May 04, 2007

Letter to the Paper LVI

Can't seem to post to this thread on Open Boook regarding futile care so I'll post it here.

The bottom line on health care resources whether money or not is that they are limited and insufficient to need. Somebody's going to die for their lack. The question is who is going to die and how many souls will have an early date with death because of improper resource allocation. The hospital administrators are juggling the question of reducing the total death toll from lack of resources while this group or that advocates for one particular case or another.

The hospital administrator may look callous in any particular case but they're playing a different game and I'm not so sure that their way of following the culture of life is not ultimately the better one. The bean counter can serve the culture of life just as well as the heroic nurse or surgeon. It would be wise to imagine how such a figure should act.

I would suggest that anyone who wishes to continue futile care should be able to. Systems do make errors and what appears futile sometimes is not in reality. They should not do so on somebody else's dime, though. They should not condemn perhaps multiple people to earlier deaths because we know about the one case but the others are safely nameless, faceless, unidentified.

Until the day comes when everybody can get all the healthcare they need, keeping someone alive without hope for improvement means somebody else who could have recovered will end up dead or unnecessarily crippled. Everybody's created in the image and likeness of God. Just because I don't know the names of those that will pay doesn't mean that it's ok to make them suffer because I want to precariously prolong my life on somebody else's dime with no hope for success.

Posted by TMLutas at 12:22 AM

March 22, 2007

Dissent in Canadian Medicine

Canada's Medical Association seems to be having a bit of trouble with it's journal (CMAJ). When the majority of your editors have been fired or resigned and the vast majority of your editorial board also tenders their resignations, something's seriously amiss. Unfortunately, like too many things in Canada, it's an undercovered issue.

HT: Medbroadcast blog

Posted by TMLutas at 11:19 AM

February 14, 2006

How to Find a Good Doctor

My wife relayed an interesting anecdote. She's doing temporary (locum tenens) work to fill in those empty slots while word of mouth brings patients to her door and a recruiter she worked with changed jobs and asked her how to find a doctor in the Atlanta area. Her advice was so good that I thought I'd blog it for the similarly perplexed who have good health insurance for the first time and don't know how to pick a doctor.

1. Contact the local hospitals and ask them for a list of nearby doctors who are taking new patients
2. Start calling the offices up and check whether they take your insurance and whether they would be willing to let you tour the office and meet the doctor.
3. Drop the practices from your list who are too busy to do such a thing or are anything other than happy to do it.
4. If you have multiple doctors who will allow you to tour, take the tour and pick the best one based on a checklist. Here's a sample:
How much do you like the doctor?
How convenient is the office location
Are the office hours convenient to your lifestyle?
how flexible are they if you would need to make an appointment outside regular office hours?

Posted by TMLutas at 09:32 AM

January 03, 2006

Missing the Freaking Point

Not all ventilators are created equal and that's the point that Steven E. Landsburg fails to understand in his otherwise on target fisking of Yucutan man's generally idiotic tear jerker post blaming George W Bush for a terminally ill cancer patient's ventilator support withdrawal.

Let's face facts. Not every poor person gets the charity care that we'd wish they had. There isn't enough money to provide 1st class medical care equivalent to what a member of Congress or a corporate titan gets. There just isn't enough money even in the most liberal of fantasy budgets.

So when you have X ventilator bed days available in your charity care budget, who do you give it to? Do you give two weeks of ICU to the poor guy who got caught in a building fire and has smoke inhallation and serious burns allowing him to recover and go back to supporting his family or do you give two more weeks to the terminal cancer patient who is waiting for her mom so that she can have her plug pulled and die in her mother's arms?

Did her brother offer a spare room and rent a ventilator for $80 a day? Let's say they did an ambulance transport (~$500), bought a hospital bed (~$700), and got somebody from the neighborhood to stay with her (~$700/wk). If mom took two extra weeks we're talking about under $4000 in expenses here. Her family could have raised that. Her family could have financed that. They didn't care enough to set back their own financial plans. (In reality, you'd shop for a cheaper bed or rent it and you'd pay more for skilled nursing visits but I can't find the appropriate numbers).

