Tag: doctors

Scientific Studies are Becoming Difficult to Read

Ellie McFarland | @El_FarAwayLand

Vaccine and climate “skeptics” have been in the news for the past decade. Known as anti-vaxxers and climate deniers to the public, they ignore science, insult people with different opinions, and fearmonger innocent people. These are the people everyone can laugh at– liberal, conservative, anarchist, or statist. Yes, everyone laughs at the meme involving an anti-vaxx mother balming pasteurized milk for her child’s scarlet fever. The media and pop culture have done a fantastic job of making the scientifically illiterate universal punching bags. But we shouldn’t be blaming these people; scientific studies have been getting harder and harder to read, and the scientific community has played its part.

Continue reading “Scientific Studies are Becoming Difficult to Read”

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What Economics Should Teach Trump About the Opioid Crisis

By Dr. Kyle Varner | United States

For a business magnate, Donald Trump is surprisingly ignorant about basic economics.

Back in August of this year, he was offered a copy of Henry Hazlitt’s Economics in One Lesson and he would have done well to take a look at what it had to say. The missed opportunity to educate himself on the subject is particularly painful now that Trump is trying to apply his economic ignorance to tackle the country’s opioid crisis.

Just last week, the President called on the Chinese government to apply the death penalty against distributors of Fentanyl, a dangerous opioid drug, because “the results will be incredible!”

America, this is not going to end well…

Governments have been trying to reduce the social harm of opioids by restricting their supply since at least 1729 when the Emperor of China issued his first decree against opium. This did not go well for the Chinese, giving rise to a highly profitable business of opium smuggling and culminating in the disastrous Opium Wars of the late 19th century.

The results have been similar in the modern war on drugs, which America has been waging for more than 100 years. Despite the federal government’s best efforts to protect public health by restricting the supply of opioids, marijuana, LSD, cocaine etc, it has been largely ineffective. Prohibition has consistently failed throughout history–and if you understand the economics of supply and demand, it’s obvious why.

The Basics of Supply and Demand

At the core of supply and demand are prices. Prices provide everyone in the market with vital information. They’re a signal to producers, telling them how to satisfy consumers and what obstacles there are to overcome.

When something as common as toilet paper becomes scarce, prices rise. The higher price prompts producers to act: new suppliers move into the market, lured by the high prices and an opportunity to undercut the competition. As supply increases, prices fall.

Market pricing mechanisms ensure that shortages are temporary and supplies of goods are available. This, however, only works in a free market. When the government intervenes, supply and demand are prevented from finding equilibrium, leading prices to stay artificially high or low.

So what happens when the government tries to restrict the supply of drugs like Fentanyl?

The Economics of Prohibition

Prices will rise. There will be a greater incentive to smuggle Fentanyl (and the even more dangerous drug Carfentanil) into the United States. And with so much money to be made, there will also be a greater incentive to divert narcotics from medical supplies in the U.S.

Narcotics obey the same rules of any other goods: the higher the price goes, the harder the suppliers work.

On the buyer’s side, there are severe consequences as well. Someone who is truly addicted to a drug is typically willing to pay for it at any cost. As prices rise, addicts often take even more desperate measures to obtain the drugs–even if it means turning crime.

How to Solve the Opioid Crisis

Instead of prohibition, we need to legalize the sale of opioids that are the least likely to kill people. This will provide addicts with less deadly and less costly alternatives to Fentanyl such as low potency opioids like oxycodone IR, hydrocodone, or buprenorphine.

We must be realistic. If people are going to take harmful drugs, the best course of action is to make the market and consumption of these drugs the least harmful. Legalizing these drugs for over-the-counter will reduce overdose deaths. By eliminating covert distribution and administration of drugs, HIV infections will fall as will hospital admissions for cellulitis and endocarditis. Billions of dollars and tens of thousands of lives will be saved.

Without the cruel and unwise policy of prohibition, fewer people will die because they won’t have to use unsafe means to get high. It’s literally the difference between choosing a simple Percocet tablet or a dirty heroin needle. Prohibition pushes people towards the dirty heroin needle.

Conclusion

For centuries, governments have been trying to protect the public by restricting the supply of opioids and with no positive results. They’re doing the same today by pressuring doctors, sending militarized police to bust down doors, and begging foreign regimes to execute people. Instead of saving people through prohibition they are spreading death and destruction.

Coercion is deadly and immoral. To help fight the ongoing opioid crisis, let’s try freedom.


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Should Doctors Stay In Their Lane? Physician Says Yes

By Dr. Kyle Varner | United States

The National Rifle Association ruffled a lot of feathers recently when it published a tweet that said doctors should “stay in their lane” on the subject of gun control.

As a practicing physician, you might be surprised to hear that I side with the NRA.

There’s something fundamentally different between diagnosing and treating a disease in a patient and recommending a new law because you treat people injured by guns.

