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EMTs and Doctors: Do you have a go bag? February 21, 2014

Posted by David Bookstaber in Healthcare, Open Questions, Uncategorized.
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This winter’s severe weather reminds us that emergency infrastructure isn’t always available. Even in populated areas a severely injured person could be stranded for days. Fortunately, medical technicians and specialists live amongst us. Unfortunately, many I have talked to don’t take emergency preparedness as seriously as they could.

If you are a medical technician and you found yourself stranded with an injury you’re trained to treat, would you have the tools you need? Typical first aid kits do not contain the following essential tools any EMT can use to save lives and limbs:

  • Airway management devices (OPAs or NPAs)
  • IV catheters and solutions
  • Hypodermic syringes and injectable lidocaine and adrenaline
  • Sutures
  • Obstetric kits

What if you’re stranded for days and have to handle and stabilize emergencies from anyone within walking distance? If you have surgical training wouldn’t you rather have general anesthetics, chlorhexidine, scalpels, and hemostats than have to try to improvise them?

Think of your training, and then think of what you could store in small “go bags” kept in your house and vehicle that you might wish you had on hand when hospitals, stores, and ambulances are hours or days away.

Pseudoephedrine Update August 30, 2013

Posted by David Bookstaber in Healthcare, Markets.
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My wife takes pseudoephedrine continuously to control chronic allergies. When the Combat Methamphetamine Epidemic Act took effect in 2006 I noticed an across-the-board price increase in the generic formulations: 20-count packs of 12-hour pseudoephedrine went up about 50%. Perhaps this was justified because pharmacies were suddenly liable for extra training, control, and logging of sales of any medication containing pseudoephedrine.

The law made it a big pain to keep a supply of the medicine: Individuals are prohibited from buying more than 3.6gr/day. And strangely, the largest and most economical size packaged by pharmacies was kept at just 2.4gr. (The daily limits do not apply if you go through the trouble of getting a prescription for the drug.)

Costco has finally come to the rescue: They now sell 3.6gr of 12-hour Sudafed for $10, which takes advantage of the full daily limit and is the same price as 2.4gr of the generic 12-hour I’ve found at any other pharmacy.

Victims of the Meth Epidemic need not worry: For whatever it’s worth it’s still a misdemeanor to buy more than 9gr in a 30-day period.

Emergency Medical Supplies September 25, 2012

Posted by David Bookstaber in Healthcare, Open Questions, Uncategorized.

I raised the subject of survival stockpiling earlier.  Here I’d like to build a list of the drugs and medical supplies that would be most useful during an extended disaster.  Ideally one would be prepared to deal not only with traumatic injuries but also with the sorts of medical problems that tend to emerge during prolonged stress and in the absence of first-world infrastructure and sanitation. (Ref also the truth about drug expiration dates.)

Beginning the list are “first aid” supplies that should be accessible to everyone:

  1. Antiseptic swabs and ointments
  2. Adhesive bandages
  3. Sterile gauze rolls, pads, and tape
  4. Sterile saline solution
  5. Hemostatic powder/pad (Zeolite, QuikClot)
  6. Thermometer
  7. Tweezers
  8. Scissors
  9. Anti-diarrheals: loperamide (Imodium), bismuth subsalicylate (Pepto-Bismol)
  10. Rehydration powder
  11. Aspirin, ibuprofen, (analgesic, antipyretic, NSAID)
  12. Acetaminophen (analgesic)
  13. Antihistimines: diphenhydramine (Benadryl)
  14. Decongestants: pseudoephedrine
  15. Expectorants: guaifenesin
  16. Stimulants: caffeine
  17. Laxatives
  18. Antacids
  19. Emetic: ipacec
  20. Ointments:
    • anesthetics (lidocaine, benzocaine)
    • antibiotics (permethrin, malathion)
    • antifungals (ketoconazole, miconazole, tolnaftate)
    • antihistamines (Caladryl)
    • antivirals (acyclovir)
    • steroids (hydrocortisone)
  21. Cold packs (note: also usable for improvised explosives)
  22. Heat packs
  23. Smelling salts
  24. Breathing barrier with valve
  25. Latex gloves
  26. Condoms
  27. Contraceptives: levonogestrel (Plan B)