Hospital beds are an expensive way to wait to die. ICU beds are ~$1800 a day. That's the hospital overhead with all that equipment, all that specialized training waiting to resuscitate you at the drop of a hat. A two week wait for mom to show up would have pulled ~$25,000 from that hospital's charity care budget.

Tirhas Habtegiris' family decided that if society wasn't willing to pay ~$25k, they weren't personally willing to pay ~$4k and spend the time and effort to keep Tirhas alive. The reality is that Tirhas was failed. But it was her family that failed her. Her touching wish didn't merit her family's consideration. Why should society have granted her wish at 6 times the cost? And if her mom would have taken more than two weeks to arrive, the cost differential would have widened, not narrowed.

Providing charity care is something that a decent society does. You can do it publicly, privately, or using a mix of the two systems. It's always rationed though and the bottom of the list for that sort of care is, and should be, very expensive care for the terminally ill that has no medical benefit. The hospital, no doubt, would have been willing to move her home, helped out with providing a ventilator, maybe even educated a family member how to tend to the machine so Tirhas could have her wish. All that could have been done for less net expense. Hospitals are willing to do all sorts of unorthodox things if they're asked. Instead, Tirhas stayed in ICU and she died of it.

It's a real shame.

I'm speaking as someone who has gone through the process, including paying the bills afterwards (in my case the relative lived and continues to live). This sad story could have ended differently. The system provided a way out. The family either didn't choose to take it or the hospital didn't educate them that there was an alternative. Either way, the fault is not George W Bush's.

Posted by TMLutas at 09:55 AM

December 26, 2005

Merry Christmas at the Hospital

So we were sitting in the waiting room and a woman pipes up "Merry Christmas everybody! Santa just dropped some gifts off 6 minutes ago". It was a very nice bit of levity in what was a nightmare of a night. And what a night! My mom, over for a visit, gets pneumonia and manifests badly right on Christmas Eve. We got home (my father and I) after she was admitted and her paperwork was done some time past 4AM. Start to finish, ambulance call to back home was 5 hours.

Now that she has appropriate antibiotics running through her, she's lost the blue lips and is lucid once again. Now we have to figure out why the darn thing presented so atypically. There are lots of theories but for those who got the news over the phone, your prayers and well wishes have been very much appreciated.

Posted by TMLutas at 10:03 PM

November 13, 2005

The US has Bird Flu

Strategy Page, in an article about using H5N1 as a bioweapon, has the following chilling paragraph:

In a recent batch of smuggled birds tested by the Fish and Wildlife Service, about a third of the sample tested positive for H5N1. Some idea of the degree to which bird smuggling may pose a threat to public health, Britainís first cases of avian flu occurred in birds brought into the country by a smuggler who had reportedly made over six million dollars in the illegal trade.

In short, we've got bird flu. There is no smuggler interdiction program that has a 100% compliance rate. We've got the stuff because two oceans aren't going to help when there's an active bird smuggling problem in your country.

Posted by TMLutas at 09:04 AM

November 02, 2005

Define "Mandatory"

My three children will be getting vaccinated against the papilloma viruses that can cause cervical cancer and take too many lives each year. I think that Glenn Reynolds is right to tout the vaccine as a worthy advance for human health and to chide those who decry it as sending a bad message on abstinence. After all, if a girl goes to the altar a virgin and remains faithful her entire life, she can still catch the virus from her cheating husband bringing it home. A big part of vaccines is not catching the consequences of somebody else's bad behavior.

And yet, I think that the promoters are going overboard:

"I would like to see it that if you don't have your HPV vaccine, you can't start high school," said Juan Carlos Felix of the University of Southern California, who leads the National Cervical Cancer Coalition's medical advisory panel.

