First, a confession. I am not one of Michael Moore's biggest supporters, and I had to be tricked into seeing SiCKO this weekend (I was promised Paris, je t'aime, which was conveniently no longer playing at the theatre!) There are two reasons: 1. his scattershot, anecdotal approach is unsatisfying to the extent that I feel I leave his movies without having learned anything substantial about the topic, and 2. I'm a bit of a snob when it comes to documentaries. Incidentally, the better half tried to persuade me not to think of Moore's films as documentary, but as "entertainment with a point."
That being said, I wanted to bring the topic into a front-page story since we've had both solid diaries and long comment threads
banging around the healthcare debate. Obviously this is going to be a major topic in the next presidential race, dominance of the Iraq debate notwithstanding.
Before I saw the movie, I made this observation in that thread:
Basically, it seems like an imperfect system either way, with the choice between between one of two extremes:
1. a fully private system in which a chunk of the population cannot afford medical costs, or
2. a fully socialized system in which everyone gets the same coverage, and the system grinds to a halt because of overuse and bureaucracy.Is it fair to say that most of us would prefer a mixed system? If so, what would that system look like?
Moore's documentary hasn't done much to change my fundamental questions, but it has highlighted a few problem spots in the debate itself.
Anecdotal evidence is one of the biggest. Moore's documentary is packed to the hilt with people who've experienced personal problems from the healthcare industry, as well as happy Canadians, Brits, and French who live contentedly healthy lives, but there's never an indication of how representative these stories are. Especially when it comes to the happy foreigners (a typically Moore-ian juxtaposition takes us from an absurdly happy middle-class Paris to the poorest slums of America in order to emphasize how much worse our system is. Instead, this left us all wondering how well healthcare works in the poorest slums of Paris, an area his camera never bothers to take us. It may have helped his film, since France supposedly has the best healthcare in the world, even for the poor - but it wouldn't have made as powerful a rhetorical point. Entertainment, indeed.)
But the healthcare debate is dominated by anecdotal evidence, whether it's the people down the street who went bankrupt because of unexpected health costs, or the Canadians who come to the United States to get more rapid hospitalization. Anecdotes can be helpful in illustrating the very human costs of bad healthcare policy - and it must be said that the most powerful moments in Moore's films are when he shuts up and lets people tell their own stories - but they can also obscure the benefits of a policy by highlighting the exceptions.
Here's one: Canadians are not crossing the borders in droves to receive American health care. Some are, especially for highly specialized care. But on the whole, Canadians are healthier and live longer than Americans - notwithstanding the fact that, as one interviewee says, "Someone will always complain, no matter what the system looks like." (see below for counterevidence) On the other hand, Moore doesn't help his argument by trying to show that Canadians on average don't spend longer in the hospital waiting room, which is simply not true - his only evidence to the contrary is a brief trip into one hospital: "Have you waited long? No? Ah, well, case closed then!"
Fortunately, web searches can help us locate more concrete numbers to clarify issues that Moore's film glosses over. A brief article filed by the American Society of Registered Nurses (hardly a disinterested source, but bear with me) provides many of the numbers that the film simply doesn't provide. Most interesting is the comparison between the country with the "best" healthcare (France) and the country with what our President has called the "best" healthcare (us, of course):
* $ spent per person: US - $5,711 (rank: 1st); France - $2,902 (rank: 9th)
* Life expectancy: US - France: US - 78.0 yrs (rank: tied for 17th); France - 79.9 (rank: tied for 6th)
* Infant mortality (per 1,000 births): US - 6.4 (rank: 16th); France - 4.2 (rank: 6th)
What's most interesting to me is $ spent per person, since arguments about spending and efficiency seem to revolve around healthcare costs. Notice that we spend nearly twice as much as that Gallic socialist hell, and yet they're doing much better than we are on life expectancy and infant mortality.
Now, I'm not naive enough to assume that the only factors going into healthcare are dollars, but clearly we're doing something wrong. Environmental factors not listed here also do have a major impact: there's certainly something to be said about the food Americans eat, for example. But one of the arguments Moore tries to advance is that this is still part of the same story: The heathcare industry in the United States is focused on medication. The healthcare industry in France is focused on preventative medicine to keep people in better overall health. Likewise: the English system of universal healthcare supposedly grants dollar bonuses to doctors who succeed at incorporating lifestyle changes into their patients' sessions: get a patient to quit smoking, get a few extra bucks.
That seems like a good idea to me, but I can imagine it wouldn't go over terribly well with our prescription drug companies. Moore also takes aim at them (and takes some deserved potshots at the loathesome Billy Tauzin ), and hints at one of our strangest problems: advertisements for prescription drugs on television. Why advertise prescription drugs to the population? Shouldn't your doctor be the one suggesting which drugs are right for you? Economically speaking, the companies know they can make better bank if you go in with a drug in mind - which increases profits but represents terrible, terrible healthcare.
The ASRN report gives some of the numbers that support Moore's arguments, so here's a USA Today article that debunks others. Another article, this time from Reason Magazine
, pokes holes in the theory that Canadians are in better healthcare hands, but occasionally resorts to bogeyman "what ifs" that I don't find all that convincing. And don't forget this recent diary
by Freedem. The more you dig into the statistics, the more healthcare reveals itself to be a labyrinthine problem, but one in which we're clearly walking down the wrong paths without a ball of yarn.