Anyone with emergency medical training will also want

  1. Manual aspirator or suction unit
  2. Sphygmometer
  3. Stethoscope
  4. Epinephrine auto-injector (Epipen)
  5. Epinephrine inhaler
  6. Hypodermic syringes and injectable lidocaine and adrenaline
  7. Sutures
  8. Airway management devices (OPAs or NPAs)
  9. IV catheters and solutions
  10. Obstetric kit
  11. Antiseptic scrub (chlorhexidine)

During disasters that might involve extended disruptions of pharmaceutical supplies, a stockpile should also include the following drugs:

  • antibiotics: levofloxacin (Levaquin), doxycycline
  • antibiotic, amebicide, and antiprotozoal: metronidazole (Flagil)
  • antifungals: itraconazole, ketoconazole, griseofulvin
  • anthilmentic: pyrantel
  • oral antiseptic: chlorhexidine (PeriDex)
  • anxiolytics, sedatives, hypnotics, anticonvulsants, muscle relaxants: benzodiazepines and barbiturates
  • narcotics: morphine, oxycodone
  • stimulants: amphetamines, modafinil
  • steroids: hydrocortisone, prednisone
  • vasodilators: nitroglycerin
  • bronchodilators: theophylline
  • urinary anti-infective: methenamine
  • general anesthetic: propofol

The Truth About Food and Drug Expiration Dates July 25, 2012

Posted by David Bookstaber in Healthcare, Markets, Regulation.
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The FDA colludes with food and drug manufacturers to maintain a twisted myth about food and drug longevity. For example, here’s an FDA “Consumer Update” in which a pharmacist emphatically warns people not to use drugs after their expiration dates.

But how are expiration dates set, and what happens when drugs “expire”? A great article by Laurie Cohen in the 2000-03-29 WSJ investigated these questions. Key discoveries:

  1. Manufacturers can set expirations as short as they want.  It appears that they mostly choose dates to optimize the turnover of inventory.  I.e., they don’t want their products sitting in stores or medicine cabinets for 10 years, even if they’re good for that long.  They’d rather stamp a date a year or two out, forcing retailers and encouraging consumers to buy “fresh” replacements.
  2. Pharmacies typically mark dispensed drugs with a 1-year date of expiration, without regard to the expiration date of their supply.
  3. Military tests have determined that most drugs are safe and potent for years after their marked expiration dates.
  4. Storage conditions have a dramatic effect on food and drug longevity.  In general, the lower the exposure to heat, moisture, oxygen, and light, the longer they last.
  5. Most drugs begin to “decay” from the moment they are manufactured.  The risk of consuming old drugs is not that they will be dangerous, but rather that they will be less effective than fresh drugs.  E.g., an old 100mg pill might be only as therapeutic as 90mg of  a new pill.

For a lot of drugs “reduced potency” is not a reason to discard them.  Perhaps the most outrageous piece of this conspiracy:

[P]oor countries — under urging from the World Health Organization — often reject drug-company donations of much-needed medicines if they are within a year of their expiration dates.

Infant formula vs breastmilk: oops June 24, 2011

Posted by David Bookstaber in Healthcare.
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Advertisements for Enfamil powdered milk often include a striking chart showing that its formula produces infants with mental performance just short of that of breastfed babies, and 7 points higher than that of babies fed its previous formula, which wasn’t supplemented with DHA and ARA.

It appears they’re referencing a study published in the March 2000 Developmental Medicine & Child Neurology. The performance metric was the Mental Development Index of the Bayley Scales of Infant Development (BSID) II.

Anyone who has had a baby in this country knows that there is a raging war between breastfeeding fanatics and their opponents who maintain that (1) not every woman has the capacity or luxury to exclusively breastfeed her babies, and that (2) formula is a reasonable alternative to breastfeeding. The former “breast nazis” tend not to tolerate exceptions to the “breast is best” mantra: Failing to exclusively breastfeed is considered tantamount to child abuse because even modern formula fails to confer all of the health benefits of breast milk. Meanwhile, two generations of adults who were often raised exclusively on formula say, “Relax, we turned out alright.”