That bothers me. Keeping people out of school because of a lack of shots is supposed to be for safety reasons, not as a punitive measure. The kind of contact that occurs during normal school activity is not going to lead to HPV transmittal. There is no safety argument for denying public schooling as a consequence of not taking this vaccine. Do we really want to expand the criteria for excluding people from an education beyond the safety of other children? If an explosion of home schooling makes this sort of punishment an impractical stick what else can be taken away? A right to drive? A right to drink? What's the natural stopping point?

I'm not sure that there is a natural stopping point. I wish there was. Ace of Spades writes about:

I didn't mention this in the original piece, but there is sometimes an undercurrent of punitive prudery running through these arguments. One can make a good-faith argument against the vaccine, but sometimes people do seem to be thinking, way back in their skulls, "Well, you're a dirty whore. A little cervical cancer'll learn ya."

Punitive prudery sounds pretty awful. In fact, it's probably a good way to get to Hell. But is it appropriately punished by forcing a child out of the public schools?

You can sidestep the question:

Further, when the debate is over the "mandatory" immunization, I assume "mandatory" has wiggle-room in it. I think parents can opt out of MMR vaccination; I assume they could do the same with this one. It might be a pain in the ass to do so, but, you know, if you've chosen to let a kid risk getting cervical cancer which could be prevented by a shot, I think the least you can do is fill out some f'n' paperwork.

but that's just ignoring that first quote. Some public health officials don't want there to be any wiggle room.

I wouldn't have a problem with a few more roadblocks to nonvaccination beyond a little paperwork. In my book, it wouldn't be out of line to track at least the girls and inform them of the issues and offer vaccination when they achieve their majority. I do have a problem with those girls achieving their majority with substandard education because mom and dad have funny beliefs.

Posted by TMLutas at 12:25 PM

October 25, 2005

Drink Up!

Death from cirhossis may be a thing of the past soon. Such good news will save countless lives including an awful lot of creative types who famously drink themselves to death. The cure isn't getting trumpeted widely in those same circles and it seems a curious thing. It's an Adult Stem Cell (ASC) cure, of course, as all the real practical work is turning out from the ASC research pathway.

Embryonic Stem Cell (ESC) research gets a tremendous amount of press but doesn't provide any real cures. ASC provides cures but gets little to no press coverage trumpeting its triumphs.

Curious. It's almost as if there were an agenda there...

Posted by TMLutas at 10:13 AM

October 18, 2005

The Flu is not Overhyped

Instapundit passes on a reader remark.

As a medical researcher, I want to make a gentle but sincere plea to the blogosphere to calm down this flu hysteria just a bit. The main way that flu kills is by predisposing its victims to "superinfection" by bacterial illnesses - in 1918, we had no antibiotics for these superimposed infections, but now we have plenty. Such superinfections, and the transmittal of flu itself, were aided tremendously by the crowded conditions and poor sanitation of the early 20th century - these are currently vastly improved as well. Flu hits the elderly the hardest, but the "elderly" today are healthier, stronger, and better nourished than ever before. Our medical infrastructure is vastly better off, ranging from simple things like oxygen and sterile i.v. fluids, not readily available in 1918, to complex technologies such as respirators and dialysis. Should we be concerned? Sure, better safe than sorry, and concerns about publishing the sequence are worth discussing. Should we panic? No - my apologies to the fearmongers, but we will never see another 1918.

Patrick Cunningham M.D.
Assistant Professor of Medicine
Section of Nephrology
University of Chicago

No matter the method of flu death in the hypothetical, the reality is that we've got a bug that, in its limited spread to human populations, has a 55% mortality rate. These are real corpses and not theoretical deaths prevented by magical medical infrastructure.

If it retains that virulence, vast swathes of humanity will fall. They will fall in the Gap because there's no money, no infrastructure, no medicine available. They'll fall in the Core too, because we're going to run out of things. A rampaging flu virus is going to cause a huge surge demand in a field that Core-wide has come under either partial or full socialism, whether de-facto or de-jure. We've been eating our seed corn on the medical front for a long time now and we don't really know how bad the rot has progressed.