A final note on the film: it doesn't help when Moore's clearly bending the material. In the infamous Cuban segment - infamous because it's already sparked more debate than the nearly 2 hours of material devoted to our healthcare crisis - Moore lauds the Cuban system, which he notes is world-famous for its excellence (no specifics given). However, earlier in the film he presented a list of the countries with the best healthcare: and Cuba was two slots below the United States. This isn't necessarily a contradiction, but Moore's silence on such a glaring juxtaposition doesn't speak much to his straightforwardness on the issues.
But, like the better half said, this isn't a film aimed at people like me. This is a film aimed at people who don't google at 2am to dig up healthcare statistics, and who feel disgruntled about their insurance plans but don't know how to talk about it. It's a film aimed at getting people talking rather than offering solutions: agitprop for 21st century America.
And it did get me talking, so there you go.
__________________________
Saint, n. A dead sinner revised and edited. - Ambrose Bierce
For the record,
I did finally get to see Paris, je t'aime at another theatre. It's a mixed bag, but the worst segments are mediocre, and the best are sublime. Worth the ticket alone for Alexander Payne's entry, which manages to do in 5 minutes what some filmmakers never accomplish in their careers: humor, pathos, love, sadness, all wrapped together in one painfully wonderfully human package.
__________________________Saint, n. A dead sinner revised and edited. - Ambrose Bierce
Quick comment
I've seen medical literature that attributes the longer lifetime in France to diet.
One has to be careful with corollations.
Why advertise prescription drugs to the population? Shouldn't your doctor be the one suggesting which drugs are right for you? Economically speaking, the companies know they can make better bank if you go in with a drug in mind - which increases profits but represents terrible, terrible healthcare.
That's just awful. Those poor doctors can't say, "I understand that has been highly advertized, but this drug here which just went off patent works just as (or almost as) well, and will cost you less money." As you know, patents are short, and there is a rush to make up the millions spent to bring them to patent, let alone their test mates which didn't make it.
A good example is Crestor, which the last time I checked, really was the best in its class. However, it is on patent and expensive, and another drug may work very well for most people.
Meanwhile, doown at the hated HMOs, when someone comes in and asksfor Crestor, they just roll in the aisles.
Are you suggesting that drug companies not be allowed to advertize their products?
Best statement:
The more you dig into the statistics, the more healthcare reveals itself to be a labyrinthine problem, but one in which we're clearly walking down the wrong paths without a ball of yarn.
Normally, we don't even ask what all the goals of our healthcare system should be, or even why we call it a system. or, for that mater, why we think it should be a system.
But what about the children.
Quick replies:
Which I specifically said in the diary, after comparing the US to France:
We agree, so I'm not sure why you thought to point that out. Another point:
Yes, I am: for those products that can't be bought over the counter. Why do we label some drugs prescription only? Because we don't believe the consumer has enough background to make informed choices about them.
A very good article here
(pdf!) charts the growth of consumer-targeted prescription drugs, and outlines some of the potential positives and negatives of the trend. The positives may be a more informed populace, although if the drugs are still prescription, I don't see how that changes anything - it's the doctor who needs to be informed. The negatives may be an increased overrealiance on medication (we're already the world's most medicated country 
) and, since doctors make money by pleasing patients, doctors more likely to sign off on unnecessary medication.
Finally, on this:
Very good points, and in some respects the crux of the debate. I think a reasonable argument can be made that some kind of system has to be in place for two reasons:
1. Expense of specialized procedures. I really don't see any purely market-based solution that makes it easier for people to get access to procedures that require either a high level of technology or specialty.
2. Circumstances. Healthcare is, by its very nature, the thing we need when we're least in a position to pay for it. Part of the problem we have now is that some people unable to work because of a health condition are also those unable to pay to correct that health condition, which is simply the nature of the beast. People certainly need to be smart about saving, but an unexpected accident can change one's financial circumstances overnight.
Incidentally, there was a funny anecdote in Moore's film about a woman whose insurance company refused to cover her ambulance to the hospital after she was knocked unconscious in a head-on collision. The reason? It wasn't pre-approved!
__________________________Saint, n. A dead sinner revised and edited. - Ambrose Bierce
I admit
I was in the middle of doing something and scanned your piece quickly, planning to return later. So I didn't catch that. Sorry.
Why do we label some drugs prescription only? Because we don't believe the consumer has enough background to make informed choices about them.
I have a different idea, and it has to do with the AMA being the best union in the world. Despite this, I don't think you have made a case that prescription drugs should not be advertised. I like the restraint of saying," ask your doctor about Crestor."
The positives may be a more informed populace, although if the drugs are still prescription, I don't see how that changes anything - it's the doctor who needs to be informed.
This reminds me of two things. First, I always wince when reading business type things wherein they say that advertising is good because it informs people. I always thought that a little glib. On the other hand, and secondly, the trend in medicine is away from the doctor as authoritarian know-it-all to patient responsibility for their own care.
What you go on to say is true:
Expense of specialized procedures.
