Good grief

Smart's overrated

Health Care: Radiance's Reform

As Glenn McGee points out in Case 45, we need to change the way we look at healthcare. However, this book was published back in 1995. What he framed as a warning of future comings is now on our doorstep.   The first thing he brings to light is that fact that the baby boomers were getting ready to hit retirement age, conveniently enough 2013 is the year the very first of the baby boomers have reached the statutory retirement age (67.)  Having held control of most of the lawmaking bodies in the country since around that time, there has been very little done that is going to ease the financial burden the Medicare system places on us as tax payers and members of an ever changing economy.

A little bit of a rundown of things I recall from “problems with government finance” here at MTSU supplemented with personal knowledge and a bit of internet searching about healthcare spending at the federal level.   The first thing I want to do is clear up a very popular misconception that is (at least seemingly) primarily responsible for the lack of change over the years.   When you get a paycheck and your taxes and social security is taken out, that is not going into a pot to pay healthcare and social security when you are old, it is paying for those things right now.  The feeling like they have been paying in and now it is the time to cash in, is one of the big reasons a lot of people do not want to make changes or eliminate social security and the Medicare programs they feel like it is owed to them.   I bring this up to establish the fact that if we are ever to change this pattern, something both McGee and I believe is necessary, a generation has to come into political power knowing that they have to choose to make it harder on themselves so that it can be more fair in the future instead of knowingly burdening our children with our care. 

I also want to bring up something I have made a seemingly obvious observation, something everyone seems to thing but no one says.  Many (if not most) people I see working in the healthcare field are not happy with their healthcare.  Insurance is a nightmare; Medicare, Medicaid, Tenncare (and similar programs), private insurance, it’s all the same. The same meaning extremely difficult to worth with and often times at least one person involved feels violated.  Before I get any farther I should mention that I have fallen in with the professors I have heard speak about Insurance, and that is that they are extremely inefficient from an economic standpoint, that inefficiency is a huge part of the problem inspiring me to choose this as my topic.  Economically all insurances work the same, lots of people put money into a big pot and when people need it they draw from the pot to help pay for their healthcare costs. A pretty simple concept, the only difference I know of in that fundamental concept is with federally funded aid the government is putting money into the pot instead of just the participants.

Now for those maddening inefficiencies, I’ll start with the biggest. Insurance companies are businesses.  They have to pay their workers, pay their executives, advertise, make themselves look good so they can survive in the corporate world, and so forth.  All of that eventually comes from your premiums, deductibles, and copays.   Without numbers to go on, my next guesses of wasteful inefficacies are Doctors prescribing haphazardly (I’ll elaborate on that further momentarily) and zero dollar copays.  Now, zero dollar copays sound nice right? Walk into the pharmacy smile and sign your name and they hand you medicine and you’re done.   Well, Economics has a little problem with that especially when combined with the next part.  When there is no cost at all, people pay less attention. They just grab whatever you hand them and take them (hopefully right, and hopefully they work,) this is not just a guess or economic theory, I see people do this on a daily basis.  Doctors make this problem far bigger by not always being very selective with the drugs they prescribe.  They fall prey to seductive drug reps and their baskets of coupons, free samples, and promises that the coupon will make it cheaper than the generic.

Spoiler Alert: 95% of the time, the generic is cheaper. Those coupons are just traps.

Or they prescribe a similar drug that is extremely expensive, when the cheaper drug would do just fine (more seduction by drug reps.) When you don’t have to pay the difference between the $200 pill and the $20 pill, people rarely care though.  Do this a few dozen times a day in each pharmacy all over the country and suddenly that $180 is a staggeringly huge difference.  Of course, vigilant and caring pharmacy workers try to mitigate this problem when they can, but they don’t always have the time or motivation.

The final problem I can point out before we can ponder about a solution is a problem in economics, if not THE primary problem. The problem(s) are called Free Riders.  Without refereeing either word in the title itself, the best way I can describe the free rider problem is through a scenario.

                Let’s say we have a happy little hippy/socialistic commune.  In this commune there is no currency, everyone works to produce food and when the food is harvested everyone partakes of it freely.  In a very small commune where everyone always know what each other is doing, it works pretty fine. But let’s say ours is just big enough that is a little default to keep exact track of everyone all the time.  Without fail, one or two people will slip under the radar and start partaking of food without helping produce it.  Those people are free riders.

