Cause and addictive effect?

Britain’s health care system is again having problems. This time, the problem is that physicians are over-prescribing painkillers, causing addictive behavior — and doing so despite strong official guidelines to the contrary. This could just be a medical trend, but one does wonder if it’s also because doctor’s in Britain are no longer very good? I know that’s nasty of me to say, but I firmly believe that American doctors are amongst the best in the world, in large part because the compensation is good enough that the best and the brightest will sacrifice their 20s and part of their 30s to prepare to be doctors. In America, they spend 4 years in college, 4 years in medical school, 1 year in internship, and 2 years in residency — and that’s just to be an internist. If they want to specialize, they could be spending another 5 years in training, for a total of 16 years learning how to be the best. Unless one is a saint, one usually does that only for the promise of lots of money (coupled, one hopes, with job satisfaction). In countries where medicine is socialized there’s not much money, there’s not much prestige, and there’s less training. Is it surprising, then, that these doctors don’t know how to follow instructions? And is that what we want here?

By the way, I’m just hypothesizing based on first hand knowledge I have about the British and American medical systems. I have not looked for concrete information to back up my hypotheses, and could just be making a fool of myself here.

UPDATE: I’ve switched to a new server, so you can feel free to look around here or check out my new site, which not only has the old stuff, but also will move forward into the future with all my new material.


Soylent green *UPDATED*

One of the most striking things about the Jewish Bible is the respect it demands for dead bodies. As a result, Jewish ritual holds that the dead cannot be mutilated in any way and must be interred as quickly as possible — preferably within 24 hours of death. Desecration is anathema to the Jews. Many people ascribe this respect to the Jewish belief in resurrection. Others though, believe that there is one other element to the requirement that bodies be treated with respect, which is the fact that the Jewish religion arose during pagan times — and pagans were deeply committed to body mutilation.

In pagan cultures, which had no separation between “church” and state, the religious leaders would routinely sacrifice people to the Gods and then, before or as part of the death process, the victims’ brains and internal organs would be ripped out by the priests for study and ritual cremation for the gods. (The story of Isaac is, as everyone knows, the definitive Biblical statement against human sacrifice.) Even if people weren’t deliberately sacrificed, but died for other reasons, the state priests could still desecrate the corpses for religious purposes. The instant burial required under Jewish law was almost certainly an effort to protect bodies from assault by pagan priests. To this day, religious Jews will not allow themselves to be cremated.

I was thinking of the pagan state’s interest ripping out the deads’ internal organs when I read this, out of England:

Gordon Brown has thrown his weight behind a move to allow hospitals to take organs from dead patients without explicit consent.

Writing in The Sunday Telegraph, the Prime Minister says that such a facility would save thousands of lives and that he hopes such a system can start this year.

The proposals would mean consent for organ donation after death would be automatically presumed, unless individuals had opted out of the national register or family members objected.

Pragmatically speaking, Brown is right — a lot of perfectly good human organs go to waste when they could be put to use in the living. Nevertheless, there is something creepy and frightening about the state harvesting dead bodies, and it made me think of Jews in pagan times. On the one hand, you had the Jews with their tremendous respect for humanity, and their rules aimed at elevating the human condition and, on the other hand, you had the pagans who viewed the body as something that could be folded, spindled and mutilated depending on how the priests interpreted the whims of the Gods.

The other reason to get worried about this proposal is the “soylent green” nature of it. Once the government gets into the business of harvesting body parts — especially if it’s the same government that runs the health care system — you might want to go somewhere other than a state hospital if you’re at imminent risk of death. Once in the hospital, you may discover to your cost that it’s cheaper for the government to let you die so that it can use your organs for someone who might subsequently be less of a burden on the health care system than you are. Indeed, the plan seems to be set up precisely to achieve that cost effective goal:

But patients’ groups said that they were “totally opposed” to Mr Brown’s plan, saying that it would take away patients’ rights over their own bodies.