In my little town, the kindly but gruff town doctor provided all the medical care. He was his own social system. He took anything from nothing to chickens to $5 for an office call, $10 for a house call. But he charged the rich people in the big Victorian houses on the end of Main St. $75 for an office visit. In return, he might agree to see them that day for a minor illness that the rest of us might wait a day to see him for. And he was generally available for fundraisers they may have, or even a few social events. (btw, he never missed one funeral of a patient of his.)
But it was understood by all in town that the rich people in town had access to specialized care that others did not, mostly at the bleeding edge of research. Where the average person might be told that their cancer was not curable, one of the rich peopole might be able to buy their way into a new treatment being tried in Cleveland. No one resented this. It was just reality. That rich person probably had a Cadillac, while you were content with a five year old Ford.
Since, we have been infected by the crazy notion that everyone deserves the best care, something impossible. So, logically speaking, we now seek to make it fair by taking money out of it, and sort of having a lottery system. In a total socialized system, you and the rich guy would have equal chances of drawing the best or the worst doctor in the system. That seems to be an improvement in fairness, but it doesn't allow any longer for the rich to pay for new treatments which will eventually bleed down to the poor. In fact, that happened all the time when I was young. That rich person who went to Cleveland had a good result, and it soon became available at the nearest hospital. The lag was usually a few years.
Maybe we should socialize our system, but in order to keep our system generating new drugs and treatments, we should demand that other systems pay for the costs of our developments. American drug companies should no longer allow European countries to set the price of drugs; rather, it would be fair for all developed countries to pay the same for them. And that includes Canada.
Short thought is: there will always be discrepancies in the delivery of health care, and wishing will not make them go away. We have to be careful that our solutions to these discrepancies don't negatively effect pother goals of our health system.
Circumstances. Healthcare is, by its very nature, the thing we need when we're least in a position to pay for it.
That's the old cunundrum. I remember one of my teachers, 29 years old, in a funk one day because he was denied health coverage due to his having a congenital heart defect. (Underneath his eyes was always blue.)
Of course, the usual answer is to spread the risk through some social measure. In the 1800s, social organizations began having members pay into a health fund for the purpose of providing at least some care when it was needed by a member. Then some enterprising people formed what they called s"social organizations" which would sell the rights to such care to any citizen who would pay. Insurance companies were born, and they were often mutal companies, that is, owned by the premium payers.
What we realize after a century and a half is that no company can afford to insure all of its members against every medical happening. mental health is largely uncovered, and we are all psychiatrically indigent (and states have traditionally provided mental health care). We in Oregon tried to provide health care for the poor, and quickly found out that we couldn't afford it. So a lineup of procedures was made based on their seriousness, times the cost and the number of times they were likely to be needed, and at the point on the list where the state money for the program ran out, a line was drawn, and nothing below that line would be funded. (There was a little play, because right below the line was a procedure which saved lives, and the crap hit the fan.) But without the ability to make these hard decisions, no plan can work.l And the dreamers never want to talk about these hard decisions. What kills programs is the reluctance to ask "what can we afford" rather than just saying that we should fund everything.
As for the pre-approved ambulance, that is not a surprising story. it works that way. Usually it is because people abuse the system. I knew mental patient who arrived at the County hospital by ambulance about twice a week for no particular reason because her family happened to have generous insurance. But even they ended up paying for the ride most of the time. (Most of the time, the woman was lonely, and just wanted to talk to somebody. The crisis entry center would talk to her for a while, and then call her a cab.) One of the crisis centers I worked at almost went bankrupt from being stuck with ambulance bills! From the city fire department! We made a deal with the city that they could use our office building at night to train police dogs to settle the bills.
Hey, Trickle Down Healthcare!
This is exactly right. And note that under this scenario it is the RICH and not the poor who end up being the guinea pigs for the new treatments. Sometimes they find out that while the treatment cures what was originally ailing you that you actually end up with something worse down the line.
__________________________Republican Maverick at Large
-4:Strongly Disagree; 0:Meh; +4:Strongly Agree
But it also prevents
people who are more than willing to be those guinea pigs from doing so. One of the anecdotes in SiCKO involved a man who was willing to undergo a not all that experimental surgery for cancer, the chances of success high since he found an exact marrow match in his younger brother. The insurance company said no, on the grounds that it was too experimental according to their company standards.
So it isn't that rich people are offering themselves for programs that no one else will take: quite the opposite! Our system of insurance makes it financially impossible for non-rich to take part in these kinds of procedures.
Would a socialized system offer more or less roadblocks to this? The instinct is to say "more", BUT if their driving incentive is to keep people healthy (the surest way of keeping expenses down, since profit is no longer an issue), I can't imagine that they'd be too opposed to it - but I'll see what I can dig up on policies in places like Canada, France, etc.
The man in question died, by the way.
__________________________Saint, n. A dead sinner revised and edited. - Ambrose Bierce
The man in question
The man in question died, by the way.
And not only was no money spent on his treatment, but from that day forth no money was spent on his treatment. Perhaps this is the most obvious way to hold down costs.
Nor will he pay any more taxes,
so it'd be a net loss for the government, and no loss for a private health insurer. Check.
__________________________Saint, n. A dead sinner revised and edited. - Ambrose Bierce
One more quick notice
I have been off medicine for hypertension for four years, My BP has been sky high, and I should by all rights be dead of a stroke, which runs in my family.