Now back to our insurances.  In insurances we can have free riders play out in a few different ways.  One is by having people never put in a penny, and draw out (the most straightforward way of free riding) and one could classify many zero co-pay government funded insurances as all free riders.  The other (and less recognized way) is to have people not participate (and pay into) insurances until they need coverage, then suddenly try and get in.  

.  Both are problems that will stop us from creating an economically sound system (or at least getting as close as we can).

So let’s list the problems we have so far.

1.                   Upcoming tidal wave of retiring baby boomers.

2.                    Social/cultural resistance to change

3.                   Insurance companies are businesses

4.                   Inefficiencies

a.    Doctor’s prescribing issues

b.   Zero-copay waste

5.                   Free-riders

                Now for the fun part, where I start suggesting solutions and you all either agree or get increasingly uncomfortable/angry.   First of all, I am in favor of all or nothing solutions and hopefully some of them will make sense. 

The first problem I’ll address in problem 3, and to fix that we must make sure that our new program is either NOT a business at all or is heavily regulated. This can be accomplished by making it a nonprofit organization and gaining work from professionals like doctors, pharmacists, lawyers, accountants, and economists by making their time a tax deductible donation, something many of those people want.  This could also be achieved by establishing set pay rates for ALL employees, including all high ranking ones that are hard to change beyond planned cost of life increases.  Problem  3 down.

The next solution solves a few things at once, but would be really hard to sell to the public and companies. Once the program is established and running, abolish all other government and private insurance companies as well as mandate enrollment.  This is where the ethics and economics get a little twisted.  Competition is shut down (to get rid of the businesses) and enrollment is mandated (to eliminate the second kind of free riders,) although this would certainly enrage many it solves the economic problems created by their desire for fair healthcare. Now everyone is paying into and pulling from the same pot, which would allow the accountants and economists analyze the flow in and out and make policies based on it.  As well as make the government input into the pot far easier to see and keep track of.  Problem 5 down as well as hopefully 4a due to the inclusion of both doctors and pharmacists.

4b has elegantly simple economic solution, put a small co-pay on everything. A one to 3 dollar copay would likely help more than most people would initially think. Practically I know it works, when a Tenncare patient shows up and sees a $3 copay, everything comes to a screeching stop that usually ends with them having to leave and get money and often with them not getting it.

The only true solution to problem one however may be what McGee suggests in case 45 that retirement may be a thing of the past, when working ment hard labor and the elderly literally could not do any work. With many jobs that are far far less physically demanding many people can work to a far older age, and therefore still contribute to society and kick in at least a bit for their healthcare.  My proposed system may not take away this possible necessity completely, but reducing the inefficiencies we may be able to reduce the cost of healthcare to a level where many more people can afford to pay in for far longer. 

My proposals may not be perfect, but hey I'm just now getting my degree. If it were that easy to solve it surely would have by now.  But hopefully they would get us on the right tract, and with time and professional input we could perfect the system or at least not collapse economically trying to support a huge population of retirees.

~Radiance

The Case for Perfection: Modern Eugenics

Eugenics has a bad reputation with society today, mainly due to its association with forced sterilization laws and Hitler’s mass murder and genocide. But is the newer form of eugenics as bad as the old ideology?  Eugenics was a movement that sought to improve the human race; the philosophy was created by Sir Francis Galton. Galton saw it as humanities duty to control what “nature does blindly, slowly, and ruthlessly” to improve our “stock” (Sandel). Unfortunately when the idea spread to America it fell into the hands of “racists and cranks” that developed the idea of genetically unfit individuals. Charles Davenport opened the Eugenics Records Office in order to discover and document those with novel genetic material that benefitted society. Unfortunately, this led to some states passing forced sterilizations laws being passed for groups there were deemed unfit, in many cases this definition applied to prisoners and the poor. Today the modern eugenics movement seems to take on a similar philosophy on improving the human state, but it falls along the lines of individual choice rather than a humanitarian duty for the betterment of society. Therefore, the modern eugenics is aimed less at forcefully controlling the course of human development as a whole and more at improvement on the individual level.

