Friday, November 9, 2012

Marijuana Legalization

The New York Times looks at the significance of Colorado and Washington's new marijuana laws:
As soon as the laws are certified, it will be legal under Colorado and Washington law for adults 21 years and older to possess up to an ounce of marijuana. In Colorado, people will be able to grow as many as six plants. In Washington, users will have to buy their marijuana from state-licensed providers.
Bringing marijuana production under the control of state-licensed providers seems incredibly logical, both from a regulatory and a revenue-maximizing standpoint.  It also seems like the best way to reduce the illicit drug trade caused by the "War on Drugs" that has done so much harm in countries like Mexico and Guatemala.  The big question now is whether or not the Obama administration will allow it:
In a statement on Wednesday, a spokesman for the Drug Enforcement Agency said the Justice Department was reviewing the ballot measures and declined to comment directly on how officials would respond to them. But he said the agency’s enforcement of federal drug laws “remains unchanged.” The United States attorneys in Denver and Seattle responded with nearly identical statements, offering no clue on whether they would sue to block the measures from being put into effect.
It is a murky landscape now, one that potentially pits voters who supported President Obama and legalization against the president’s own Justice Department. In 2010, weeks before California voted on an unsuccessful initiative to legalize marijuana, Attorney General Eric H. Holder Jr. announced that authorities would still aggressively prosecute marijuana laws.
It would be a huge disappointment to see the Obama administration continue to enforce drug laws.

On a related note, Alex at MR has linked to a study showing that states with medical marijuana laws have seen  an 8-11 percent decrease in traffic fatalities.  If true, this is a significant development for public health and safety.

Links I liked

Thursday, November 8, 2012

Longevity Project, the power of relationships

According to David Brooks' recent column, the capacity for intimate relationships might be linked not only to life success, but maybe to longer lives as well:
 Body type was useless as a predictor of how the men would fare in life. So was birth order or political affiliation. Even social class had a limited effect. But having a warm childhood was powerful. As George Vaillant, the study director, sums it up in “Triumphs of Experience,” his most recent summary of the research, “It was the capacity for intimate relationships that predicted flourishing in all aspects of these men’s lives.” 
Of the 31 men in the study incapable of establishing intimate bonds, only four are still alive. Of those who were better at forming relationships, more than a third are living.

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.