The truth is that we simply are not going to know how bad the flu is until it actually mutates and we know its characteristics. If its virulence is undiminished and its transmission follows standard human flu patterns, the statistics give pause. According to this CDC FAQ sheet:

Each flu season is unique, but it is estimated that, on average, approximately 5% to 20% of U.S. residents get the flu, and more than 200,000 persons are hospitalized for flu-related complications each year. About 36,000 Americans die on average per year from the complications of flu.

Translating out from an estimated 300,000,000 residents of the US:
5% roughly equals 15,000,000
20% roughly equals 60,000,000
The normal human flu mortality rate is 0.06% to 0.24%
A mortality rate of 55% which is what we're getting with H5N1 would equal a US death toll of range of 8,250,000 to 11,000,000 if its virulence was unabated but its transmissability was brought up to H3N2 standards through random mutation or nihilistic genetic engineering.

Let's say, for the sake of argument, that our medical system is going to save 90% of the deaths that would otherwise occur. That's 825,000 to 1.1 million dead and tens of millions in hospital. Do we have the beds? Do we have the home care substitutes? The logistics of saving these large numbers is daunting. We're not ready. We're not even close.

Posted by TMLutas at 11:56 AM

July 11, 2005


NARAL claims that it's about "choice". Now they're advertising a Screw Abstinence party. They claim that funds will be spent to promote sex education and the full range of choices. Apparently, those choices are not going to include abstaining from sex prior to marriage.

HT: The Corner

Posted by TMLutas at 02:27 PM

June 17, 2005

Schiavo Finale

I owe myself (and my readers) an honest bit of closure on Teri Schiavo. I was wrong, and the autopsy results (pdf) seems to have closed the book, on the level of damage Teri Schiavo had. I still can't understand Michael Schiavo and why he chose to act the way he acted. Seeking the additional tests the parents sought prior to letting go would have cost less, salvaged his reputation in an awful lot of people's eyes and perhaps saved us all from a national circus that should never have happened. His stand against testing and willingness to spend money on lawyers but not on medical tests was the strongest bit of evidence on the parents' side.

At this point, I hope that she is in a better place and at peace. I hope that the family will look to their own souls as they pray for hers.

Posted by TMLutas at 01:57 PM

May 15, 2005

Abortion Imperils Subsequent Pregnancy

A significant study on women who get an abortion and later try to have another child has established that having a prior abortion significantly (1.7 times) increases the chance of the subsequent "wanted" pregnancy having a risky premature birth. You can find the article abstract here which will confirm the Telegraph's accuracy for those who have an alergy to UK newspapers.

The question is whether this will change behavior at abortion clinics. Will women start to be warned about the dangers of abortion today to their future ability to have healthy children tomorrow? Will clinics be held liable if they fail to warn now that such a large study has found such a high increase in risk is associated with abortion?

Now is where the rubber hits the road for "pro-choice" feminists. They can either side with women and insist that they are fully informed of the established medical risks or they can side with the commercial interests of the abortion business. It would be nice to see some truly pro-choice women peel off and actually stand for informed choice. I'm not holding my breath.

If anybody knows where the full text of the study is freely available, I'd really love to hear about it.

HT: Michael Williams

Posted by TMLutas at 08:41 PM

April 21, 2005

Something Good From Canadian Medicine

Essence of Marijuana approved for sale under the brand name "Sativex" under the standard of "safe and effective". I do wonder whether the 30 day rule will come into play here.

Not only should this provide a real opening for the medical folks who would like to use marijuana to properly treat pain and nausea but it should also provide a useful lever for the agricultural hemp growers who would love to be able to add a billion dollars a year to the agricultural sector of the US economy by using hemp for fiber, paper products, oil, and other legal uses.

The hemp ban is particularly stupid but there's very little that's smart about US marijuana policy.

Posted by TMLutas at 04:38 PM

February 16, 2005

Some AIDS Sanity Emerges

The gay community, after a quarter century, has finally started catching up with public health officials.