Free-market eugenics puts a consumerist spin on old eugenics, egg and sperm that possess desirable traits can now be advertised and sold for often times hefty prices. Sandel documents an advertisement in an Ivy League college newspaper offering $50,000 for the egg of a 5’10” female, athletic, without any history of major family medical problems, and a combined SAT score of 1400 or higher.   He notes that some object to this consumerist approach of auctioning desirable eggs since it would exploit poor women by offering them what they could not afford, which is as morally detestable as coercion. However, unlike the old eugenics the poor are not prevented from procreation in the least bit additionally at the hefty prices of some eggs, one would venture to expect that the poor would not bother with something they could not afford. Sandel makes a key argument in this chapter when sheds light on the real issue of deliberately designing children rather than allowing nature to take its course. This seems to imply that the child is being deprived of some right to choose their own path. However, is this really a new practice to our species, or just the mastering of an ancient practice in mate choice? Some would argue that biologically, humans are made to choose prospective mates based on certain characteristics that they can pass on to ensure the survival and reproductive success of their offspring. A recent psychological study on intersexual selection and mate preference in humans was done on men and women where they were asked what traits they looked for in a mate. The traits were qualities such as; understanding, intelligent, physical attractiveness, good earning capacity, and healthy. The point being that humans have been unconsciously designing their children for centuries, it would seem that free-market eugenics just improves the options and makes them more available.

Eugenics has had a shaky reputation, but no doubt it has improved over the last few decades. If the rights are left to the individual rather than a forceful government mandate, is the eugenics movement such a bad idea? With more recent spins on eugenics such as liberal eugenics that attempts to give parents the ability to improve their child’s capacities without biasing their life choices, the movement is undoubtedly reinventing itself. With anything implemented by humanity it will be perfected through trial and era, who is to say that eugenics couldn’t contribute to the eradication of genetic diseases in society, maybe not directly but possibly indirectly. This is a case where good and bad aspects will result, of course everyone will not be satisfied, however since the philosophy is improving  to a more modern , non-coercive practice it should not be completely shut down but allowed to run its course.

Work Cited

Adamson, Joel. Sexual Selection in humans: some interesting work.  Sexual Selection and Life History    Evolution.  wordpress.com 08 Jun 2012. <http://lxmx.wordpress.com/2012/06/08/sexual- selection-in-humans-some-interesting-recent-work/>

Sandel, Michael J. The Case against Perfection: Ethics in the Age of Genetic Engineering. Cambridge, MA: Belknap of Harvard UP, 2007. Print.

GMOs

We've seen nothin' yet...

The Case for Genetically Modified Organisms

            Today there is a lot of argument about genetically modified organisms and if they are safe for consumption. A lot of the counter argument is based on “what if’s” and not solid scientific foundations. The method of modification seems to be the biggest point of contention to those opposed to GMO. The fact is we need these GMO if we are to continue to grow our population. Some of these GMO’s can actually benefit not only people but economies. So while the voice of contention is loud I want to try and show why GMO’s can be a good thing.

            When you hear the argument against GMO the largest complaint is that we don’t know what will happen when we play with the code of life. This point is silly, scientists are not playing Dr. Frankenstein and just throwing things together. A lot of research is put into finding exactly what part of the genome controls the desired allele in question. Drought resistant vegetables are an easy example, once the organism has it’s genome mapped we can find what part controls the amount of water needed and modify that one portion so that it can grow and flourish where it’s non-GMO cousins fail. To modify the genome of an organism is not playing God as much as prescribing an antibiotic is. We now have the knowledge of the chemistry of these organisms and this is nothing more than a chemical reaction.

            There are many GMO’s that we already consume that most are not aware that they are in fact GMO. Banana’s are an example of a cloned GMO. There is only one version of the Cavendish and it is continually cloned. It was artificially selected for the size and easy of growth. Seedless fruits are also GMO, they may not be chemically altered but they are artificially selected for and produced. There is no real difference between artificially selecting and forced manipulation of the genome. Scientists are not forcing a mutation upon an organism that is not biologically possible. Every mutation is possible but the probability may be very low and not fiscally viable.

