Wednesday, November 7, 2012

The right to self-medicate?

Interesting argument presented by Alex at Marginal Revolution about the liberalization of prescription drugs:
Citizens have rights of self-medication for the same reasons that they have rights of informed consent. The prescription drug system has bad consequences and it privileges regulators’ and physicians’ judgements about a patient’s health over the patient’s judgement about her overall well-being. Most troublingly, the prescription drug system violates patients’ rights.
Instead, I propose that prohibitive pharmaceutical policies, which are a kind of strong paternalism, be replaced by nonprohibitive policies that enable patients to obtain whatever medicines they choose while promoting informed consumer choices by making expert advice readily available.
I'm not sure that I disagree with this argument, but I found it a bit shocking how lightly Ms. Flanagan shrugs off concerns over addiction.
Since addicts are autonomous and able to give informed consent for treatment, including their drug of choice, they ought to be given similar authority to access treatment, including their drug of choice. One way to mitigate the potential harm of addictive pharmaceuticals would be to designate some addictive drugs as "behind the counter" and enable addicts who do not wish to use addictive pharmaceuticals to precommit to not using by enrolling in a voluntary programme. 
I don't feel comfortable saying that, "well, there is a study saying that addicts are able to give informed consent; therefore we can dismiss concerns about increased access to highly addictive drugs leading to increased addiction rates."  This brings up an interesting argument about whether public health laws (and other laws, for that matter) should be designed for the lowest common denominator or the highest. I like a lot of libertarian ideas, but the place where the most hardcore libertarian ideas often lose me is when they seek to legislate for the highest common denominator, with little regard for the lowest.

Tuesday, November 6, 2012

Healthcare - the French system

French NHI is more generous than what a “Medicare for all” system would be like in the United States, and it shares a range of characteristics with which Americans are well acquainted—fee-for-service practice, a public–private mix in the financing and organization of health care services, cost sharing, and supplementary private insurance.
And yet it still costs significantly less than our healthcare system.  One big reason:
The number of nonphysician personnel per bed (in France's hospital system) is higher in public hospitals than in private hospitals; in the aggregate, it is 67% lower than in US hospitals
From the American Journal of Public Health's series comparing health systems.  The article is old, but nevertheless quite interesting.

Healthcare Price Databases

Kaiser reports on the trend in healthcare price databases.  According to the All Payer Claims Database Council's map, there are now nine states with such databases and several others that are on the verge of implementing their own.  

As the Kaiser article discusses, these databases are expected to help reduce some of the wild variations between the cost of different procedures: 
The price of a knee MRI in Colorado varies from $350 to $2,336...
The eight-fold range in MRI prices stands out, as does a four-fold difference in spending per health plan member between nearby counties. It ranges from a low of $1,000 per year in Hinsdale County to a high of just over $4,000 in Pitkin County. 
The databases themselves seem to vary in their degree of user friendliness, and publicizing their existence may be difficult.  Nevertheless, this innovation has the potential to significantly improve the functioning of our healthcare markets.  Ultimately, it may even be of more use than the ACA's much-touted health benefit exchanges.  

Sunday, November 4, 2012

Escaping the tyranny of cultural choice

Dorian Lynskey's column on the tyranny of cultural choice rang a bit too true for me:
In the most heartfelt chapter of his book Retromania, the music critic Simon Reynolds admits to a strange nostalgia for the boredom of his youth. "Today's boredom is not hungry, a response to deprivation; it is a loss of cultural appetite, in response to the surfeit of claims on your attention and time." One of the many ways in which technology leaves the human brain gasping to keep up is in its provision of almost limitless choice, because time remains as limited as ever. "Life itself is a scarcity economy," writes Reynolds. "You only have so much time and energy."
Technology has birthed new versions of the bedside pile of books: the neglected links stacking up in my Twitter Favourites column; the high-minded Netflix queue compiled by a tired parent who has somehow mistaken himself for a film-studies undergraduate; the earnest documentaries waiting in silent accusation on my DVR, like an unused gym membership, until the day the device mercifully crashes. At the same time, the digital buffet can erode your ability to commit to one thing at a time. The main reason I don't own a Kindle or iPad is my suspicion that, without the firm anchor of a physical book, I will get restless and float away in a sea of options.
I've spent the past few years tweaking my media consumption so that I can capture all the most interesting knowledge (twitter, instapaper, google reader, evernote, etc...).  A few months ago, I finally got the formula right, to the point that I could now spend all day on the internet and never run out of interesting stuff to read, which is to say that I've gotten a little bit too good at capturing potentially interesting information.  My book list is impossibly long, and catching up with my twitter feed and my google reader often seem more like chores sometimes.  Finding a fun new article seems more exhausting than anything else.  So, after the reading this article, I decided that some new rules are in order.  Some ideas to experiment with over the next few weeks:

  • Limit myself to two media consumption sessions per day, one the morning, one in the evening.  During those two sessions, I can check my twitter feed, go through my google reader feed and browse articles from my instapaper, but I'm not allowed to go back in time, so I will accept that anything that I don't feel like reading during those two session was not enough of a priority, and shall be remorselessly x-ed out of my browser.  If there was something that I was truly excited to read, but that I ran out of time for, I can save it to my instapaper.  
  • Spend more time on books.  I spend too much time in front of a computer as it is.  Books require more mental discipline; I cannot just sit mindlessly in front of a book.  And they do not require me to sit in front of a computer, a position that is becoming bad for my back.  
  • Find a non-computer-based hobby.  A musical instrument seems like the best bet.  
  • Be more disciplined.  This, as ever, is probably the greatest struggle.  

Friday, November 2, 2012

Annual checkups and the overconsumption of healthcare

Naomi Freundlich has a terrific post on annual checkups:
It sounds like heresy, but recent evidence challenges the long-held belief that the annual physical is beneficial for healthy adults. Researchers at the Nordic Cochrane Center in Copenhagen wrote last week that although a regular check-up with multiple screening tests might seem to offer the advantage of catching problems like heart disease and cancer early, their review of studies involving some 180,000 adults actually found no benefit. People who had annual check-ups were no less likely to be admitted to the hospital, become disabled or miss work than those who did not have regular physicals. Even more surprising, they were no less likely to die from heart disease, cancer or any other illness.
The study's authors offer a compelling theory for why this might be the case:
In fact, subjecting healthy adults to this yearly battery of tests may do more harm than good. The authors write, “One possible harm from health checks is the diagnosis and treatment of conditions that were not destined to cause symptoms or death. Their diagnosis will, therefore, be superfluous and carry the risk of unnecessary treatment.”
I'm increasingly starting to believe that overconsumption of healthcare is a bigger issue than previously realized.

Looking at the minimal differences in longevity between rich and poor countries only strengthens this theory.  We spend much more on healthcare than many middle-income countries, but receive very similar results in life expectancy.  The U.S. spends $7,000/person on health; Mexico spends $800.  But U.S. life expectancy is only two years longer than Mexico's (78.2 in U.S. versus 76.2 in Mexico).  And that's despite the fact that violence and traffic accidents kills 7% of Mexico's population versus only 3% in the U.S.

Links I liked

Robin Hanson on the impatience of idealism
More from Ta-Nehisi Coates on language learning
Good news
Probably good news