anything, will there be increased pressure to removed medical care from people and to “allow” them to die?


Planned Parenthood and Fungible Money

Planned parenthood is again in the news, and there is a lot of debate about the impact of giving one dollar to planned parenthood.

One side says that money is fungible so that even if I give one dollar to planned parenthood to do cancer screening, I free up a dollar for PP to put the dollar they would have otherwise spent on cancer screening towards the rest of its budgeted activities, one of which is to fund abortions. So, if I give  a dollar to planned parenthood — the argument goes — then some portion of that dollar goes to funding abortions. Megan McArdle makes this argument.

Though I’m pro-choice, I don’t share the outrage that was roiling my Twitter feed this morning.  It is, as Josh Barro noted, absurd to pretend that abortion is somehow incidental to Planned Parenthood’s services, and since money is fungible, giving them money is probably helping to fund abortion provision.

The Washington Post’s Clare Coleman says the opposite.

Opponents of Planned Parenthood insist that giving the organization federal dollars allows it to spend other money in its budget to provide abortions. That is not possible — there is no other money.

Title X is a federal grant program that exists solely to help low-income and uninsured people access contraceptives and sexual health care; 5.2 million people use the program annually. But Congress has never appropriated enough money to take care of the estimated 17 million Americans who need publicly funded family-planning care. There always are more patients than subsidies.

I’m very confused by Clare, and I don’t think Megan is strictly right either.

Instead, to know what an extra dollar would do for abortion funding at PP, we would have to know whether planned parenthood prioritizes certain services and what the priority curve looks like — the budget of PP at every level of funding. In other words, the impact of  a dollar may be different depending on how much money PP already has. Pretend that PP has grown so large that it is financing all the abortions that are asked for in the whole country. Then, if I give a dollar, am I helping to fund abortion? No, because the number of abortions that are performed would be the same whether I gave that dollar or not. There are cases in which it seems that a fungible dollar will not drive an increase in abortion services.

One might object that this is obviously not the position of PP today, and on that, I just don’t know. If I gave a dollar to PP, probably some of it (a small percentage) would go to fund abortions, but it might not. It’s possible that at current levels of funding, new donations are being pushed toward some other service, so that each dollar effectively goes, 100%, to something other than abortion services.


NASA, Zero Pox, and Weather Report

This post is about sticking with an issue long enough to see what history has to say about otherwise very uncertain pronouncements in tough situations. One reason Barack Obama did so well in the primary against Hillary is that both politicians had made a decision about the Iraq war, Hillary for and Barack against, and Barack turned out to be substantially correct (or did he? A longer time horizon maybe revealed that he was the one who was wrong, but things change as time stretches on).

Thus,  one really good character trait is judgment, which is the ability to get things right when complete information is lacking.

I bring this up because I want to brag a little bit. In this post I argued that the government would win handily in a national security / privacy case called NASA v. Nelson. Basically, the government was requiring some background checks for some contract engineers at a jet propulsion lab, and they complained about it. Well, I am proud to say that I was right and that the government won a UNANIMOUS VICTORY. Now I don’t know if this ruling is good in the sense that it makes our system of law more just or fair, but I am saying that after reading the facts of the case, I thought it was a clear victory for the government.

Ok, but really, this is a small point. The bigger point is that we need to study history to learn about our capacity for judgment. Inevitably we face hard choices, and so we go with one option over the other. The only way to sharpen our ability to make those type of choices is to go back, and do some history to see how our process of decision-making is successful or not.

Here I talked about a book I’m reading called Scourge. This book has something to say about judgment and history as well.

In the 90’s smallpox had been eliminated from the world and only existed in the laboratories of the CDC and some Ex-Soviet bio-weapon facility. The question was, what to do with these viruses. Some people advocated destroying them and so, seemingly, ending the existence of that virus on earth (since it cannot survive outside of humans). Others thought it would be worth keeping the ‘ole virus around to learn things from it. This debate was very hard to resolve at the time that it was brewing most fiercely. “Destructionists” thought that nothing could be learned from smallpox because it did not have a suitable animal model from which results could be extrapolated from. They also argued that there was a risk in keeping the virus around to be stolen or for an accident to happen.

Those on the other side thought that the virus could be used to learn about the human immune system as well as to create new drugs and more sophisticated vaccines. They argued that other countries had secretly preserved the virus and that the U.S. as well as the rest of the civilized world should do the same.

Well who was right? History gives a partial answer. Not only did research discover a suitable animal model for further research, but there were significant strides made in finding antibiotics that attacked the virus as well as new vaccines that would work for immunosuppressed people.