            The growth of GMO’s is important so we can find ways to feed our continuing population. As people are living longer and longer land space is shrinking and making the most of the available area is paramount. Why should we worry about a crop possibly not coming in when we can plant a crop that is more efficient in its environment?  If we are heading for Global Warming then shouldn’t we find ways to ensure our crops flourish? And if we can find ways for developing countries to become self sustaining don’t we owe it to ourselves to ensure everyone can eat? GMO’s offer the solution to world hunger, so shouldn’t we take action?

            The only part of the GMO argument that is valid on scientific merit is the patent fiasco. How a genome can become patentable is a farce that needs to be readdressed. But if we can put aside unfounded prejudices and see GMO’s as the great invention they are maybe we can get to the business of taking care of each other. I am not a pro-GMO person but I find it interesting  what people have issues with when they don’t truly know what the process is.      

Ethical Dilemmas in Organ Donation

Earlier I did my presentation on the ethics of living organ donors well here's a site that I think has some interesting points that I had not come across when I first began my research on the topic but they also do have some of the points that I had discussed.

Organ Donation Ethics

Life?

• Don't talk to me about life!
• The first ten million years were the worst. And the second ten million: they were the worst, too. The third ten million I didn't enjoy at all. After that, I went into a bit of a decline. 
• "Reverse primary thrust, Marvin." That's what they say to me. "Open airlock number 3, Marvin." "Marvin, can you pick up that piece of paper?" Here I am, brain the size of a planet, and they ask me to pick up a piece of paper. 

-Marvin (the Paranoid Android)

But this is offered strictly for comic relief. For the record, and despite a few dispiriting bioethical conversations: I'm still an optimist about life. I'm for it.

Bioethics and the Christian World View

Here is my essay for my final in lieu of a final exam . Hopefully it sparks some controversy and we can debate and get other people's views.

Bioethics is the application of ethics to the emerging medical technologies and biological research. It blends law, philosophy, insights from humanity and medicine to bear on the complex interaction of human life, science and technology. Bioethics covers a wide range of topics including abortion, reproductive technologies, genetic intervention, stem cell research, physician-assisted suicide, and end-of-life medical decisions. Christians have very strong views on the topic of bioethics. They base their views on the Biblical teachings of Jesus Christ. The main teaching they apply towards bioethics is the sanctity of life.

Beliefs about sanctity of life lie at the heart of all ethical debates on embryonic stem cell research, abortion, and euthanasia. Christians believe there is no doubt that human life is created at conception. They believe the Bible clearly supports the view that life begins at conception. The Old Testament provides most of the information on God’s view of life before birth, since it gives Christians the law. The law specifically addresses the issue of taking the life of a fetus in the book of Exodus. Exodus 21:22-25 states, “If men who are fighting hit a pregnant woman and she gives birth prematurely but there is no serious injury, the offender must be fined whatever the woman’s husband demands and the court allows. But if there is serious injury, you are to take life for life, eye for eye, tooth for tooth, hand for hand, foot for foot, burn for burn, wound for wound, bruise for bruise.” This verse says that a man who induces abortion or miscarriage is to be punished, indicating that God values life before birth. Another verse that Christians use to fight for the sanctity of life is Psalm 139 which states, “For you created my inmost being; you knit me together in my mother’s womb. I praise you because I am fearfully and wonderfully made; your works are wonderful, I know that full well. My frame was not hidden from you when I was made in the secret place. When I was woven together in the depths of the earth, your eyes saw my unformed body. All the days ordained for me were written in your book before one of them came to be.” For many Christians, this verse is all they need to explain that life starts at conception. God’s knowledge of human life begins when humans are made in the womb. God sees embryos as human life, not just a cluster of dividing cells.

Christian’s stance on abortion started at the very beginning when they were a part of the Roman Empire. The Romans had a very low view of human life and had widespread abortion practices in their empire. Many historians tend to think that poverty and food shortages were the primary reasons for the prevalence of abortion. However, historical data shows that poverty was not the primary cause for high abortion rates among the Romans in the early Christian era. At this time in history, there was little respect and honor for marriage in the Roman lifestyle. With little respect for marriage, many Roman women became involved in adulterous sex and became pregnant. They only way to destroy evidence of their sexual indiscretions was to have an abortion. Another reason for abortions was the Roman desire to be childless. Many Romans desired to be childless and unmarried because they hoped to cash in on their “friend’s” wills.