While many are calling for a renewed commitment to prevention efforts and free condoms, some veterans of the war on AIDS are advocating an entirely new approach to the spread of unsafe sex, much of which is fueled by a surge in methamphetamine abuse. They want to track down those who knowingly engage in risky behavior and try to stop them before they can infect others.

It is a radical idea, born of desperation, that has been gaining ground in recent months as a growing number of gay men become infected despite warnings about unsafe sex.

Although gay advocates and health care workers are just beginning to talk about how this might be done, it could involve showing up at places where impromptu sex parties happen and confronting the participants. Or it might mean infiltrating Web sites that promote gay hookups and thwarting liaisons involving crystal meth.

Other ideas include collaborating with health officials in tracking down the partners of those newly infected with H.I.V. At the very least, these advocates say, gay men must start taking responsibility for their own, before a resurgent epidemic draws government officials who could use even more aggressive tactics.

"Gay men do not have the right to spread a debilitating and often fatal disease," said Charles Kaiser, a historian and author of "The Gay Metropolis." "A person who is H.I.V.-positive has no more right to unprotected intercourse than he has the right to put a bullet through another person's head," he said.

Once this new ethic takes hold, whenever it finally does, and creates a new homosexual consensus, I would expect that infection rates will finally start dropping from their depressingly persistent rate of 40k a year. Once we figure out the long-term effectiveness of these common sense measures, we can start counting the corpses of the unnecessary dead, the people who could have been saved but weren't because of liberal political correctness and homosexual militancy.

RIP to the victims, by then most of the perpetrators themselves will likely be deceased.

HT: Michael Williams

Posted by TMLutas at 12:23 AM

January 30, 2005

Adult Stem Cells Explained

I ran across a great article on adult stem cell research and why it is the superior alternative to embryonic stem cell research. I just thought I'd share. As far as I can tell, we're still in the same situation as in 2001 when the article was written. Embryonic stem cell research still gets great press and lousy results while adult stem cell research gets pushed to the side in the press while providing the bulk of advancement in scientific knowledge and the entire advancement of health in actual patients.

Posted by TMLutas at 04:30 PM

November 09, 2004

How HSA's Help Save US Health

Tyler Cowen misses the boat on HSA's because he's looking at the effects on the purchasers of healthcare. He finds that:

The plan has some admirable economic elements.† It provides a tax-free vehicle for savings; most economists agree that capital income should not be taxed.† But it is less of a health care plan.† Most of the potential beneficiaries from HSAs already receive excellent levels of care.† In sum, I like the idea of market incentives, but do not believe that HSAs will do much to make us healthier.†

One of the more perverse aspects of third party payment is that to become a provider affiliated with a healthcare company, your doctor contractually gives away his ability to set prices as he likes. Efficient innovation is no longer as richly rewarded while at the same time his customers become less price sensitive. While a few medical professionals maintain boutique practices of entirely cash based patients, this is not practical for the vast bulk of doctors so they must handcuff themselves to the pricing "guidelines" that the health insurers (sort of) provide.

HSA patients vastly increase the pool of price sensitive cash patients so that more doctors can rid themselves of the handcuffs of insurance provider contracts and enter the medical free market. Once free market providers become not just for the rich boutique medicine providers but also for the middle and upper middle class, you end up with a new stratum of providers who have middle class patients but have pricing flexibility. What ends up happening is that once you regain the ability to offer differential pricing, you can give discounts to those with a lower ability to pay and not force them to either accept humiliating charity or do without care.

It is the lack of the ability of providers to give discounts and the twinned problem of shame at "taking handouts" that currently afflicts a significant amount of those who receive less care than they should. This segment will increase their medical care consumption and thus, improve the overall health picture.

Posted by TMLutas at 07:48 PM

July 28, 2004

Iron Blog Subjects: Animal Research

Going through the Iron Blog topic list:

Either a new product is safe or it is not safe. Anybody who wants to introduce something like a medical device, a new operation, a drug, is faced with the dilemma that they think it's safe but nobody knows until it is tried many times. So who goes first?