Without wading into the debate or the data, I had sympathies for both groups: One would presume that human milk is the optimal food for human babies, and it seems unlikely that scientists have identified and mass-produced every nutrient that breasts distill. On the other hand, it’s obvious that the full range of human potential has been realized in people who never tasted breast milk, and while we may not have perfected it there has been plenty of scientific attention to producing a formulaic substitute.

There exist many legitimate circumstantial obstacles to breastfeeding, so individual feeding practices should generally be respected. But this Enfamil study makes a strong argument for the “Breast is Best” camp: After all, up until ten years ago formula lacked two nutrients that contribute to a significant and measurable improvement in infant development. Oops! So what else is our formula missing, and what is the associated price we’re paying in human health and performance? The short answer: We’ll never know.

Formula has three extraordinary hurdles to jump before it can even begin to address this sort of question:

  1. A specific nutrient has to be identified that is lacking in the existing formula but is present in breast milk
  2. A performance test has to be created that can be applied to babies
  3. A double-blind test has to be run that shows a statistically significant difference in performance between babies fed with and without the nutrient

Perhaps the greatest obstacle is the second. For example, what developmental benchmarks are missing from the BSID? Not only is it hard to measure a baby’s performance on anything, but there is also quite a limit to the performance they can even display at such an early stage of development. Our best current tests might still be missing some testable characteristics, but they are certainly missing untestable or latent characteristics that manifest themselves later in life. However, by the time a human is fully developed any “breast vs. formula” effect has been so muddied by other nurturing factors that it can’t be statistically discerned.

QOTD: Root Causes of Education and Healthcare Inequality February 5, 2010

Posted by David Bookstaber in Education, Government, Healthcare, Markets.
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From Will Wilkinson’s paper last year on Income Inequality:

If we are worried about inequalities in education and health care, as we should be, we might stop to consider that these are precisely the areas we have chosen to shield most jealously from entrepreneurship and market

Skipping the Simple Fix December 21, 2009

Posted by David Bookstaber in Healthcare, Regulation.
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Brian Daley points out that government is skipping the easy fix — opening a national market for health insurance — in favor of socializing a significant part of our economy:

Everyone likes his doctor but hardly anyone likes his health insurer. So what thoroughly puzzles the logical mind is why Congress and the administration have focused on taking over the country’s health-care delivery system when what everyone really wants is health-insurance reform.

Plans can be standardized for easy price comparisons. Paperwork can be standardized for easy processing. The 50 separate state departments of insurance can be replaced with one set of national regulations to allow insurers to compete nationwide. The chronically uninsured can be provided with catastrophic health insurance by the federal government—all without adding the trillion dollars of deficit spending the Congress and administration now want to spend to take over the health-care delivery system.

Health-care providers can be required to post their prices, as well as their rates of mortality and morbidity, on the Internet so informed consumers can comparison shop based on both the price and quality of care.

Reforming how health-insurance plans are designed, whom they cover, and who pays for the uninsured is faster, easier and cheaper than the congressional bills, and it would reduce bureaucracy and minimize the interference of government agents in the patient/doctor relationship. The power of the Internet can be unleashed to pull back the curtain that currently conceals what providers are charging for health care just as the Internet revolutionized the way consumers now shop for automobiles.

Granted, Obama & Company recently let the cat out of the bag, admitting that nationalization of the medical industry has long been of paramount importance to the left-wing agenda.  On Saturday Obama explained, “After a nearly century-long struggle we are on the cusp of making health-care reform a reality in the United States of America.”

At least now we know what this is really about….

When Will the FTC Investigate the FDA? November 16, 2009

Posted by David Bookstaber in Healthcare, Regulation.
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The massive healthcare lobby can’t break the FDA’s stranglehold on medical innovation.  Can a bureaucratic turf war do it?  Consider the following statement by the Federal Trade Commission Chairman, Jon Leibowitz:

We’re going to be very concerned about any practice that could increase prescription-drug costs to American consumers.  You can’t let drug safety be used as a tool to delay … competition.

