August 2009

We spent yesterday afternoon at a cook-out at our friend’s house. Sweet corn, steak grilled over charcoal and mesquite chips, potato salad and apple pie. But it was so cold we had to go indoors to eat. Our friend said that this is first time he’s lit the fire and eaten fresh sweet corn on the same day.

John at Powerline notes similar indications of unseasonable cool weather:

here in the Upper Midwest, but it came uncomfortably close. Now we have frost warnings for northeastern Minnesota and northwestern Wisconsin. Some places in the region recorded record lows today.

Of course, the recent colder than usual temperatures are just anecdotes. Gateway Pundit has links to more such anecdotal evidence; like this one, for example:

Thousands of stranded train passengers wait outside a railway station in China’s southern city of Guangzhou February 2, 2008. China is not yet over the worst of a winter weather crisis that has killed 60 and doomed millions to a cold dark Lunar New Year holiday next week. The State Council, China’s cabinet, issued a warning that snow, sleet rain and icy rain will sweep most parts of southern China for several more days, the official Xinhua news agency reported late on Friday.


LGF links to a report that some advertisers are going to Boycott the Glenn Beck show:

Among the advertisers to pull spots from the popular cable talk show are Geico, owned by Warren Buffett’s Berkshire Hathaway (BRK .A 101,550, -600.00, -0.59%) (BRK .B 3,329, -26.13, -0.78%) ; Procter & Gamble (PG 51.93, -0.37, -0.71%) ; Sargento Cheese; and Progressive Insurance (PGR 16.26, -0.17, -1.04%) , according to the companies and Color of Change, one group that is organizing a campaign against the program.

I already boycott Geico and Progressive. I won’t even go to Indians games at Progressive Field. Looks like P&G also goes on my “do not buy” list, joining GM and Chrysler.

In her Facebook response (reproduced here) to President Obama, citizen Palin cites chapter and verse on why people should be concerned that Obamacare will include independent panels that will make life-and-death decisions. These panels operate at the personal level and at the policy level. At the personal level, quoting Palin:

Section 1233 authorizes advanced care planning consultations for senior citizens on Medicare every five years, and more often “if there is a significant change in the health condition of the individual … or upon admission to a skilled nursing facility, a long-term care facility… or a hospice program.” During those consultations, practitioners must explain “the continuum of end-of-life services and supports available, including palliative care and hospice,” and the government benefits available to pay for such services.

And at the policy level, again quoting Palin:

My original comments concerned statements made by Dr. Ezekiel Emanuel, a health policy advisor to President Obama and the brother of the President’s chief of staff. Dr. Emanuel has written that some medical services should not be guaranteed to those “who are irreversibly prevented from being or becoming participating citizens….An obvious example is not guaranteeing health services to patients with dementia.” [10] Dr. Emanuel has also advocated basing medical decisions on a system which “produces a priority curve on which individuals aged between roughly 15 and 40 years get the most chance, whereas the youngest and oldest people get chances that are attenuated.” [11]

President Obama can try to gloss over the effects of government authorized end-of-life consultations, but the views of one of his top health care advisors are clear enough.

Of course, President Obama didn’t help his cause when he pondered whether or not his grandmother should have received a hip replacement. Kausfiles has the fatal transcript:

Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance. It’s not determinative, but I think has to be able to give you some guidance. And that’s part of what I suspect you’ll see emerging out of the various health care conversations that are taking place on the Hill right now.

Some Democrats are twisting Palin’s word to suggest she claimed the bill promoted euthanasia. Howard Dean is one:

On CNN Sunday, former DNC Chairman and Vermont Governor Howard Dean dismissed Palin’s comments. “About euthanasia, they’re just totally erroneous. She just made that up,” he said. “Just like the ‘Bridge to Nowhere’ that she supposedly didn’t support.

“There’s nothing like euthanasia in the bill. I practiced medicine for a long time, and of course you have to have end of life discussions – the patients want that,” Dean said. “There’s nothing… euthanasia’s not in this bill.”

But Palin did not talk about euthanasia; she was talking about the denial of life-saving or life-extending care based on demographic and cost considerations. Replacing expensive life-saving care with cheap palliative care is not euthanasia, although it is on the same slippery slope.

Peter Singer, the famous Princeton professor of bioethics, has an essay in the NY Times magazine explaining why healthcare should be allocated according to quality-adjusted life-years:

Health care does more than save lives: it also reduces pain and suffering. How can we compare saving a person’s life with, say, making it possible for someone who was confined to bed to return to an active life? We can elicit people’s values on that too. One common method is to describe medical conditions to people — let’s say being a quadriplegic — and tell them that they can choose between 10 years in that condition or some smaller number of years without it. If most would prefer, say, 10 years as a quadriplegic to 4 years of nondisabled life, but would choose 6 years of nondisabled life over 10 with quadriplegia, but have difficulty deciding between 5 years of nondisabled life or 10 years with quadriplegia, then they are, in effect, assessing life with quadriplegia as half as good as nondisabled life. (These are hypothetical figures, chosen to keep the math simple, and not based on any actual surveys.) If that judgment represents a rough average across the population, we might conclude that restoring to nondisabled life two people who would otherwise be quadriplegics is equivalent in value to saving the life of one person, provided the life expectancies of all involved are similar.

This is the basis of the quality-adjusted life-year, or QALY, a unit designed to enable us to compare the benefits achieved by different forms of health care. The QALY has been used by economists working in health care for more than 30 years to compare the cost-effectiveness of a wide variety of medical procedures and, in some countries, as part of the process of deciding which medical treatments will be paid for with public money. If a reformed U.S. health care system explicitly accepted rationing, as I have argued it should, QALYs could play a similar role in the U.S.

He gives the example of a drug called Sutent that slows the spread of kidney cancer and may give victims an extra six months of life, but at a cost of $54,000. He argues that the rest of society should not be burdened with that cost when the same money, spent elsewhere would do more good. In making this argument, Singer ignores the role of innovation in a free market.

It certainly doesn’t cost $54,000 to manufacture enough Sutent to treat one patient for six months. The $54,000 has to cover the development cost of the drug, which could be tens or hundreds of millions of dollars, and the loss of profit when the patent on the drug expires and cheap, generic versions flood the market. Now, obviously, the cheap generics do not pose the same ethical quandary as the expensive proprietary version. It benefits society to have cheap generic drugs instead of hugely expensive proprietary drugs developed by the pharmaceutical industry. But the point the Singers and Ezekiel Emanuals of this world don’t understand is that you can’t get cheap generic drugs without first developing the expensive proprietary drugs. Pfizer would not develop Sutent unless it could recoup its R&D costs, FDA approval costs, etc. etc. and make a profit. And if Pfizer did not develop Sutent, there could be no generic version to follow. Moreover, developing Sutent likely opened other research avenues for developing even better drugs.

One could make the moral argument that is is better for society to invest in expensive drugs today so that it can get cheap drugs tomorrow. The US does that today, as this chart shows:
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The rest of the world benefits, as US drugs are sold at marginal cost to socialist systems that fix prices, and as US drug patents expire.

The same argument applies to other areas of medicine. The initial costs of developing new treatments are high, but costs come down as the treatments become routine. The moral universe of Professor Singer ignores the beneficial impact of profit and innovation in a free market.