Euthanasia is the intentional killing of a patient by act or omission as part of their ‘medical treatment’ when the patient’s life is felt not to be worth living. It is currently illegal in all countries but there are strong pressures to make it legal. Christians believe that life is sacred from conception and euthanasia is murder because it involves the killing of human beings. Whether it is human life as a fetus, an infant, or an adult, Christians see God as the creator of all human life, and thus it is God’s exclusive prerogative to end an individual’s life. Genesis 9:6 states, “Whoever sheds the blood of man, by man shall his blood be shed; for in the image of God has God made man.” Human life is not ‘our property’ but rather belongs to God. Christians believe only God has the right to take life, not doctors or ourselves.

The common foundation of human value and dignity is human nature, not the size, level of development, environment, or functional capacity of human body. Therefore, intentionally ending and thus devaluing the life of a dying patient innately opens the door to the devaluing and possible destruction of any human life. It is not a doctor’s decision or a patient’s decision to end a life. Christians believe that right can only belong to the one who created life, God.

In conclusion, bioethics and Christianity are intertwined. Abortion, stem cell research, euthanasia, and reproductive technologies all conflict with the Christian’s view on sanctity of life. Christians believe that life begins from the time of conception and ends only when God decides to take one’s life. It is no one else’s right to take a life whether the life is taken while one is still in the womb or if the person is very old and near death. Humans are created in God’s image and are therefore valued above all other creatures. Abortion and euthanasia run contrary to Christianity’s beliefs and what is found in the Bible. Today, Christians fight valiantly to end these practices all over the world.

National Institute of Mental Health abandoning the DSM

Betsy here.
I don't know much about the topic, but my bet is that many people in the class do, and that this is a rather large deal.
http://mindhacks.com/2013/05/03/national-institute-of-mental-health-abandoning-the-dsm/?utm_source=feedly

A moral victory

We have acknowledged many issues this semester, haven't we class? Success!

Have a good life, bioethicists. That's really what this course has been all about.
==
Postscript. And speaking of life...

I just caught up with this incredible Radiolab story during my walk this morning. Food for thought, for those on all sides of the abortion/life/personhood debate. Happy ending too. You'll smile, you'll cry, you'll laugh...

A short comment on anti-science and its relation to public health

I apologize in advance for the crude style I employed when writing this.
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When you were last severely diseased or injured, from where did you seek treatment? Most likely, you were treated by a trained and licensed medical professional. Your treatment was backed by evidence of current scientific medical knowledge. Unfortunately, this does not ensure perfect recovery, and in some cases, such as cancers, cannot ensure survival. Most drugs carry a plethora of undesirable side-effects. Medical knowledge is not complete, and these “blind spots” in it are being researched to create better treatments. However, some may view medicine's ignorance not as a temporary problem being progressively solved, but as an indictment against the institution as a whole. When one or a loved one is not cured or dies despite receiving the best available treatment, antipathy can be inspired in those who believe medicine ought to be perfect (a goal, to be sure, but not feasible for now). Medicine as an economic market exacerbates such antipathy by tainting medical research's reputation: “Are they trying to cure me or make me into a life-long customer?”, but the intersection between medicine and economics is another discussion. It is enough to say here that healthy skepticism of corporate incentives can be fanned into paranoia towards all of medicine. So, where do these people go when they have health concerns? Now enters anti-science.

It comes in myriad forms and appeals to wide ranges of people. It is perpetuated by anecdotes and testimonial. Often, it attempts to both cloak itself in science's credibility while simultaneously attempting to discredit science. For instance, Kevin Trudeau's well-selling book, Natural Cures They Don't Want You to Know About, encourages the reader to distrust conventional forms of medicine as conspiracy against your health and props itself up with these insinuations, as though his pay-walled “natural cure” for cancer is the true evidence-based remedy. Homeopathy and faith healing are just a couple of examples which find their niche in distrust of scientific medicine. Homeopathy essentially amounts to selling sugar or water pills to cure nearly any symptom, such as headaches or nausea. Sellers claim it works by “water memory” and dilution, whereby water comes into contact with a substance and “remembers” it and is then diluted to a level at which none of the substance remains. Supposedly, the dilution is what amplifies homeopathic pills' efficacy. In his video, CoolHardLogic explains homeopathy in more detail, debunking its claims along the way:

Faith healing is a religious alternative to scientific medicine which derives its base from the willingness of believers to “let go and let God”. The popular image of a faith healer is that of a preacher before a large audience, loudly and passionately invoking their deity's name and commanding demons or ailments to vacate a patient's body thereby. Patients are then declared healed via miracle. To show that they receive information from their deity, they produce specific ailments and other bits specific to individuals, such as addresses. Peter Popoff was a prominent faith healer during the 1980s until James Randi and Alec Jason exposed his fraudulent methods (he was receiving the information about those in the audience from his wife through radio transmission).