While I can sympathize with how sad it is to see one shooting attack after another in the news, the fact remains that gun violence is currently at a historic low in the United States. The FBI reports that gun violence was actually at its all-time highest in the mid-1980s. The rate has gone from 6.2 shooting deaths per 100,000 people in the 80s down to 3.4 per 100,000 in 2016. That means shooting deaths actually went down almost 50% in the last 30 years!

But whether or not gun deaths are going up or down, the key issue is in presenting partisan political proposals as medical recommendations.

When you push for a medical recommendation to become law, you are essentially trying to make the entire nation your involuntary patient. When doctors put on their white coats in political discourse and recommend authoritarian policies, they’re acting outside the scope of their expertise–and trying to force their opinions on millions of unwilling subjects.

The idea of informed consent is paramount to medical practice. As doctors, we should never force our therapy on our patients. Not only is this immoral, but the results can be deadly.

For decades, medical professionals have advised low fat, high carb diets, which studies increasingly show is completely misguided. Had this been just advice from doctors to their patients, that would be one thing. Instead, with the government’s support, this advice was established as indisputable fact and taught to an entire generation. The result has been to kick off a diabetes epidemic that’s set to make my generation the first in American history to have shorter life expectancies than their parents.

This is also the same profession that refused the idea that stomach ulcers could be caused by H. Pylori for twenty years. This stubbornness prevented people from getting the appropriate treatment for easily curable stomach ulcers, leading hundreds of thousands of people to suffer or die unnecessarily.

Today, because of irresponsible medical prescription practices, the US is currently facing an opioid epidemic that claimed the lives of an estimated 72,000 people last year. This is roughly the same amount estimated to have been killed by guns in that same time period.

Clearly, “staying in our lane” and focusing on the problems being perpetrated by our own industry could have a much more significant impact on the country than getting involved with gun politics at a time when guns have never posed less of a safety threat.

While many of my colleagues think of laws as helpful rules that let people get along, the truth is that laws are enforced by governments with the use or threat of violence. This isn’t hyperbole–if people fail to comply, they will be arrested and locked in a cage.

Medicine and public policy have no legitimate relationship to each other. Medicine concerns itself with diagnosing and healing individuals. Public policy concerns itself with the use of state violence against peaceful people.

As healers, we should always reject the use of violence. Even if we think a law might make the world a safer place, it remains immoral to condone the use of violence to stop violence.


This article was originally published on KevinMD.com

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The Lies Opponents of Single-Payer Health Care Just Keep Telling

Craig Axford | United States

Another day, another article by an opponent of universal health care publishing lies about Canada’s single-payer health system. That’s right, lies. There’s no point anymore in giving the people that publish these articles the benefit of the doubt given both the evidence and people’s experiences with the health care systems they are attacking are so radically different from what they describe.

There’s a list of talking points critics of programs like single-payer work from. I’m sure at some point they were written down somewhere, but by now everyone on both sides of the universal health care debate can recite them from memory: single-payer is expensive, there are long wait times, patients are denied their choice of doctor, and of course people suffer and die needlessly as a result of one or more of the above problems.

In an article appearing in The Hill on July 28, Dr. Dean Waldman follows the talking points to the letter. He offers us a list of assertions, but no data to back any of them up. He makes a number of claims about the Canadian and British health care systems without once telling us how they compare either in terms of cost or outcomes to the US system, all the while implying the US system is far superior to both. My family’s experience is limited to the US and Canadian systems so I won’t spend much time on the UK’s National Health Service other than to cite some data.

No health care system is perfect. By its very nature health care delivery involves difficult choices. These choices are often forced upon health care providers and insurers (whether the insurer is the state or a for-profit company) under very difficult circumstances. If you’re looking for situations where the outcome was less than ideal, or even tragic, you can find examples in doctors’ offices and emergency rooms around the world.

But if you’re going to use these examples to tear down a country’s entire health care system and to hold your own up as superior at the same time, intellectual honesty demands that you show the examples you are using occur with less frequency in your own system than in the system you’re attacking. So, for example, you don’t allege one problem with the Canadian health care system is a lack of patient choice without also showing that there is a greater degree of choice under the American model. If it turns out there is less choice in the US than in Canada, you have to admit that the Canadians have at least done a better job of providing choice to patients than the US.

The same is true when it comes to cost. Telling people over and over again that single-payer is too expensive without providing any comparisons to the cost borne by consumers and society as a whole under the American model is being dishonest.

Dr. Waldman, like so many before him, makes a number of assertions without providing his readers with any comparative data. He claims, “The British and the Canadians pay a very high cost for their systems, and not only in monetary terms. Single-payer health care systems take away individual choice, they discourage life-saving research and innovations, and they exchange quality of care for a balanced budget.”

It’s worth noting here that the first sentence and the second appear to contradict each other. On the one hand “The British and the Canadians pay a very high cost of their systems” in, among other things, dollars, but on the other “they exchange quality of care for a balanced budget.” Either the government in these countries is spending a lot on healthcare or they are skimping on it to avoid deficit spending. Which is it?