There are more than 8,000 patients waiting for an organ donation and more than 1,000 a year die without receiving the organ that could save their lives.

The Government will launch an overhaul of the system next week, which will put pressure on doctors and nurses to identify more “potential organ donors” from dying patients. Hospitals will be rated for the number of deceased patients they “convert” into donors and doctors will be expected to identify potential donors earlier and alert donor co-ordinators as patients approach death. [The emphasis is mine because, if this isn’t scarily Orwellian, I truly don’t know what is.]

Organ donation can be a great gift and I honor those who decide to make it a part of their death. Nevertheless, I cannot conceive of a situation in which it should be anything but voluntary. Having the same government that provides medical treatment make the decision is the stuff of the worst kind of Utopian totalitarianism.

UPDATE: The above story was from the right leaning Telegraph, which presents the plan as something upsetting (something with which I agree). Here’s how the left leaning Guardian presents the same story, with the focus on the needy transplant recipients, not on the state’s increasing control over life, death and after death:

A revolution in the way organs are donated for transplant is called for today by the government’s chief medical officer as concern grows over the acute shortage of donors and the rise in unnecessary deaths.

An expert report to be published this week says that every major hospital in Britain must have an organ donor specialist skilled in persuading grieving families that the hearts, lungs, kidneys and other vital organs of their deceased relatives should be used to save the lives of others.

Sir Liam Donaldson, England’s chief medical officer, will back the findings of the government’s taskforce on organ donation, but wants to go further and introduce a new system of donation because the shortage of organs is so severe. Three people a day are dying while on the waiting list for a transplant as the demand for a new organ is rapidly outstripping their supply.

Donaldson is advocating a system of ‘presumed consent’, where everyone in Britain would be presumed to be a donor unless they had specifically opted out, or unless their families had objections.

‘We have one of the lowest rates [of organ donation] in Europe, far lower than Spain,’ he told The Observer. ‘We have one thousand or more patients dying on the waiting list each year, and there is a lot of suppressed demand, with doctors not even referring patients on to the list because there is no hope for them. That is a lot of patients dying.

‘I think at the moment people often don’t know whether their relative would have wanted to be a donor. Families are being approached when they are in a very distressed condition and, faced with uncertainty, their default position is to refuse consent. Often the quality of their dealing with clinical staff is not as good as it should be – the dialogue could be better. It does require considerable skill to handle such sensitive situations.’

Today we reveal the heartbreak of those who are waiting for organs and the uplifting stories of families who have consented to donate, and launch a campaign for the UK to move to the new system of presumed consent so that hundreds more lives can be saved.

As for me, having read that, I still find too Orwellian the thought of the government, in all its bureaucratic splendor, deciding who lives and who dies, and desecrating the dead in between those two extremes.

Britain begins outsourcing health care — to the patients

Britain’s ailing national health care system continues to try to heal itself, usually at patient’s expense. I don’t know about you, but this proposal doesn’t strike me as something that’s going to result in improved health care:

Millions of people with arthritis, asthma and even heart failure will be urged to treat themselves as part of a Government plan to save billions of pounds from the NHS budget.

Instead of going to hospital or consulting a doctor, patients will be encouraged to carry out “self care” as the Department of Health (DoH) tries to meet Treasury targets to curb spending.

The guidelines could mean people with chronic conditions:

• Monitoring their own heart activity, blood pressure and lung capacity using equipment installed in the home

• Reporting medical information to doctors remotely by telephone or computer

• Administering their own drugs and other treatment to “manage pain” and assessing the significance of changes in their condition

• Using relaxation techniques to relieve stress and avoid “panic” visits to emergency wards.

Gordon Brown hinted at the new policy in a message to NHS staff yesterday, promising a service that “gives all of those with long-term or chronic conditions the choice of greater support, information and advice, allowing them to play a far more active role in managing their own condition”.

The Prime Minister claimed the self-care agenda was about increasing patient choice and “personalised” services.