Things is, the drugs that work for me are cheap, safe, and are not abuse drugs. I could have afforded them. What i couldn't afford is the doctor to write the prescription. (I recently found a way to get a prescription.)
I've never been a believer in drug laws,, which are designed to save us from ourselves. I have held this position for as long as I have known what the word 'drug' meant.
Just awful
Sure, they can say that, but will they? I only have the dreaded anecdotal evidence to support this, but in my personal experience, doctors will automatically prescribe the latest, greatest drug. Especially, it seems, when the patient has insurance. I have, more than once, had to specifically ask for a generic prescription after discovering the copay on the initially prescribed drug was rather high because it was a "Tier One" (or whatever) drug.
__________________________We are the environment. There is no distinction. What we do to the earth we do to ourselves. —David Suzuki
RE: Just awful
So, let me understand the bottom line here: under our existing system you, personally, were able to (a) make informed decisions, and (b) get access to the most affordable drugs available (i.e. generics, where they exist)? Does that sort of accurately summarize the situation?
__________________________Republican Maverick at Large
-4:Strongly Disagree; 0:Meh; +4:Strongly Agree
Accurate summary
Yeah, pretty accurate. I also have a decent health insurance plan. When I didn't, I couldn't even afford the generics, so I just chucked the prescription when I found out how much it would cost.
Not exactly sure what your point is. I am not complaining about my situation regarding health care at all. I've got it pretty good these days. Of course, I also probably pay more in insurance premiums than I personally would spend on health care if I didn't have insurance. Insurance companies love to have people like me as a customer! (Although now my wife more than makes up for that.)
I was simply pointing out that relying on doctors to have the financial interests of their patients in mind when making prescription decisions is perhaps not the best thing to do.
__________________________We are the environment. There is no distinction. What we do to the earth we do to ourselves. —David Suzuki
That's the idea
I was simply pointing out that relying on doctors to have the financial interests of their patients in mind when making prescription decisions is perhaps not the best thing to do.
One would expect that the doctors would ordinarily have their own financial interests in mind. We would normally expect the patient to have his own financial interests in mind.
One of the problems (I'm making a narrow point here) with third party payer systems is that no one has the financial interests of the payer in mind. If that third party is an insurance company, you will see lots of resentment hen they assert their interest. If that third party is the government, well, NO ONE has the financial interests of the tax payer in mind, do they?
So, in any system where the patient has no finanicial interest in keeping the costs down, they are likely to be higher. And we all know that if the government is involved, well, they will gladly pay $500 for muscle propelled nail driving devices, and they will pay $2 for aspirin.
Except when costs get out of hand, then they get arbitrary. Ever deal with Medicare?
Speaking of nonsense,
using Medicare as a predictor of how bad spending would be under socialized care begs the question of why it's cheaper in other countries that have a more centralized health system.
And one of the reasons is precisely because healthcare makes up a higher percentage of government spending: the government has every incentive to keep spending down, especially in nations that, unlike ours, have no interest in running on a deficit.
__________________________Saint, n. A dead sinner revised and edited. - Ambrose Bierce
Here's today's laugher
government has every incentive to keep spending down,
No one working with OPM has an incentive to keep spending down.
What happens is that eventually, the money becomes limited. In fact, that has happened to Medicare, which cuts people out of treatment regularly for financial reasons.
You don't think that Medicare just pays for anything the doctor orders , do you? Not only do treatments have to be pre-approved, they have to be renewed to continue. "MTB" is often the judgment on renewal applications.
This is always going to be the reality because the amount of treatment that could be brought to bear on diseases costs more than the total amount of money available in the entire country.
Facile response,
given that I was not talking about our government, but those that - amazingly - are not spending $2 an aspirin. I know this concept must be foreign to you, but they are keeping costs per patient lower than we are. Anything productive to say on that, or would you prefer to keep laughing?
__________________________Saint, n. A dead sinner revised and edited. - Ambrose Bierce
I think that's an issue
No matter who we put in office, no one is pressured to NOT spend $2 for an aspirin. We can look at other countries all we want, but as long as the government is flush with cash (via higher taxes) they will find a way to spend it, and health care is no exception.
Not that I think that the Status-quo, wait-till-it-gets-better option is any better, but our government doesn't know how to have any restraint on spending, and it's amazing that we think they'll take better care of health care when they can't even be upfront and honest with us on earmarks. Put in Republicans, and they hide tax collections in obscure appropriation bills. Elect Democrats, and they hide tax collections in obscure appropriation bills. Imagine the fun they can have with tax money intended for health care. $2 Million for a Cough Medicine History Museum, anyone? (That shouldn't be funny, but I wouldn't put it past them).
If you have a child who keeps asking you for more money and does not care to justify how they spend the money they already get, you are going to be reluctant to give them more money.
Congress can't handle immigration, they run from tax reform, social security, and energy. They're not ready for another system to manage--especially one that could allow lawyers manage our health system. We might as well just throw the dollar bills into a landfill-bound garbage can (which, ironically, may actually get to its intended destination more efficiently).
__________________________http://wealthweekly.blogspot.com
Wii FC:2805-8311-8040-2678
Brawl: 2277-7051-2186
I can't wait for the
"Coming of Dextromethorphan" display.
The expectorant room promises to be fun!