The importance of these innovations can be seen by considering 9/11.  The pessimists seemed to get a lot of credibility for their assertion that there were bad people that would not hesitate to use biological weapons if they could get their hands on them, especially after the anthrax scare right after 9/11.

Of course, history may reverse and trick us again. What if the next attack takes place using stolen viruses from the CDC or from a decaying Soviet biowarfare lab? Then the decision to retain the virus is going to look pretty stupid, and the “right decision” may continue to change depending on what actually happens.

Thus there is a difference between what is in fact the best decision and what is the best decision at the time and given the available facts. Only smart thinking can make the latter, but only history can teach us what the former was.

What I mean is that there is a difference between what happens and what was calculated to happen. If the risk of having the virus stolen was, objectively, 1/1000000, then it made sense to store the virus, even if history takes the path of that extremely minute percentage and it gets stolen and then used. The right decision at the time would be storing the virus, but history would teach us that it would have been better to destroy it.

Also, just found out about this song “Birdland” by Weather Report. It’s quite good.


Soviet Biological Weapons

I’m reading a pretty good book right now called Scourge and its by Jonathan Tucker. It’s all about smallpox and it’s basically divided into two sections.

In the first section, Tucker talks about how the WHO staged a long campaign to eradicate smallpox from the world, which as we know, succeeded despite a lot of cynics and skeptics. There are some pretty cool stories here, like about how a group of Indian doctors came to vaccinate around one of few remaining smallpox cases on the planet and were met with resistance by a tribal elder. Both the doctors and the elder claimed that their respective positions were their “Dharma” (religious duty) but then when the doctors came to forcibly vaccinate everyone with soldiers, the elder relented and issued a proclamation saying that it must be god’s will that vaccination happened. He then offered the health workers a single cucumber as it was all he had to fulfill the guest-welcoming obligations that he had as elder.

Another fascinating tidbit about the elimination of smallpox is that it was almost entirely due to the Soviet Union which provided a lot of funding and vaccines for its accomplishment. In fact, there was an insightful little section where a U.S. diplomat is speaking with his Soviet counterpart and is trying to get a promise that the Soviet Union would continue to produce vaccines at their current rate. There was some fear that the Soviet would cut back on production, but the Soviet representative said that the Soviet economy was so inefficient that once it started producing something, it could not stop. This was a lucky fact for the international smallpox eradication effort.

Then the story turns to what happened after smallpox was eliminated, and basically the story is that the Soviets embarked on an INCREDIBLY stupid and silly bioweapons program. This stuff is wild.

First, the soviets thought about not having a bioweapons program, but they continued after receiving false information from U.S. double agents, they became convinced that WE had a growing bioweapons program. We were feeding this misinformation to the USSR and they ate it up, and so created a HUGE bioweapon program. Wow, big mistake on the part of the U.S.

Anyway, they created all these special facilities and sometimes specimens got lose and they had to suppress all the information. The USSR even has their own area 51 which is some island that I forget the name of. Pretty creepy. By 1989, they had HUGE factories dedicated to growing and processing very virulent forms of smallpox and they were experimenting with fusing smallpox with ebola. Yea, damn.

The most interesting thing of all though, was HOW STUPID the whole program was right from the start. I don’t mean stupid because it was horribly immoral and wasteful, but even stupid from the perspective of military relevance.

As a weapon, smallpox is kind of useless, because it works over 10 days and can be vaccinated against. It also won’t do anything to prevent the U.S. from firing all of its nuclear weapons in retaliation which, as we know, work right away to kill millions of people. So the soviets thought that they would use smallpox AFTER a nuclear conflict to MAKE SURE all of the U.S. people died.

This is unbelievably stupid because first, it doesn’t really make sense to think that many people would really survive an all out nuclear conflict with the USSR. Also, if they did survive, what on earth could be the benefit of showering plague down on the last remnants of human civilization? Certainly there is no military value since infrastructure and daily life is shattered beyond recognition. Further, the radiation from all the nuclear bombs would probably kill smallpox in the air preventing its effective transmission. And lastly, releasing smallpox back on the world is just as likely to eventually result in SOVIET citizens and military personal getting sick. Using bio warheads would have just re-introduced what the WHO had worked so hard to eliminate.

So basically, what this book has taught me is that the U.S. was really dumb to try to get the Soviet Union to believe that we had bioweapons (which we did not) and then the Soviet Union went BEYOND STUPID to build a huge bioweapon production chain solely for the purpose of making sure that an apocalyptic nuclear exchange between the US and the USSR DID IN FACT RESULT IN THE DEATH OF EVERYONE ON THE PLANET.