You can do all the computer modeling you want. While the models may be very good at predictions, they are not complete models of all processes and interactions that happen in real life. Inventors regularly get surprised by results in real people that weren't caught in computer modeling. This isn't to say that computer modeling is useless. It's a cheap, efficient, and very fast way of going through an awful lot of possibilities and throws out a lot of bad ideas cheaply.

But if you don't have animal based research, you end up having to validate your computer model testing directly against human beings. Let's be honest and admit that doing this will result in a lot of injuries and deaths that would otherwise be avoided by animal testing.

But excess human injuries only matter if human beings are intrinsically worth more than animals. You have to buy into the concept that even the most vile human being is worth more than your average dog, cat, or even higher primate. To do otherwise is to concede that Mengele's human experimentation methods are salvageable, all that is needed is a revised list of unworthy humans who do not deserve life, liberty, and the pursuit of happiness.

Posted by TMLutas at 05:59 PM

Iron Blog Subjects: AIDS Funding

Going through the Iron Blog topic list:

How much do you fund efforts to cure a disease? Do you increase funding to placate the crazy protestors outside your door or do you fund strictly on the basis of how many people are dying and could they have done anything to not get the disease? In the case of AIDS funding, clearly we're over funding based on heavy mau-mauing of legislators all over the 1st world.

AIDS is avoidable in a way that breast cancer isn't yet AIDS funding trumps breast cancer funding by quite a bit as it trumps most other diseases in federal dollar funding even though it affects fewer people, kills fewer people than several other diseases.

In the end, this is a despicable decision by politicians who want to live their lives undisturbed by protests more than they want to save lives by prioritizing research into the cures for the biggest killers. We all deserve better.

Posted by TMLutas at 01:01 PM

June 02, 2004

Stem Cell Spin

Kevin Drum should know better by know to refer to embryonic stem cell research by the generic term stem cell research as if there was no such thing as adult stem cell research. The truth is that of all the research excitement over embryonic cell research, it is the adult stem cells that are producing the best results currently and are the furthest along in clinical trials, even in countries that do not restrict embryonic stem cell research.

It's dishonest spin to ignore the more promising treatments in order to play partisan political games.

Posted by TMLutas at 04:06 PM

May 24, 2004

Walking Again

A new study has shown incredible promise by combining three new spinal cord injury treatments in one triple treatment. Taking cells from the rats' own bodies, researchers were able to create a huge improvement, allowing 70% average mobility for all the experimental rats. It's very good to see an improvement in patient prognosis free from all the political controversy that seems to accompany so much biotechnological progress these days. Hopefully, they'll be able to translate these rodent results into human studies very soon.

HT: Slashdot

Posted by TMLutas at 02:04 PM

May 11, 2004

Letter to the Paper XXI

The Bit Bucket gets suckered by a sob story about stem cell research and I had to set him straight. No, Republicans aren't cruel, heartless Luddites. Democrats are playing a nasty form of special interest politics and manipulating everybody's heartstrings:

Frankly, I smell politics and desperation on this issue and it's not a very good recommendation for the Democrats.

There are two forms of stem cell research. Republicans favor adult stem cell research getting priority with restrictions placed on fetal cell research for moral reasons and cutting funding for it for practical reasons. The practical part is that in terms of medical value, having cells from somebody else, differentiated or not, causes immunological problems.

If you have two treatments of equal effectiveness, one fetal, one adult stem cell you would always go for the adult because you would not have to worry about your immune system killing off the graft, and maybe you. You wouldn't have to take immunosuppressant drugs for the rest of your life.

For the Democrats, I'm afraid, it's follow the money time. One of the big problems is where do you get fetal tissue to harvest the stem cells. Abortion clinics can turn a medical waste product into an important revenue source. With abortion rates sinking and political pressure on the clinics, they need all the ancillary revenue that they can get in order to stay in business so there is a financial incentive for them to push fetal stem cell research.

