Category Archives: Healthcare

Should we force drunks to drive? Compulsory Voting: For and Against

Choice

I’ve not yet read the June-release of Compulsory Voting: For and Against, but it comes well-recommended. Here are two blurbs by George Mason colleagues of the authors:

“The frustrating thing about arguments over citizenship in democracies is that everyone is right, meaning that everyone is also wrong. There are powerful arguments in favor of asking citizens to act on a moral obligation to become informed, so as to move toward an ideal world. In that view, argued ably here by Jason Brennan, anyone who fails to become informed should voluntarily abstain. Lisa Hill argues that Brennan has it backwards: ‘good’ elections are not the result of an informed citizenry. Rather, a broadly accepted electoral process, legitimated by universal participation, is what creates an informed citizenry. Who is right? An extraordinary and very fair-minded treatment of significant issues in democracy around the world.”
Michael Munger, Duke University

“Should the government force citizens to vote? Brennan and Hill’s Compulsory Voting crisply presents the strongest case in favor as well as the strongest case against mandatory participation in the electoral process. Although the two authors defend opposite conclusions, both show that philosophy is better with careful social science – and that social science is better with careful philosophy. A book full of ideas, clarity, and candor.”
Bryan D. Caplan, George Mason University

Incidentally, prof. Bryan Caplan is the author of one of our favorite Public Choice books The Myth of the Rational Voter.

For more background try my post Public Choice: rational ignorance, pork and rent-seeking.

How will we know if the ACA is working?

I don’t know the answer to these five concise questions formulated by Tyler Cowen. Do you?

I have read a good deal on this topic and I am not very satisfied with most of it, from either side.  Too often citing and then refuting weaker claims from the other side is conflated with showing that one’s own view is right.  Here are a few issues we ought to consider and indeed focus on:

1. Five to ten years from now, how much do we think employment will have gone down as a result of ACA?  (That is from the employer mandate, high implicit marginal tax rates because of the subsidies, and also from a lesser need to stay employed to have health insurance.)  By the way, you can’t in other contexts believe strongly in rigidities and then confidently point to a small employment response within a one year time frame and claim to know these labor market effects are small ones.

1b. How will the effort to introduce greater equality of health care consumption fare if wage and income inequality continue to rise?  Will this attempt at consumption near-equalization require massively distorting incentives?

2. Given your answer to #1, and given how much employment itself boosts health, will ACA even have improved overall health in America?  Whatoutcome indicators might show this?

3. Given that prices in the individual insurance market already seem to have gone up 14-28 percent, and may go up more once political scrutiny of insurance companies lessens, what is the overall individual welfare calculation from this policy change?  I mean using actual economic policy analysis, of the CBA sort, not just noting that more people have health insurance.

4. Given supply side constraints, how much did ACA increase the consumption of health services in the United States?  (I take the near-universal bafflement over the first quarter gdp revision a sign of how poorly we understand what is going on.)  And how good or bad a thing is the ongoing but accelerated shift to narrow provider networks?

5. How much of the apparent slowdown of health care cost inflation is a) permanent, b) not just due to the slow economy, and c) due to ACA?  Or how about d) the result of trends which have been operating slowly for the last 10-20 years?

I have lifted Tyler’s complete post to serve as a checklist for monitoring the results. It will take a while – especially solid outcomes data. It isn’t at all obvious how the outcomes can be measured.

Chemical-Free Products: The Complete List

Derek Lowe

Here’s a comprehensive review of chemical-free consumer products, courtesy of Nature Chemistry. I’m flattered to have been listed as a potential referee for this manuscript, which truly does provide the most complete list possible of chemical-free cleaners, cosmetics, and every other class of commercially available product. Along similar lines, I can also recommend (…snip…)

Source: by research chemist Derek Lowe. Derek is a remarkable insider source on preclinical drug discovery.  

The world’s deadliest animals

World s deadliest animals

During the Gates Notes Mosquito Week Bill Gates posted this Chart-of-the-Year.

(…snip…) What makes mosquitoes so dangerous? Despite their innocuous-sounding name—Spanish for “little fly”—they carry devastating diseases. The worst is malaria, which kills more than 600,000 people every year; another 200 million cases incapacitate people for days at a time. It threatens half of the world’s population and causes billions of dollars in lost productivity annually. Other mosquito-borne diseases include dengue fever, yellow fever, and encephalitis.

There are more than 2,500 species of mosquito, and mosquitoes are found in every region of the world except Antarctica. During the peak breeding seasons, they outnumber every other animal on Earth, except termites and ants. They were responsible for tens of thousands of deaths during the construction of the Panama Canal. And they affect population patterns on a grand scale: In many malarial zones, the disease drives people inland and away from the coast, where the climate is more welcoming to mosquitoes.

What the Tamiflu saga tells us about drug trials and big pharma

We have been subscribers to the All Trials network since founded by physician Ben Goldacre in Jan 2013. The mission statement is simple “All Trials Registered | All Results Reported”. The above-captioned article by Dr. Goldacre will make it clear why this initiative is so important:

Today we found out that Tamiflu doesn’t work so well after all. Roche, the drug company behind it, withheld vital information on its clinical trials for half a decade, but the Cochrane Collaboration, a global not-for-profit organisation of 14,000 academics, finally obtained all the information. Putting the evidence together, it has found that Tamiflu has little or no impact on complications of flu infection, such as pneumonia.

That is a scandal because the UK government spent £0.5bn stockpiling this drug in the hope that it would help prevent serious side-effects from flu infection. But the bigger scandal is that Roche broke no law by withholding vital information on how well its drug works. In fact, the methods and results of clinical trials on the drugs we use today are still routinely and legally being withheld from doctors, researchers and patients. It is simple bad luck for Roche that Tamiflu became, arbitrarily, the poster child for the missing-data story.