Another example of how people can, in the right circumstances, find the most ridiculous and bizarre courses of action attractive. Geez


HIV Segregation in South Carolina and Alabama Prisons

I read this article about the Obama administration’s plan to sue the correctional authorities of South Carolina and Alabama for keeping HIV positive prisoners in a separate area of the prison (interestingly, all the other states have gotten rid of segregation for HIV positive prisoners).

This article that I referenced is a good on to read, not for its arguments about the issue itself, its treatment of substantive issue is pretty superficial, but because it gives one a good idea of how much controversy this is kicking up despite the fact that its just a hard issue, for any president and for any political party. Apparently some right wing nutcases are accusing Obama of trying to spread AIDS with this policy, while those on the left, and there are equally screwballs there, are denouncing the policy with pretty strong language, assuming the liberal position to be correct.

In reality, it seems that there are some really hard, ethical, medical, and constitutional issues.

Here’s how I understand things. A lot of people who go through prison have diseases at greater frequencies than the average population. They have AIDS and various types of hepatitis for example (and interestingly, this is a another side effect of our silly drug war which puts a bunch of needle users in close proximity to each other. Brilliant.) Also, the chances of transmission are high in prison. As we know from TV and other crude jokes, sexual contact can be rough in prison, and it can be coercive and not safe to say the least. There is also needle sharing as well as tattooing which can further spread disease.

South Caroline and Alabama have responded to this by keeping HIV positive prisoners together in prison. Now this raises a bunch of problems right away.  First, is such segregation constitutional? And does it violate certain U.S. human rights commitments? I don’t really think so. The ACLU, in this report, make claims like this, and sadly, I think some of them are a little deceptive.

Can prisons segregate inmates? I’m no constitutional scholar, but i know that this issue was debated at the supreme court in the context of a California policy which racially separated inmates for their safety (gangs formed on racial lines would go after each other). Here too, I think there is an argument that segregation is for the safety of the inmates and so could be justified.That does not mean that the policies of S. Carolina and Alabama as they currently exist are justified. The report I referenced discusses some pretty cruel, discriminatory, and traumatizing practices, but again, I wonder if this is just endemic to a prison system that no one realizes houses real human beings. This is partly why I think this report is a little deceptive. Yes, the report quotes many inmates discussing how segregation affects them, but really, it seems like their stories are just indicative of how PRISONS traumatize people, which is really unfortunate, but not something that would be remedied by not segregating prisoners with HIV. Now, there are other real issues like prisoners with HIV get prevented from getting prison jobs, which are critical to getting parole and better treatment within the prison. This is just straight discrimination.

Also, there is an issue of whether its fair to require disease testing for prisoners as this violates their confidentiality. Hmmm really? I’m pretty liberal, so I’m susceptible to this point, but seriously, how extreme to you have to be to see that there could be good reason to force prisoners to submit to some medical tests when coming into prison, where the government is trying to keep a bunch of dangerous people in close quarters. Also, there are probably ways that confidentiality could be preserved without giving up the segregation policy.

Still, we come to the million dollar question: how effective is segregation at preventing the spread of HIV? Well, the ACLU claims the jury is still out. SERIOUSLY? After all that, the ACLU does not have clear evidence that segregation is medically ineffective at reducing HIV spread? Hmm, that bothers me a little bit. In its place the ACLU suggests various harm reduction methods like clean needle distribution (in prisons?) as well as condom distribution and voluntary HIV counseling. I’m sure all that is effective to a degree, but is it AS EFFECTIVE as segregation of HIV positive prisoners? It seems hard to support that claim and why should we not do all we can to protect other prisoners. If one prisoner rapes another and passes HIV to that person, that seems like a huge problem and its probably not enough to just be distributing condoms.

Still, I don’t really know what to think about this issue. The main critic of segregation (the ACLU) seems to have neglected the most important part of the argument, but that doesn’t mean they aren’t right, it just means the jury is out. In the meantime, I guardedly think that segregation is permissible. Of course as implemented, they are probably pretty abusive, but this would be a reason to fund prisons better and watch out for conditions at them more closely, not get rid of segregation.

Like I said, I’m interested in seeing what else goes down in this debate/lawsuit, but the rhetoric being used to describe this case is way out of proportion to how difficult it is.


Kidneys in Iran

Here I talked about the price of a kidney.

This article from the Cato Institute discusses the usual arguments in favor of a kidney market, which I find very persuasive. The interesting point of this article is that it claims to have found a working example of a kidney market, in Iran. Yes, leave it to Cato to dig for the good examples. Apparently, Iran has a compensation scheme for kidneys and according to the author, this has all sorts of good effects.

Thanks to Aaron for showing this to me.