Government happy talk notwithstanding, a lot of Brits are also suspicion that this is an Orwellian plan where all patients are equal, but some are less equal than others:

But an internal Government document seen by The Daily Telegraph makes clear that the policy is a money-saving measure, a key plank of DoH plans to cut costs.

Critics claimed the plan would provide doctors with an excuse for ignoring the elderly or those with debilitating, but not life-threatening long-term conditions, and would not work without significant investment in community health services.

The Arthritis Research Campaign said it risked providing health managers with “an excuse for neglecting elderly patients”.

Jane Tadman, a spokesman for the charity, said: “Arthritis is already too low down the priority list and the fact that this is being mooted as a money-saving measure is very worrying.

“Some GPs don’t take arthritis seriously enough, and the result of this could be to give them another excuse to tell arthritis patients just to go away and take their tablets.”

The Patients’ Association welcomed more moves to empower patients, but warned against using self-care systems to save money.

“We are all for better-informed patients,” said Katherine Murphy, a spokesman. “But it is a concern that financial pressures will take precedence over clinical needs.”

Peter Weissberg, the medical director of the British Heart Foundation, said: “People affected by heart disease need specialist care. Whilst we support changes that empower people to look after their own health, we would be very concerned if they led to any reduction in the availability or quality of expert care for those who need it.”

You really can’t blame the government, though, for this somewhat inane proposal. What we’re seeing is the inevitably of nationalized health care.  For a long time, Europeans enjoyed a strong economy (in England, aided by Thatcher’s reforms), and mainland Europe especially benefited, for many years, from the American military presence that removed Europe’s obligation to put money into its own defense infrastructure. A failing health care service is also probably inevitable when you have a declining (that is, shrinking and aging) native work population, and an influx of immigrants who rely on the system but either don’t work or work in such low paying jobs that they can contribute little to the system on which they rely. In other words, the government is doing its best to deal with a whole bunch of economic chickens coming home to roost.

More unintended managed health care consequences

When it comes to managed health care, the law of unintended consequences just keeps rolling along. The news out of England today tells the story of a woman who has been barred from New Zealand, where her husband has already moved, because she is “too fat.” Apparently in the conflict between politically correct thought and its managed care economy, the latter wins. Anyway, here’s the story:

A British man who moved to New Zealand has been told by officials that his wife is too fat to join him.

Richie Trezise, 35, a rugby-playing Welshman, lost weight to gain entry to New Zealand after being rejected for being overweight and a potential burden on the health care system.

His wife, Rowan, is now on a strict diet. However, she has been battling for months to shed the pounds so they can be reunited and live Down Under.

Mr Trezise moved to New Zealand in September after shedding two inches from his waist on a crash diet. He said that if his wife was not allowed to come out by Christmas they would abandon the idea of emigrating.

His employer-backed skills visa was initially rejected by immigration officials when they discovered that his body mass index, or BMI, was 42, making him morbidly obese.

BMI measures a person’s weight in relation to their height. Anything over 25 is regarded as overweight, and 30 or above is obese.

But his wife Rowan, who planned to emigrate with him, has failed to overcome the obesity test.

Mr Trezise is a submarine cable specialist, who has also served in the Army.

He said yesterday: “My doctor laughed at me.

“He said he’d never seen anything more ridiculous in his whole life. He said not every overweight person is unhealthy or unfit.

You can read the rest of the story here. It’s obvious that New Zealand’s medical bureaucracy has not yet caught up with recent scientific findings showing that excess weight does not automatically correlate with ill health.

In the old days, when immigrants to America arrived at Ellis Island or Angel Island (the entry point for immigrants from Asia), the doctors looked for contagious diseases and mental illness. I was raised in an era when we were taught at school (and are still taught at the Ellis and Angel Island museums) to be horrified by the insensitivity of it all. Indeed, even now, some on the Left seem inclined to turn a blind eye to immigrants with nasty things like untreatable, highly infectious tuberculosis, fearing that it could be used as a wedge issue to tighten immigrant controls. But in New Zealand, in the name of managed care, you can keep out the people who just don’t look right. That makes Ellis Island look almost humane.