Regardless, both in Canada and in the UK the amount of money spent per capita on health care is far below what Americans spend on it. In Canada’s case that was $4,752 in 2016. In the UK the amount was $4,192 for the same year. Dr. Waldman rightly points out that in the United States that amount is over $10,000 annually, but his failure to provide any context is troubling given he wrongly implies healthcare is incredibly costly in both Canada and the United Kingdom. Indeed, Dr. Waldman goes so far as to claim the single-payer system being advocated by Senator Bernie Sanders would cost a whopping $18 trillion, or roughly 90% of the total current US economy. Given Canada currently spends more than 50% less than the US per capita, that’s an obvious falsehood.

Source: Peterson-Kaiser Health System Tracker

Dr. Waldman and other critics of universal health care programs would likely respond that it is precisely this lack of spending that is the problem. Setting aside the fact that such an argument directly contradicts their claim that universal health care programs are too expensive, this objection raises the important question of what the citizens of countries like Canada and the UK are getting for their roughly $4 — $5,000 in per capita health care spending when compared to the average American’s more than $10,000 investment in the same product.

Given Dr. Waldman’s unsupported assertion that “There is death-by-queueing in single-payer systems, where sick persons die from treatable conditions because they could not get care in time and succumb ‘waiting in line’ for care,” we would expect to find that Americans spend less of their lives suffering from disability and disease than Canadians, the British, or others living under the heavy hand of government-run healthcare systems. But instead, the US leads the developed world by a wide margin when it comes to the number of years lost to disability or premature death.

Source: Peterson-Kaiser Health System Tracker “Disability adjusted life years (DALYs) are a measure of disease burden and the rate per 100,000 shows the total number of years lost to disability and premature death.”

Dr. Waldman works for the Texas Public Policy FoundationBy itself, this is an unremarkable fact, but one has to wonder if being from Texas is the reason he’s not so keen on drawing attention to the shortcomings of America’s healthcare when compared to other nations. Texas has the highest maternal mortality rate in the developed world. According to an NBC News story on the crisis in Texas, “Texas’ maternal mortality rates are 35.8 per 100,000 live births as of 2014, according to a study in Obstetrics and Gynecology. By comparison, the maternal mortality in Japan was 5 per 100,000 live births, according to UNICEF’s 2015 data. In Poland, it was just 3.”

What about life expectancy? Given Americans are spending so much on healthcare relative to everybody else, surely they get a few extra years for it. Nope. According to the Organization for Economic Cooperation and Development (OECD), as of 2017 life expectancy in Canada was 81.9 years, in the UK it was 81.2, and in the United States it was 78.6. In fact, Chile and Costa Rica had higher life expectancies than the United States.

Finally, a note about choice. My wife and I have lived in Canada for seven of the last eight years and will be returning within days of this article. During our time in Canada, we’ve had several direct encounters with the health care system and have gotten to know a number of Canadians that have been dealing with it their entire lives.

Because my wife has type 1 diabetes, finding and keeping affordable healthcare in the United States was always a struggle. Group insurance through an employer was the best option, but this meant that every year as her employer signed on to a new plan she often had to find a new doctor because her old one was not part of the new insurer’s network.

As the name implies, single-payer means there’s one insurer for everyone. No doctor is outside a Canadian province’s network. If a Canadian travels to a new province, agreements between provincial governments guarantee coverage will be maintained. The only reason a doctor might turn someone away is because he/she is no longer accepting new patients.

My wife has been able to find a specialist she likes in Canada. There’s absolutely no danger that at the first of the year British Columbia is going to decide to drop her doctor from their network because every doctor is paid through the same network. In other words, Canadians have by far greater choice than Americans. Americans insured through their employer have no say in who the insurance carrier will be from year-to-year and the pool of doctors inside any given insurer’s network will always be smaller than the total number of doctors available. It is simply false to speak of American healthcare as an example of choice in this context.

Healthcare delivery always involves tough choices. Triage requires individual doctors and entire healthcare systems to prioritize the treatment patients will receive according to the staff and other resources available and the demands being placed upon the system on any given day. That’s true in every country in the world.

But Dr. Waldman and other critics of universal coverage are simply wrong when they say that countries like Canada and the UK are doing a poorer job of handling these choices than the United States. The statistics don’t support their claims and haven’t for quite a while. The fact that Dr. Waldman failed to provide data for Canada or the UK in his article should make clear he knew the data didn’t support his argument.

Speaking from personal experience I can say without hesitation that the cost to us of the Canadian system has consistently been very small relative to what we spent on healthcare in the US. Test results have been available to us within 24 hours every time and our treatment at doctor’s offices and hospitals have been excellent. In the US, getting test results required a return visit to the doctor’s office which usually meant another bill. The amount taken out of our pay-checks in the United States to cover our personal portion of the monthly insurance costs would have paid for roughly 6 months of premiums in British Columbia.

It’s time Americans stop listening to the critics of universal healthcare and start looking at the data. By every measure the American health care system is failing to deliver the kind of care so much spending should guarantee every single citizen. When it comes to health care the United States lives in one very big glass house. It should stop throwing stones at other countries and start taking a good hard look in the mirror.

Follow Craig on Twitter or read him on Medium.com

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