RE: Facile response,
They are keeping costs down by rationing care and avoiding care through the use of long waiting periods. How much of that privately spent money to go either to a private clinic in Canada or to come across the border to the US is factor into those spending figures, BTW?
It is easy to make the costs look low when you (a) don't provide the services promised, or (b) hide a significant portion of the cost in out of pocket expenses of patients that don't show up on your books.
__________________________Republican Maverick at Large
-4:Strongly Disagree; 0:Meh; +4:Strongly Agree
Do you think
that we are not over-medicated as a society? I've posted some links that make that argument, so I'd be interested to know what your opinions are on this.
Given that it's more time consuming to work out a healthy living regime and it costs doctors nothing to prescribe a medication, it's no wonder that we're trying (and failing) to accomplish with pills what other countries are trying (and succeeding) to accomplish with preventative medicine. Our system makes no sense except in the arena of profit.
Let's talk for a second about incentive, since that's one of the debates that comes up a lot whenever socialized medicine is discussed. The argument is that companies will have no incentive to push for newer and better technology, since competition will be severely stifled. This may be true.
On the other hand, let's do a comparison of the goals of profit-driven medicine versus socialized medicine. The incentive in the first is profit, pure and simple. So here's a question: as a drug company, does it make more economic sense for you to develop a medication that keeps symptoms at bay, or one that cures a disease? Clearly the first, and this may go a long way towards explaining why we're such a pill-based culture. Likewise, is it more worth it for a doctor to bill insurance companies for multiple visits, or for a single, comprehensive visit? Again, the first brings in more cash.
Now, compare that to the British system as outlined by Moore (with a grain of salt, since I haven't read up on the specifics). What incentives drive the industry once profits are taken out of the picture? For the government, lowering the amount spent on healthcare is at the top of the list, given how large a portion of spending has to be dedicated to it. To that end, they give bonuses to doctors who keep their patients healthy and out of the hospital, for which they receive extra compensation when successful. By shifting the focus of how one makes money from pure profit to health, the end result - a healthier overall population - is achieved.
That does sound good to me.
__________________________Saint, n. A dead sinner revised and edited. - Ambrose Bierce
This is nonsense
right here (this specific and oft-made abwstract nonsense):
So here's a question: as a drug company, does it make more economic sense for you to develop a medication that keeps symptoms at bay, or one that cures a disease?
Of course. I well remember while people were dying around me of polio wishing that that there might be some way to cure the disease, or, even better, to prevent the disease. But, you know, it never happened, even though someone leaked that some doctor the name of Salk had developed a preventative vaccine. There was a huge industry at that time treating polio victims in hospitals, and that meant lots of drugs were being sold to aid in that treatment. A whole system of spas and clinics provided all kinds of care for those who had survived polio but suffered after effects. FDR, for instance, spent a mint on such care. And we all know the rotten, evil capitalists in the health care system weren't going to allow some vaccine to interrupt their profit stream. So, they quashed it, and no one brought it to market.
That is why to this day, polio ravages our children every year.
Possibly nonsense,
and yet here were are, consuming far more medication than the rest of the world, and to what end?
Do I think the prescription drug companies are hiding some miracle vaccines in a vault? No, not really. Do I think it's much more to their benefit to hype yet another antihistamine instead of shifting their research to the sources of allergy-development? Given the money that Claritin has raked in by the bulldozer-full, I most certainly do.
__________________________Saint, n. A dead sinner revised and edited. - Ambrose Bierce
Didn't you just say the same thing
twice?
I assume you are speaking of developing some vaccine that would prevent allergy development.
btw, do you think that Claritan qualifies under fairleft's notion of something that is a benefit of society? Just asking. Maybe your answer depends on whether you have an allergy that is best treated with Claritan.
Do you know off-hand how much it cost to bring Claritan to market? Please include all its failed drug-mates in the pipeline.
Do you think there is something wrong with raking in a profit for Claritin?
In fact, I did not say the same thing twice.
I said companies likely do not have vaccines hidden in vaults, but they also don't have any economic incentive to put research towards longer-range solutions. Why should they, especially when we're talking about something non life-threatening like allergies?
When did this become an issue of right or wrong? I'm talking about incentives and benefits, and it's to the benefit of drug companies to produce something like Claritin, because it brings in a very large profit.
What Claritin does not do is provide anything but temporary relief for a condition that affects Americans far more than the rest of the world, oddly enough. But if there's no incentive towards researching long-range solutions, then more money will be thrown at antihistamines. Which it is.
And it's terrible health policy. Not "morally" wrong, or whatever else you were trying to lead with that question, but if the goal of healthcare is health, then it's certainly misguided.
__________________________Saint, n. A dead sinner revised and edited. - Ambrose Bierce
You make a lot of assumptions
without any backup.
Perhaps you will tell me the exact expenditures of the drug companies on allergy research.
Do you have any idea of the difficulties involved with allergies? Scientifically speaking?
But if there's no incentive towards researching long-range solutions, then more money will be thrown at antihistamines. Which it is.
Like i said, that is why our children are dying of polio to this day.
pico, you are making abstract arguments that fit your belief. My bet that a preventative for even some allergies would be a gold mine. My bet is that any drug company would love to have one.