The kicker is that of all the stem cell therapies out there, it is adult stem cell research that is objectively the most promising because it's providing real results in the form of usable therapies to cure actual patients.

So distraught relatives like Nancy Reagan get told over and over the big lie that their loved ones are being denied treatments because the big bad Republicans are anti-science and some of them bite. It's a cynical, evil manipulation of people under severe stress. The current compromise leaves the back door open that fetal stem cells might have actual value but puts the heaviest government research bets on the stem cell research that is actually producing results. Democrats would like to reverse those priorities.

Why would any normal person without a financial stake in the outcome want to support that?

Posted by TMLutas at 11:28 AM

April 23, 2004

Pharma Price Controls Going?

Contrary to Chip Taylor I don't view the coming bill to allow imports from Canada to be the beginning of price controls in the US. I think it's the beginning of the end of price controls in Canada. The name brand medicines are really what this is all about. The drug companies haven't wanted to test NAFTA and have given in to the idea of lowering prices for Canada in order not to provoke the government there from invalidating their patents. But if it's the case of completely giving up their largest market and destroying their business versus trying their luck in court I predict that the majors will withdraw from the Canadian market unless Canada normalizes prices to resemble US levels.

This will somewhat lower US prices but the larger effect will likely be higher Canadian prices.

Posted by TMLutas at 05:55 PM

April 22, 2004

Healthcare Conscience

Andrew Sullivan's getting hysterical about a proposed law in Michigan. Contrary to Sullivan's assertion, and the overwrought article that he relies on for evidence, nobody is going to put up a sign saying "we don't treat gays". In fact, the bill prohibits any conscientious objections from ever being known by patients [11(1)c of the bill].

The way it would really work is that if a nurse objects to providing birth control advice, she doesn't get assigned to patients who want that service. There is also an exception for emergency treatment where everybody is required to pitch in to save lives. And whatever Michigan requires as a normal standard of care is not changed at all by this bill so if you're a solo practitioner, you're kind of out of luck on conscientious objections. With nobody else to hand care off to, you have to provide it anyway to maintain the proper standard of care as defined by the state. Furthermore, you can't discriminate against people with a particular condition like AIDS. That sort of discrimination is specifically prohibited.

Unlike Andrew Sullivan, I looked up the text of the bill and provided a link to it. It's not that long and is written pretty clearly. Homosexuals, prostitutes, drunks, and adulterers would continue to get medical care. It's just that those who have moral objections are much less likely to be fired for expressing them with the passage of this legislation. That doesn't seem to me to be a bad thing at all.

Posted by TMLutas at 02:15 PM

March 15, 2004

Yay For Stem Cell Research! I

What's a pro-life libertarian doing cheering on stem-cell research? Well, when it's adult stem cells and it provides an actual cure, I'm all for it.

Imagine that, you don't have to kill embryos to get a workable permanent treatment for baldness using stem cells. In fact, if you were to use embryonic stem cells, results would likely be worse. Think of that, the next time somebody tries to sell the tripe that only embryonic stem cell research is worthwhile because adult stem cells aren't as flexible.

Posted by TMLutas at 01:15 PM

March 11, 2004

Class Action Bonanza?

An article over at Clayton Cramer's Blog on condoms has opened my eyes to some interesting Democrat coalition fissures. It's a case of the free love feminists against the trial lawyers.

It seems that HPV is a sexually transmitted disease that is not stopped by condom use. rates vary widely from 1% to 88% depending on the population. Men are asymptomatic but women with HPV can get cervical cancer. California already has warning labels but Democrats are balking at making them a national requirement.

The problem is that cervical cancer fears from a disease that has no effect on men might make women have far fewer sexual partners, restoring female chastity to some extent. This makes free love advocates and feminists on the left very unhappy. On the other hand, tobacco litigation experts have got to be salivating over the idea of a product that is known to cause a crippling and sometimes fatal disease but carries no warning label.