Memories — bad ones

Back in 1981, during a summer break in college, I got a job working as a medical transcriptionist for a couple of research virologists in a local hospital.  Their past secretary had been a disaster but, because of union rules, they couldn’t fire her.  Fortunately, for them, she got pregnant and went on maternity leave.  I came on board, a 20 year old college student, and finalized five articles for them, one of which dealt with a bizarre cancer that was showing up amongst gay men in New York:  Kaposi’s Sarcoma.  I typed lots of stuff about that, understanding little of what I typed, but keeping hold of that name in my brain.  A few years later, of course, the puzzle pieces that were bedeviling my employers came together — KS was one of the most visible signs of someone with advanced AIDS.

I hadn’t thought about Kaposi’s Sarcoma in a long time and, it turns out, most HIV/AIDS patients and their doctors hadn’t either.  The disease had gone underground, beaten back by the new AIDS treatments.  What’s disturbing now is that KS is making a comeback amongst AIDS patients.  All of us, high risk and low, have gotten complacent about medicine’s ability to beat back even the most virulent diseases.  It’s not 1348 anymore.  And then you read a story such as this one and realize that, even if we close the front door, Mother Nature often finds another way in.

More on the joys of socialized medicine

Gotta pick up the kids, so no comment here.  Read and draw your own conclusions.

Joe Klein isn’t as smart as he thinks he is

Drudge proves himself to be a good sport by linking to a Joe Klein post at Time Magazine’s website, in which Klein savages Drudge. Drudge is probably more than a good sport, though. He’s smart, too, because all that the post does is make Klein look like an idiot. Here is Klein’s post, in its entirety:

I know this is old news, but this guy is shameless. The headline, with a photo of a three-quarters crazed Hillary, is HEALTH INSURANCE PROOF REQUIRED FOR WORK but the linked story says this:

At this point, we don’t have anything punitive that we have proposed,” the presidential candidate said in an interview with The Associated Press. “We’re providing incentives and tax credits which we think will be very attractive to the vast majority of Americans.”She said she could envision a day when “you have to show proof to your employer that you’re insured as a part of the job interview — like when your kid goes to school and has to show proof of vaccination,” but said such details would be worked out through negotiations with Congress.

How stupid does he think we are? Answer: Extremely dumbolic.

I’ll have more about Clinton’s health plan in this week’s print column.

Ah, Joe. I don’t know how to tell you this, but your post shows that Drudge’s headline was entirely accurate. Drudge says Hillary would have “health insurance proof required for work.” And Hillary says she can easily imagine the day, under her plan, when “you have to show proof to your employer that you’re insured as a part of the job interview.” Now, I know I’m not as smart as a writer at an intellectual hot spot like Time Magazine, but even my limited mind has figured out that Drudge’s summary and Hillary’s quotation say the same thing.

I assume Joe is trying to make the point that Hillary’s requirement that adults enter her health plan as a precondition of employment is entirely innocuous because we already require kids to show proof of vaccination to go to school. That’s not a very good point, either. First off, a lot of people are very resentful of this requirement, feeling that vaccinations are more dangerous than the risk of disease. I happen to disagree with them, as I’m very pro-vaccination, but their attitude already goes to show that many people are less than thrilled by having the government push them around in a medical sense for them to gain entry somewhere.

But Joe also ignores the public safety issue involved here. The reason kids have to show proof of vaccination is to prevent the spread of deadly epidemic diseases of the type the used to ravage the school populations in America (polio being the most obvious example). Hillary, however, is saying that her dream is to see every private employer become a government agent by withholding employment opportunities from adults who haven’t meekly lined up for their doctor’s appointment under Nanny Hillary’s Care.

How stupid does Klein think we are?