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If these methods are indeed only charlatanism, why might many people experience some relief when using them? The answer comes in the form of a well-known, well-forgotten phenomenon: the placebo effect. The placebo effect is the ability of the body to respond to positive expectations a person has with regard to some treatment (the opposite is the nocebo effect, pertaining to negative expectations). What a person thinks a substance will do to them demonstrates a remarkable effect on their condition, potentially relieving patients and aiding recovery. Placebo conditions, in which participants are apparently given treatment but do not actually receive the drug being tested, are used in research to discern whether a drug has an effect greater than what can be explained by the patients' expectations. Thus, vague or general symptoms, such as headaches, nausea, pain, etc., which respond more to placebo than diseases, such as AIDS, can be “cured” by homeopathy or faith healing. In the case of faith healing, the vague symptoms of more serious conditions appear to temporarily wane, as seen with the arthritic woman with Popoff.

Some might argue that the scrutiny and anger spurred in scientific communities is unwarranted. Although they do not work on more serious diseases, they can relieve those general symptoms and those who use these methods are provided comfort in the process. Certainly, if an individual is aware of all the information pertaining to their chosen alternative medicine, they should have the freedom to choose it. However, those who argue along this line have forgotten that humans and choices are affected by other humans and choices. If a person is convinced homeopathy or faith healing is effective, because it worked on their headaches or pains, they may be more likely to forgo scientific medicine for the same methods when they have been afflicted with something graver, like cancer. When they do this, they are likely to die. Steve Jobs is a high-profile example of unnecessary death (or early death) due to ineffectual alternative treatments.

http://www.dailymail.co.uk/news/article-2049019/Steve-Jobs-dead-Apple-CEO-shunned-conventional-cancer-medicine.html

Our decisions can be influenced by the decisions of those with whom we associate, as well. If you know people who provide anecdotes and personal experiences which claim homeopathy or other anti-scientific positions are credible, you may be more likely to accept those positions.

The most egregious effect of anti-science, though, is with parenting. Children cannot seek or have great difficulty seeking treatment outside of their parents' methods, if they are even aware that they need it. Now, alternative healing is not the choice of the individual, but the only available mode of treatment. Recently, the child of a couple in Pennsylvania died after they decided to pray for the child's healing rather than seek scientific medical treatment. This was the second child of theirs to die, experiencing similar symptoms, left only to prayer for help.

http://rt.com/usa/second-child-dies-parents-pray-301/

Anti-vaccination supporting parents have also caused difficulty, endangering their children by refusing vaccination against mumps, measles, and rubella, among other viruses. This also risks the health of those around them by potentially exposing more people to these viruses, leading to possible resurgences of currently controlled diseases. Anti-vaccination movements have even halted the eradication of polio in some countries, such as Nigeria.

http://afraf.oxfordjournals.org/content/106/423/185.short

The confident statistics and claims by the progenitors of anti-scientific treatments become disquieting when one understands the implications.

http://homeopathyresource.com/homeopathy_statistics.shtml

We can begin to address the issue by at least eliminating state funding and propagation-through-classes of anti-science. This, along with promoting scientific literacy, is necessary to minimize public health risk due to misconceptions and involuntary use, as in children, but we cannot expect anti-science to completely disappear.  In the same way, some still dogmatically advocate geocentrism or even a flat Earth in the face of photographs of the Earth and Solar System from the International Space Station and the Voyager missions.
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Interestingly, those who stand to benefit most from anti-science have the same motivation as those whom supporters fear in the pharmaceutical industry.  They are the burgeoning alternative healing industry and they want to be profitable.

-Alexander Thorne

@fromtheRiverbed