If it weren't a life and death issue, the political implications would be highly entertaining to watch as they play out. Unfortunately, people are and will be dying because of this political fight so a lighthearted mood is highly inappropriate. The bottom line is that condom mania is just not an appropriate attitude if what you really care about is public health.

Posted by TMLutas at 09:12 PM

February 19, 2004

Voting to Kill Canadians VI

I really would prefer not to have to continue this series but the train wreck unfolds before your eyes. With Pfizer biting the bullet and cutting supplies, they'll play cat and mouse for awhile until either Canada steps in and stops it or Pfizer just withdraws from the country. No doubt, they won't be the only ones.

Canada, no doubt, would love to just break patent protection but if they do, they are more vulnerable to US retaliation than just about any other country on the planet. Something's got to give but I don't think it's going to be NAFTA. In the meantime, misjudgments of drug supplies are going to be inevitable and people will be severely inconvenienced or do without. Hopefully the body count won't rise too high before a solution is reached but remember, this is a train wreck that is decades in the making. Successive governments have been voting to kill canadians for a very long time. Eventually the bill comes due and actual deaths occur.

I only hope the victims aim their anger properly.

Posted by TMLutas at 11:31 PM

February 15, 2004

Malaria: US Unindicted Coconspirator? II

Ah, back from church. On our way there, I asked my wife about the story (she being the medical half of the family). When I asked her about the efficacy of chloroquine, she said that it was still ok for a few spots where there wasn't extensive resistence like some parts of latin america. She then said that she'd never prescribe it for an american because there would be too much legal liability to risk it. When asked whether it was appropriate for Africa where there was resistence, she simply said no.

What are we paying for, malaria medicine or do gooder self-esteem? If it's the latter, it's both a stupid waste of money and a public health crime.

Posted by TMLutas at 02:15 PM

Malaria: US Unindicted Coconspirator?

National Review has a very disturbing article on the current malaria treatment debacle in Africa. In a heavily documented J'accuse letter published in the Lancet.

If the accusations are true, and I believe that they are, US citizens, through USAID's badly conceived political pressure to override scientific recommendations are morally guilty of malaria's drug resistant resurgence in Africa.

More on this later.

Posted by TMLutas at 10:02 AM

January 31, 2004

Thank You France: International Plague

The PRC is probably the most problematic country when it comes to infectious diseases. It's got both a large territory and a huge population. And it's been cursed with a secretive government that is embarrassed by its public health failures which has the perverse effect of making them much worse. As diseases emerge, they often emerge in the PRC and the delay in instituting traditional public health clamp downs means that the cost and body count go much higher than is necessary, but apparently not for much longer.

The Pasteur Institute is recognized around the world as a leader in health and it will be extending that expertise into the PRC when it opens up a branch there with a mixed french and chinese staff and promises of autonomy and an institutional policy that "will respect Pasteur values" which has always put health first embarrassment second.

This is a major step towards guarding against the worrisome prospect of international plague outbreaks. It's always nice to see the french showing what they're capable of doing on the positive side. They're not all bonehead ankle biters. May they get a leadership that reflects that reality, and soon.

Posted by TMLutas at 09:44 AM

November 13, 2003

Manitoba Pharmacists Sound Alarm

Illinois pharmacists have invited their colleagues from Manitoba to speak to the Illinois legislature about Gov. Blagojevich's plan to reimport drugs from Canada. The view from pharmacists up north is clear. Drug reimportation will create shortages in Canada.

The real question is now that they've been told directly will the Illinois legislature care or will they pass explicitly 'screw you' legislation that deprives Canada of sufficient medicine to treat its own ill and if they do, what will Canada's politicians do about it?

Posted by TMLutas at 03:21 PM

July 23, 2003

Off with his leg

I'm in a medical mood today so here's a bizarre tale about the consequences of abandoning the hippocratic oath. Apparently 87% of doctors in the US don't ever take the oath, something that astonishes most laymen when we first hear of it. And with self-disfigurement disorders and suicide on the table, a doctor who can't be counted on to say no is downright frightening.

Posted by TMLutas at 11:11 AM