And it is a great poster child. The battle over Tamiflu perfectly illustrates the need for full transparency around clinical trials, the importance of access to obscure documentation, and the failure of the regulatory system. Crucially, it is also an illustration of how science, at its best, is built on transparency and openness to criticism, because the saga of the Cochrane Tamiflu review began with a simple online comment.

Tamiflu being made by Roche

 

(…snip…)

This is a pivotal moment in the history of medicine. Trials transparency is finally on the agenda, and this may be our only opportunity to fix it in a decade. We cannot make informed decisions about which treatment is best while information about clinical trials is routinely and legally withheld from doctors, researchers, and patients. Anyone who stands in the way of transparency is exposing patients to avoidable harm. We need regulators, legislators, and professional bodies to demand full transparency. We need clear audit on what information is missing, and who is withholding it.

Finally, more than anything – because culture shift will be as powerful as legislation – we need to do something even more difficult. We need to praise, encourage, and support the companies and individuals who are beginning to do the right thing. This now includes Roche. And so, paradoxically, after everything you have read above, with the outrage fresh in your mind, on the day when it feels harder than any other, I hope you will join me in saying: Bravo, Roche. Now let’s do better.

• Ben Goldacre is a doctor and the author of Bad Pharma.

You can help the All Trials mission. Join and sign the petition here. Spread the word, lean on your politicians, get involved.

Will Obama Ever Enforce His Health Law?

Megan McArdle's analysis and outlook has been accurate so far. She is increasingly pessimistic:

This is President Obama’s signature legislative achievement, the program for which he will be remembered. And he doesn’t have the courage to defend it, even when he is no longer facing re-election. If he won’t stand up for the hard choices his law requires, he can’t think that anyone else will either.

Megan's Intelligence Squared debate was excellent: Resolved: Obamacare Is Now Beyond Rescue.

 

The Trouble With ‘Scientific’ Research Today: A Lot That’s Published Is Junk

A number of empirical studies show that 80-90% of the claims coming from supposedly scientific studies in major journals fail to replicate.

Henry I. Miller surveys the wreckage of sloppy medical research.

…Another worrisome trend is the increasing publication of the results of flawed “advocacy research” that is actually designed to give a false result that provides propaganda value for activists and can be cited long after the findings have been discredited.

Dr. Miller is referring to the Gilles-Eric Séralini scandal:

(Séralini has made a specialty of methodologically flawed, irrelevant, uninterpretable — but over-interpreted — experiments intended to demonstrate harm from genetically engineered plants and the herbicide glyphosate in various highly contrived scenarios.)

Megan McArdle asks: “Where have all the uninsured gone?”

So far Obamacare has signed up roughly 15% of the 5 million uninsured that were used to justify the ACA. Megan puzzles over what this means:

(…) You’d expect the early numbers to be somewhat weighted toward the previously insured, who probably want to maintain continuous coverage. Still, this is a fairly wild skew, and it leaves us with a burning question: Where are the uninsured? Did hardly any of them want coverage beginning Jan. 1?
(…)
Maybe they were buying insurance directly from the insurance companies. But industry expert Bob Laszewski seems to say no, that’s not the case: “This is consistent with anecdotal reports from insurers I have talked to that are seeing very little net growth in their overall individual and small group markets as of January 1.”

That leaves us with two possibilities: First, would-be applicants may simply be waiting until March. They’ve gone without insurance a long time; why not wait a few more months and save on premiums?

The second possibility is more troubling: There may be something seriously wrong with our understanding of who the uninsured are, and what they are willing and able to buy in the way of insurance. I don’t know exactly what the fault may be in our understanding. But if the numbers stay this low, I’d say we need to reassess the state of our knowledge about the uninsured — and the vast program we created to cover them.

 

Metastatic cancer cells implode on protein contact

By attaching a cancer-killer protein to white blood cells, Cornell biomedical engineers have demonstrated the annihilation of metastasizing cancer cells traveling throughout the bloodstream.

The study, “TRAIL-Coated Leukocytes that Kill Cancer Cells in the Circulation,” was published online the week of Jan. 6 in the journal Proceedings of the National Academy of Sciences.

“These circulating cancer cells are doomed,” said Michael King, Cornell professor of biomedical engineering and the study’s senior author. “About 90 percent of cancer deaths are related to metastases, but now we’ve found a way to dispatch an army of killer white blood cells that cause apoptosis – the cancer cell’s own death – obliterating them from the bloodstream. When surrounded by these guys, it becomes nearly impossible for the cancer cell to escape.”

That is from the Cornell press release. I sure hope these results can be replicated. How difficult is the technique?

 

Re-Examining the FDA Antibiotics Decision: Banning Growth Promoters Won’t Be Enough

Denmark weaner pigs experience

Chart via Hagan Vigre, Danish Technical University, 2009

Further to the Denmark experience, Maryn McKenna has a new essay at Wired

The object lesson in changing antibiotic patterns is Denmark, which in 2000 made farm antibiotics prescription-only, and banned nontherapeutic uses altogether. It’s often pointed out, on the ag side, that Denmark had an increase in deaths among weaner pigs immediately after that ban was rolled out; but within 3 years, weaner pig survival improved and returned to where it had been before the ban.

What reversed the trend was Danish farmers’ understanding that it wasn’t enough just to remove antibiotics from meat production. What was necessary was to change the conditions in which meat animals were raised, so that the welfare threats which the antibiotics had addressed no longer existed.

That seems to me to be the lesson that meat production in America needs to learn, if the FDA’s intention to remove growth promoters is going to be meaningful. Simply reducing antibiotic use (if that does indeed happen) isn’t adequate; by itself, it may even be a threat to welfare. Changing the livestock practices that made antibiotic use necessary will improve animal and human health both.