Of course, the ellipses conceal the qualifier that will dash our hopes: The FTC is only interested in ensuring competition of “generics” for drugs coming off patent.  If a useful drug never makes it to the market in the first place because of the excessive regulation by the FDA he probably doesn’t care.

We Already Have Government Death Panels September 24, 2009

Posted by David Bookstaber in Healthcare.
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Among them, as I have pointed out before, is the FDA.  Matt Alsante brings our attention to the latest mass death sentence handed out by our government:

As the debate about health-care reform has heated up, there’s been a lot of talk about creating expert panels that give bureaucrats control over what treatments we can receive. Truth be told, these panels already exist. Earlier this month, the Food and Drug Administration (FDA) bureaucracy made a decision that will deny women a viable option for fighting ovarian cancer.

What About Universal Legal Care? September 5, 2009

Posted by David Bookstaber in Healthcare, Judiciary.
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Since government already has its sleeves rolled up to reform the healthcare industry, Richard Rafal offers “A Doctor’s Plan for Legal Industry Reform” along the same lines.  Which only seems fair — after all, if the U.S. Constitution provides for any universal right to healthcare it has hidden that right in its “penumbras.”  But it explicitly enumerates universal rights to legal care (legal counsel, due process, speedy trials, the right to petition the government, etc.).  The judicial system is our last governmental defense against infringement of our inalienable rights, but these days it is practically inaccessible except through the legal cartel.

Rafal’s Legal Industry Reform is worth reading in full, but here are some highlights to get you started:

Each potential legal situation will be assigned a relative value, and charges limited to this amount. Program participation and acceptance of this amount is mandatory, regardless of the number of hours spent on the matter. Government schedules of flat fees for each service, analogous to medicine’s Diagnosis Related Groups (DRGs), will be issued. For example, any divorce will have a set fee of, say, $1,000, regardless of its simplicity or complexity….

Legal “death panels.” Over 75? You will not be entitled to legal care for any matter. Why waste money on those who are only going to die soon? We can decrease utilization, save money and unclog the courts simultaneously. Grandma, you’re on your own.

Ration legal care. One may need to wait months to consult an attorney. Despite a perceived legal need, physician review panels or government bureaucrats may deem advice unnecessary. Possibly one may not get representation before court dates or deadlines. But that’ s tough: What do you want for “free”?

The Problem with Government Healthcare August 31, 2009

Posted by David Bookstaber in Government Spending, Healthcare.
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The WSJ gave Betsy McCaughey half of their opinion page on Thursday to expose the views of Ezekiel Emanuel (“Obama’s Health Rationer-in-Chief“).  The disapproving essay concludes with a question, “Is this what Americans want?” and seems to presume that Emanual’s principles for allocating scarce medical resources are so horrifying that simply describing them is sufficient to reject them.

However this did not reduce my enthusiasm for Emanuel’s philosophy.  McCaughey’s citations show Emanual raising essential issues, making excellent ethical arguments, and providing solutions that make perfect sense for government spending on individual welfare.

The problem with this debate is that it is about two separate but sometimes correlated questions:

  1. How much healthcare should government provide?
  2. Should government healthcare usurp private markets for the same goods and services?

What is both reasonable and necessary for government healthcare would be unethical for free market medical services: Namely, a system for rationing finite resources that considers cost and benefits in a social, not individual, context.  Government can’t pretend that it has unlimited resources.  And in this debate I have not yet heard an explicit argument in favor of the default method for allocating scarce resources: queues.

Government needs some socialist basis for (A) taking money from some people (via taxes) and (B) giving it to others (via medical services).  Of course a major part of the debate pertains to (A), i.e., the degree and manner in which government is justified in coercing some people to contribute towards the health of others.  But given some level of government-sponsored healthcare Emanual offers an ethical framework — indeed, the only coherent one I have encountered — for part (B): disbursement of finite resources

The second question raised above is more difficult, but insofar as a rationing system is employed to problem 1A it need not interfere with private markets.  I.e., Govenrment should not encumber private commerce in medical goods and services even if it does itself engage in socialized medicine.