In the mean time, damn those drug companies for providing drugs which relieve symptoms. Damn them.
btw, If your purpose is to screw the makers of Claritin, ask for the generic version.
When my daughter has her next allergy attack, I won't give her any medicine, telling her that pico says that relieving her symptoms is terrible health policy. (She uses the evil diphenhydramine.)
You make a lot of
emotional arguments to try to further your points:
Strawman/Appeal to Emotion--In the mean time, damn those drug companies for providing drugs which relieve symptoms. Damn them.
Appeal to Emotion--When my daughter has her next allergy attack, I won't give her any medicine, telling her that pico says that relieving her symptoms is terrible health policy. (She uses the evil diphenhydramine.)
Try to argue without resorting to these cheap rhetorical shots. pico did not call anyone evil, nor did he suggest you should not give allergy medicine to your daughter.
Bad form.
Please read
nor did he suggest you should not give allergy medicine to your daughter.
No, he just said it was bad health care policy. Why would I want to use bad health care policy on my owhn daughter? Would you?
Strawman/emotional attack--In the mean time, damn those drug companies for providing drugs which relieve symptoms. Damn them.
Sorry, but this is exactly what he is saying. He thinks and so stated that the drug companies should NOT be developing more antihistamines, but rather spending their research dollars elsewhere, in some sort of research on allergy prevention, like he apparently knows they are not.
This is rather an example of taking his arguments to their logical conclusion. period.
I'm sorry if it caused you to get emotional. Not my purpose. My daughter is just a case at hand.
I think pico was clear about what he thinks about the makers of Claritin.
I did not say
your points were wrong (nor am I saying they are correct either), but there is something to be said for putting substance ahead of an antagonistic (and IMO enticement to emotion) style in a public debate forum.
Maybe I should write another diary (in addition to the other two--here
and here 
--I pointed out to you previously) about what people's goals are here. If it is to point out faults in others' reasoning, that is great but try to use a style that invites others to see the errors of their ways (laughing and saying people are not contributing intelligent remarks, et al, are not the best strategies to complete this task). If it is just pure ego boost from trying to ridicule people, that is kind of sad and I recommend a more fulfilling hobby. If it is to downright change ingrained opinions, we are such a small community that the significance of this impact is questionable leading me to believe it is either ridicule or ego boost since your style does not suggest the most efficient route to change minds or show faulty reasoning.
I suggest people relax a bit around here and calm down with the over the top rhetorical styles that seem more interested in chasing people off than creating understanding or workable solutions.
Thanks.
I see from your
mind reading that i am a reprehensible person.
I didn't know Ihad all that in my mind.
Case in point. n/t
Here's my case in point
there is something to be said for putting substance ahead of an antagonistic (and IMO enticement to emotion) style in a public debate forum.
And the accusations get worse from there.
I weas feeling emotionally attacked and a little low after i read your vicious, non-substantive words. I had to look around the furniture of my mind to see just how reprehensible I actually was.
Me bad. Me bad.
Agreed. n/t
Republican Maverick at Large
-4:Strongly Disagree; 0:Meh; +4:Strongly Agree
RE: You make a lot of
Ha. This is funny. In my experience --> MOST <-- liberals argue PRIMARILY from the position of emotional argumentation ...
But think of the little children!
__________________________Republican Maverick at Large
-4:Strongly Disagree; 0:Meh; +4:Strongly Agree
Especially on this topic
"4,000 million Ameriocans are without healthcare"
Above, the patient whose insurance company would authorize an experimental treatment died. How sad. ( Note: these two words are meant to recall Mose Allison's autobiographical song wherein he says he never really knew his dad, and remarks, "How sad.")
Yes, liberals and their emotional arguments
I must point out however, that your mention of this emotionalism is aiding Al Qaida!!!! Who want to invade and kill us all and then forcibly convert our corpses to Islam!!!!
Yes, this emotionalism is a liberal-only habit
< /snark>
RE: Yes, liberals and their emotional arguments
Where did I say this was a liberal only phenomenon?
Can you explain how my pointing out that --> MOST <-- liberals tend to argue from an emotional perspective is aiding al Qaeda?
__________________________Republican Maverick at Large
-4:Strongly Disagree; 0:Meh; +4:Strongly Agree
RE: RE: Yes, liberals and their emotional arguments
Where did I claim that you did?
Can't tell you. It would reveal weaknesses to the enemy. Just trust me and don't do it again or the deaths will be on you head.
(I apparently closed my snark too quickly last time, so I'll leave it open here)
RE: RE: RE: Yes, liberals and their emotional arguments
By the official rules of snark, or sarcasm, isn't this:
supposed to have some element of truth to it whereby you are thus making fun of my prior comment?
__________________________Republican Maverick at Large
-4:Strongly Disagree; 0:Meh; +4:Strongly Agree
RE: RE: RE: Yes, liberals and their emotional arguments
I suppose you COULD read it that way. Just as one COULD read your inclusion of the word 'liberals' in your comment as exclusion of non-liberals from the same degree of categorization. But pointing that out wouldn't have gone anywhere.
Agreed. n/t
Republican Maverick at Large
-4:Strongly Disagree; 0:Meh; +4:Strongly Agree
Give me one reason why I should bother
responding to comments like this:
which is not only completely wrong, but pretty reprehensible, at that.