Healthcare: Government is the Problem, Not Cost August 17, 2009

Posted by David Bookstaber in Healthcare.

Craig Karpel makes an excellent point in his essay today, “We Don’t Spend Enough on Health Care.”  He cites studies suggesting that it would not be unreasonable for the American healthcare industry to grow from 17% of GDP today to more than 30% of GDP in a few decades.

Why not?  Industrialization has steadily decreased the resources Americans must devote to satisfying the basic human needs of food, clothing, and shelter.  With increasing resources to spend on non-necessities it should not surprise us to find individuals more disposed to indulge in advanced medicine.  Entertainment and luxury goods have a limited power to increase quality of life, especially once health and vitality begin to decline.  Until we have achieved perfect immortality health technology is the ultimate luxury good.

Yet government and the liberal establishment are evangelizing an odd perspective on the healthcare industry.  Obama’s attempts to increase the federal government’s role as a purchaser and provider of healthcare are premised on the argument that, “The cost of health care has weighed down our economy.”

The President’s complaint seems to be about the efficiency of healthcare — i.e., the amount of dollars it takes to purchase a given level of service.  It is true that any market inefficiency “weighs down our economy,” insofar as we enjoy greater production at a lower costs when markets run more efficiently.  We could say the same about any sector of economic activity — “The cost of transportation has weighed down our economy.  If only we could move people and goods more efficiently our economy would certainly grow!”

In this case, the President is actually saying, “We’re spending 17% of GDP on healthcare, and that’s too much because I happen to know we could get the exact same goods and services for just 15% of GDP!”  Of course, anyone who still believes that a government can acquire or provide goods and services more efficiently than for-profit enterprises in a free market hasn’t been paying attention for the last century.  Indeed, insofar as there are obvious inefficiencies in the healthcare industry government interference is invariably the dominant cause.

A slightly different formulation of the President’s complaint might be, “We’re spending 17% of GDP on healthcare, and that’s too much because we need to increase spending on [insert the cause du jour — the war, or the space program, or entitlements to special interests….]”  In which case this is just an opportunistic appeal for increasing government control of the economy.

In the first case the President is almost certainly correct — America’s healthcare spending is less efficient than it could be — but for the exact opposite reason he would stipulate:  The federal government’s staggering regulation and spending in healthcare impairs the efficient operation of that industry.

In the second case, we should celebrate a society that can afford to devote such unprecedented resources to any sort of discretionary spending.  We might debate priorities: Perhaps there is some level or character of individual healthcare spending we should find as tasteless as megayachts.  But so long as we are a free republic that is a debate that should be conducted outside of the halls of a coercive government.

American Politics Confronts the Ugly Reality of Fascism August 11, 2009

Posted by David Bookstaber in Government Spending, Healthcare.
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If the government is going to provide medical services with finite resources then it is going to have to make difficult choices: It can’t take a spare-no-expense approach to treating every single person.

I addressed the question of how to rationally distribute life-saving resources three years ago.  Any coherent allocation of these resources will be fascist, which makes government healthcare even more politically unpalatable in a culturally libertarian country like the United States.

Amusingly, the Obama administration is under attack because its healthcare policy advisor, Ezekial Emanuel, earlier this year published “Principles for Allocation of Scarce Medical Interventions” reminiscent of mine.  It may not help that he gave his proposal the vaguely orwellian name, “The Complete Lives System.”

QOTD: Kidney Donation July 15, 2009

Posted by David Bookstaber in Healthcare, Human Markets.

I have complained that “sexy” diseases get unfair resources, and current laws and regulations hurt the donor supply for life-saving human organs.  Kidney shortages are particularly troublesome because normal people have two kidneys but only need one.  Yet more than 80,000 people in this country alone linger on dialysis regimens and face early death waiting for a kidney donation.  Virginia Postrel elaborates:

Kidney patients ought to command the kind of outrage that demanded a cure for AIDS. The [waiting] list doesn’t have to exist. It is a result not of medical necessity or economic constraints but of public ignorance, conscious policy, and complacent institutions. Too many people are suffering unnecessarily. . . .

The obvious solution . . . is, of course, money. Altruistic blood donors often receive freebies like movie tickets or paid vacation hours that would be illegal for kidney donors. Plasma and sperm donors routinely receive cash, as do egg donors and surrogate mothers, who get tens of thousands of dollars. If transplant centers could pay $25,000 or $50,000 to each living kidney donor, many more people would line up to contribute.

Health Reform Myths July 1, 2009

Posted by David Bookstaber in Healthcare.
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George Newman has an excellent analysis of twelve arguments made in support of current government plans for intervening in the healthcare markets.

Congress Imitates Homer Simpson — II May 24, 2009

Posted by David Bookstaber in Energy, Healthcare, Taxation.
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Some federal legislators have decided that all of that government-subsidized sugar we’ve been adding to soft drinks all these years might not be so good for us.  Since government has assumed responsibility for the health of American citizens our representatives are ready to take action.  Naturally, they’ve decided to reduce those crop subsidies.

Oh wait, no, they’ve actually decided that the way to fix this problem is to impose an excise tax on sweetened drinks.  I.e., they’ll continue to pay farmers to grow more corn and sugar than the market wants, but they’ll discourage Americans from drinking it with a “soda tax.”

Because of course the best way to correct the unintended consequences of government is with more government.

Reminds me of Homer Simpson’s solution to overdosing on stimulants:

Clerk: Hey, you can’t take that many pep pills at once.

Homer: No problem, I’ll balance it out with a bottle of sleeping pills.

Sodium, Salt, and High Blood Pressure May 11, 2009

Posted by David Bookstaber in Healthcare, Regulation.
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Excessive consumption of sodium can raise blood pressure.  High blood pressure causes all sorts of expensive and deadly diseases.

Leave it to Bloomberg’s New York City to jump in at this point and conclude that we need government action to reduce sodium in everyone’s diet.

Of course, it’s not that simple.  But it is interesting.  I contacted the CDC, FDA, and NYC Health Department to compile and confirm the following information.

First of all, extreme imbalances of any electrolyte — high or low — can cause health problems, including permanent organ damage and death.  There is no question that on average Americans consume more sodium than is nutritionally necessary.  It is also medically proper for people with hypertension to reduce their intake of sodium as a first step to lower their blood pressure.  But if you don’t have high blood pressure there is no reason to specifically worry about your sodium intake.  (Although you may notice that if you stick to a healthy diet you are avoiding a lot of junk foods with elevated sodium content.)

Health officials seem to warn interchangeably about excess “sodium” and “salt.”  But it’s the sodium that matters, and there are salts in your diet that do not contain sodium.  Yes, table salt is conventionally sodium chloride, and sodium chloride does happen to be the primary source of sodium in human diets.  But it’s not the only one: you probably also regularly consume sodium bicarbonate and sodium nitrate.  When you look at the FDA nutrition label for a food, the “sodium” line is supposed to list the entire mass of elemental sodium regardless of what molecules it is bound up in.

Better that 99 go unaided than 1 be improperly treated March 5, 2009

Posted by David Bookstaber in Healthcare, Judiciary, Markets, Regulation.

Wyeth v. Levine struck me as a horrendous decision.  As the WSJ summarized from the dissent:

Justice Alito’s larger point is that “drug labeling by jury verdict” undermines the workability of the federal drug-labeling regime. Juries are presented with tragic plaintiffs who were injured, not the unknown patients who are helped, by a product. Hence, they tend to focus on risks more than overall benefits. By contrast, federal regulators are tasked to take the long view and factor in the interests of all potential users of a drug. 

The existing regulatory tax (i.e., the FDA approval process) on development and sale of drugs is already so high that consumers are certainly being harmed, being deprived of life-saving products that would otherwise be available to them.  This decision now allows individual states to unilaterally impose additional tort taxes, which harm the ability of interstate corporations and consumers to engage in mutually agreeable commerce.