Seriously, give me a reason. I came into this discussion doing my best to discuss common ground issues, and this is the b.s. you're starting to throw at me in response?
__________________________Saint, n. A dead sinner revised and edited. - Ambrose Bierce
Specter has already
rushed to your defense. Bless him.
You did seem to me to downplay the importance of treating symptoms of allergy and seemed to not want the drug companies to continue to explore for better treatments for allergies.
To be truthful, your saying that it was bad health care policy was a shock to me. Not an anaphylactic shock, but a shock never the less.
And my daughter HAS been saved from death by allergy with epi a time or two. Good thing my wife is a nurse.
Anyway, me bad. me bad.
No, that is not what I was doing.
Putting the bulk of research towards treating symptoms instead of towards cures is bad health care policy, but it has nothing to do with how your daughter uses what's available to her. And it's awfully dishonest of you to jump to that.
Incidentally, when I was a kid I was allergic to pretty much everything they tested me on, including foods, animals, plants, whatever. As an adult I've retained serious problems with hay fever, and medications tend only to work in the short term (I took biweekly shots as a kid, as well).
If your daughter has a problem with histamines, she may want to consider neti
as a possible treatment. (That link goes to a study by the University of Wisconsin)
__________________________Saint, n. A dead sinner revised and edited. - Ambrose Bierce
The kid
has pretty much gotten over serious allergies, although she still gets the hay fever and stuff. Asthma, not so much, but it is better than the breathing treatments twice a week she used to require.
We spent a lot of time with her at the ER (always pre-approved) with her when she was very young.
We had a great HMO back then.
Anyway, I thought your statement6 was ideologically based, not based on any actual knowledge of decision making.
To tell you the truth, I haven't the foggiest idea where a scientist would start looking for a cure to allergies.
Anyway, I'm just not as paranoid as some here.
Nor do I have the same need to have for profit businesses confomrm to my idea of what they should be doing.
But then, I don't expect dogs to stop screwing on my lawn just because it's immoral. I just turn the hose on them.
So, I think we should use the hose on corporations when they do something we think they shouldn't.
Now, what great medical breakthroughs, medicine-wise, have come out of socialized medicine recently? There's been a few, including a couple from Cuba, but most are coming from the US because there is more incentive to do the research here. In your socialized system, not only would cures not be pursued, improvements in amelioratives wouldn't be either.
One bright spot is India, which may become a player.
Where do you get this from?
Is there some study, article, statistic you could point to?
My impression always was that the US v. EU and Japan do the bulk of research and invent most of the new drugs about equally between them. And it's the level of government funding and tax breaks to scientific institutions and private enterprise that make the difference not how much profit is made selling health insurance (do health insurance companies fund any research at all?).
__________________________Sic semper tyrannis
woodsman, woodsman
please stay your axe.
I've been googling on and off all day. I'm very bad at it.
I found this:
This from a 2002 report.
I also found many European reports lamenting their falling behind, noting that once Europe was the leader, and resolving to come back to prominence. On the other hand, I note that Novartis, based in Switzerland, I think, recently moved their R&D facilities to the US.
I'm stll looking for that clear chart of contry by country new drug finds like i've seen. Help me out.
Lies, damned lies, and...
I hate to make an obvious point, but this is a good example of how numbers can support or demolish an argument depending on how you approach them:
Let's turn those numbers into percentages based on population size (in other words, all other things being equal, a larger country should be producing more drugs than a smaller one):
Japan: 127 million people, or roughly 1.19 drugs per million
U.S.A.: 302 million people, or roughly 0.86 drugs per million
U.K.: 60 million people, or roughly 0.6 FDA priority-review drugs per million
U.S.A.: 302 million people, or roughly 0.26 FDA priority-review drugs per million
So why is socialized England producing over twice the number of drugs for its resources than we are? Could it be that the argument that socialized medicine stifles innovation is a fabrication, if not an outright lie?
__________________________Saint, n. A dead sinner revised and edited. - Ambrose Bierce
Thanks for the demonstration
Of course, thjis piece of lying with statistics is really transparent. No one was discussing "drugs developed per unit population."
I would say that this conversation needs to go a few layers deeper than "socialized medicine stifles innovation." The question is why it is that not only do drugs seem to be developed here at a faster rate, but why even companies based in other countries want to launch them here. Further, some companies are moving their research headquarrters here, even as the actual research by even American companies is being outsourced. finally, Europe actually had the lead in new drugs until a decade or so ago.
I'm sure the answer as to why is not so simple as "socialized medicine."
My suggestion is to simply ask the question directly.
As usual, any actual discussion is destroyed by those taking an ideological position for or against socialized medicine, and then connecting that in a broad brush way to drug innovation. It forces one to draw conclusions on questions before and without considering the facts.
Huh?
Er... they don't. That was the whole point of my statistical experiment. Per capita*, we develop drugs more slowly than in Japan or England.
The lie is in presenting the numbers as if they represent rate (your word), which they most certainly don't. A comparable example: is city A or city B growing at a faster rate, if city A increases by 10 people and city B increases by 20? Ah, you need to know more, don't you? In fact, you need to take the sizes of the city into account, don't you?
Otherwise, I agree that the conversation needs to go deeper than a simple ideological argument.