I searched the blogosphere trying to understand how six of this Supreme Court’s judges could have backed this decision (best summary is here).  The only supportive analysis I could find suggested that this decision was really about federalism: preserving the rights of the states to not be preempted by the federal regulation.  But Overlawyered has a concise rebuttal to that notion:

Federalism is a two-way street, and permitting states to impair interstate commerce through a litigation tax upsets the federalist structure of the Constitution.

Stevens’ majority opinion notes, “Congress has repeatedly declined to preempt state law….”   So hopefully Congress can promptly close the floodgates of harmful litigation this decision just opened.

What Are We Really Giving Up? March 3, 2009

Posted by David Bookstaber in Healthcare, Natural Rights.
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Carrot or stick.  Silver or lead.  Government, like organized crime, tends to present you with immediate rewards and penalties that leave any reasonable person with no choice but to comply with their wishes.  It does not often make it clear what the true long-term cost of compliance is in terms of liberty.

I have pointed out how government-provided healthcare naturally and morally justifies government intervention in unhealthy personal behavior.  Now James Bovard at PA-AAPS points out the darker side of government-mandated computerization of medical records.  Granted, there are good arguments for this movement — improved healthcare efficiency, error reduction, cost savings.  The current government has decided that it has an interest in forcing the issue, so it is offering the carrot of funding for the transition and suggested that it will soon apply the stick of financial penalties to healthcare suppliers that resist.  But Dr. Bovard warns: Once government has paid for your private information, it owns it.  And don’t be surprised if it chooses to use it in ways you dislike.

Why flu spreads more during winter February 10, 2009

Posted by David Bookstaber in Energy, Healthcare.
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Shaman & Kohn are getting a lot of press for their article documenting a correlation between absolute humidity (AH) and flu virus transmission and survival.  But it was already well established that flu incidence peaks during the winter.  Shaman & Kohn have merely “rediscovered” this fact through a correlated variable: Apparently nobody covering their article is aware that AH and outside air temperature are nearly perfectly correlated on a seasonal scale.

Humidity itself is an interesting subject: For a given temperature and pressure there is an absolute limit to how much moisture air can hold.  The hotter the air, the higher that limit.  Relative Humidity (RH) indicates the ratio of actual water vapor to theoretical water vapor in the air.  When air is cooled, holding all else constant, RH increases because the capacity of the air for holding water decreases with temperature.  When RH hits 100% and the air is cooled further the moisture begins to condense right out of the air.

This presents all sorts of problems for indoor air quality.  Ideal indoor relative humidity is 30-50%.  Any higher and fungus begins to thrive.  Any lower and humans begin to dry out, which leads to health problems, some of which we’ll come to shortly.  During the summer even relatively dry outdoor air can hold enough water vapor to cause elevated humidity when cooled to comfortable indoor levels.  Fortunately modern air conditioners include condensers that remove enough moisture from the air they cool to keep humidity in line.  But many houses still have problems in basements, which are naturally kept cool by underground heat mass: As the outside summer air makes its way inside and cools in the basement, its relative humidity shoots up.  Without dehumidifiers basements get that musty smell indicative of fungus thriving on the moisture.

In the winter we have the opposite problem: Cold winter air, even at 100% humidity, dries out as it is heated indoors.  Without artificial humidifiers the RH of heated air can fall to single digits, which is drier than many deserts.  Humans acclimated to more temperate weather do not handle dry air well: their skin and sinuses dry out and crack.  Dry mucus membranes are more vulnerable to pathogens.  Which is why the onset of winter in temperate climates causes a spike in influenza: Eyes and noses are irritated from the dry air, so people are constantly touching them, sneezing, and coughing.  If that weren’t enough to get pathogens out of their body and onto their hands, then when they go outside the cold gives them a runny nose.  Now everyone’s hands are covered in respiratory pathogens, and they’re constantly putting their hands near the dried out mucus membranes those pathogens crave to infect.

No surprises here: Humidify your air during the winter to protect your respiratory membranes.  Wash your hands and keep them away from your face when they haven’t been washed.