* - edited since I don't have the numbers on researchers, but I somehow doubt that England is fielding the same number we are. In fact, the numbers might be even worse for us, considering how many people we have working in this country in the medical field.
__________________________Saint, n. A dead sinner revised and edited. - Ambrose Bierce
"per capita"
is just nonsense.
The rate is "per year."
Population size has nothing to do with it. geesh!
In fact, you need to take the sizes of the city into account, don't you?
If you are talking about rate of increase (or decrease) in population. We are not. We are simply talking about rate of new drug discoveries per country. In fact, it is standard to consider the US v Europe. (15 countries)
It is a term like miles per hour. Drugs per year. You might try to say that it is unfair because we have more people. But remember, Europe had the lead not that long ago. When you think of the great drug companies of my youth, a large per centage of them were European. Now, even some of the European companies are moving the research operations here.
Perhaps you need a primer in statistics...
Obviously size of the country has nothing to do with it. Next you'll be telling me that the United States produces more drugs than Andorra, and I'll be equally shocked. Clearly our system must be superior to the system in Andorra, then. All five of its citizens would agree.
Incidentally, I looked up the site where you got those statistics. A press release from a U.S. marketing firm? Really?... lol I was hoping for something like an actual academic study. But what's worse is how they try to put a smiley face on what's obviously not a terribly positive picture. Take a look at these numbers side-by-side:
and
So if we set NCEs at 1 for Europe and 1.6 for the U.S. (since the study doesn't give the actual numbers), that means the U.S. is producing 0.53 NCEs for every billion spent, and Europe is producing 0.59 NCEs for every billion spent.
In other words, the only reason they're behind us is because we're larger and wealthier. For every dollar spent on research, they're making better gains. And that's assuming that "European counterparts" means all 15 countries taken as a whole, not individually. If not, the numbers for us are even worse!
That study is as close to "lying with numbers" as one gets without being boldface about it.
__________________________Saint, n. A dead sinner revised and edited. - Ambrose Bierce
Okay, pico
In other words, the only reason they're behind us is because we're larger and wealthier.
If you can justify this logically, I will pay you. What was the only reson they were ahead of us a couple of decades ago?
The only reason. How stupid do you think the people here are? You have no respect.
You win. You aren't interested in honest discussion, you are simply interested in a**hole sophism.
You have a chargee about the statistics, the study I cited from the National Academies, you majke that charge known. If you have a problem with any statistics, provide better statistics.
Again, your sophism is amazing. The question was not how many NCE per unit money spent, it was how many new drug discoveries per country. Period.
The question, I guess, is why it costs so much here, and I guess that has to do with how much it costs to get a drug to market. Think?
YOu can peddle the ideological crap anytime. Let me know if you ever want a real discussion.
I thinhk you
've just poisoned this board beyond redemption.
Jerk!
Fu**l off, b****rd. A**ahole.
God, I hate it when people like you ruin a good thng.
Yerp, China gets more drugs out because they have more people. That's right.
I was so hoping that this place was going to be about intelligenct discussion and not mere chanting.
You sheeple ruin it for us.
Really sad flameout.
It's pathetic when someone can't acknowledge that he may be mistaken.
Which is a dishonest claim, given our size. Period. I notice my point on Andorra wasn't lost.
Similarly: Andorra has less crime than we do. Clearly they have a superior penal system, because size of population doesn't matter when studying total numbers. Right?
That is the argument you're making, in essence.
Hey, guess what: this supports my point, too: if China isn't producing the same level of innovation per capita, then they're doing something wrong. That China isn't leading the world is an indication of just how wrong their system is.
But this is a spectacular flameout. Are you going to come in again later and explain that you were just joking? You do that a lot, I've noticed.
__________________________Saint, n. A dead sinner revised and edited. - Ambrose Bierce
RE: Really sad flameout.
And a fitting tribute to your self-centered intransigence.
__________________________Republican Maverick at Large
-4:Strongly Disagree; 0:Meh; +4:Strongly Agree
Is that directed at me?
I'd be more than happy to pull this whole thread into another diary and let the community decide who's being reasonable/unreasonable.
__________________________Saint, n. A dead sinner revised and edited. - Ambrose Bierce
RE: Is that directed at me?
Is it attached to your comment?
I note that you took a shot at MS related to making jokes or specifically claiming to make jokes, a lot. I interpretted this as attempting to imply that MS was not playing fair somehow or was somehow dishonest. Was this not you intent?
So I felt obliged to help the pot to see that it was calling the kettle black with respect to it being sad when someone can't admit that they are mistaken. I have noticed that in you a lot too (but not necessarily in this thread as I have not followed it closely).
I have no dog in this fight, but I don't like to pass up a good opportunity when I see one. :)
Please carry on ... as I know you will!
__________________________Republican Maverick at Large
-4:Strongly Disagree; 0:Meh; +4:Strongly Agree
Reference to something else:
I got angry at a comment of MS's the other day, because I thought it was condescending. He replied that he was only joking, and that we're reading too much into what he rights. That very well may be true, especially for the comments he was addressing.
Here, I'm being semi-snarky, because if that's an attempt at humor, it's pretty far off the mark. But I see why'd you read my response that way.
__________________________Saint, n. A dead sinner revised and edited. - Ambrose Bierce