At 07:42 PM 12/17/02 -0800, Deborah Harrell wrote:
In preface, I think you took my 'Evil Overlady' without her smileys... :)
And I hope you noticed the line at the bottom of my post:
Taking The Contrarian POV Maru
;-)
--- Ronn! Blankenship <[EMAIL PROTECTED]> wrote: > Deborah Harrell wrote: > >- Ronn! Blankenship wrote: > > > OTOH, where *does* one¹ hold the line on health > > > costs? > >_____ > > > ¹Be that "one" the government, an HMO, a private > > > insurer, or the individual. > > > >No easy answer - I do think people should take more > >responsibility for their own health re: lifestyle > >(habits, nutrition, exercise), which would reduce > >significantly (~40-50% IIRC) the big killers like > >heart disease and stroke. > > Although there are still people who are active, eat > well, take their > vitamins every day ;-), etc., and as far as they or > their doctors can tell > are in good health until the day they present at the > ER with what turns out > to be a heart attack, stroke, cancer, or some other > disease which leads to > long-term, perhaps permanent, disability . . . not > to mention healthy > people who have accidents that leave them disabled > and requiring expensive long-term medical care . . . Well, yes, of course - I did say that healthy lifestyle changes could reduce arteriovascular disease by ~40-50%; that leaves ~50-60% still extant. > > Educating children about > >their bodies and health would be essential (and a > few > >"scare" tactics like cutting open a heavy smoker's > >lung should be included - I will never forget my > first look *and smell* of that disgusting blackened > mass!). OTOH, avoidance of environmental toxins is > essentially > >impossible, so we do need agencies to watchdog > >industry and research potential carcinogens etc. > > Is it your opinion, then, that all cancers are > caused by exposure to > toxins, and could be avoided if the toxins were > removed from the environment? Nooo, many are unfortunate genetic changes, in either the parent's genes (ie congenital) or in the individual cell during division (ie spontaneous) and the body's immune system for some reason was unable to destroy the malignant cells; others are from some non-chemical insult, like a virus or radiation. However, many chemicals *are* known carcinogens (eg benzene, asbestos); I was pointing out that research into health effects of industrial chemicals, although not cheap, is ultimately more cost-effective than poisoning large populations and then having to deal with the aftermath.
Though many of those chemicals were not found to be carcinogenic until after they had been in use for many years.
<snip> > OTOH, you may have heard the same story I did on the > news today about the > woman who was stopped when she set off the metal > detector at the > airport. The detector kept going off, even after > she had removed all > traces of metal from her person and clothing. It > turned out that what was > setting off the metal detector was a clamp which had > been left in her > abdomen after surgery some four months earlier . . . Ouch! Hadn't heard that one. That's why one is supposed to have an instrument count before and after surgery, but *before* closing the patient. :P
Maybe the doctor needed to get to his bank before it closed . . . ;-b
> >As Evil Overlady, I would institute local programs > >(tailored to the community/culture) to work > >intensively with folks and their particular > >addictions, be they food, nicotine or whatever; but > >after a specified time (to be > researched/negotiated), > >if the person returned to the deadly behavior, care > >for that aspect of their health would be > eliminated.
So when a person who couldn't quit smoking shows up at the ER with a heart attack or cancer, they are just sent home to die (if they make it that far)?
> Okay, so we outlaw alcohol, tobacco, and all other > "recreational" drugs > (including coffee and tea?), as well as > unhealthy/excessive food. No no no!!! Where is the personal responsibility in *that*?! How does 'educating and providing an intensive treatment program' morph into 'outlawing'?! As Evil Overlady I have no intention of engaging in foolishly dangerous actions, remember? <VBG> I would *not* want to promote a black market in these things!
That is of course why I said we'd have to wipe out those crops.
I just want to link _actions_ to _consequences_, along the lines of "It is not my job to rescue you from your deliberate ignorance." <Therefore I snipped your argument about wiping out things, b/c that is obviously a losing battle!> > Most "unhealthy" foods are not unhealthy > unless consumed in > excessive amounts and/or to the exclusion of other > foods, leading to an > unbalanced diet. Who will be the food police Once again, NO! Educate, treat if necessary, and make clear the consequences of *deliberate ignorance* of one's freely-made choices. Personal responsibility is paramount (with exceptions, as now, for children and the mentally deranged or retarded, who clearly cannot be held fully responsible for their ignorance). > And what about when > new research shows that what was formerly considered > bad for you is indeed > good for you, at least in moderation, and what was > good is now bad for you: <BOSEG> I was sooo happy when dark chocolate (small amounts, in truth) was found to have beneficial antioxidants! (you did see my 'Chocoholic' sig?) >(Did you happen to notice one > of the headlines on the > new issue of _Scientific American_: something to > the effect that the > government has been giving us bad advice about diet? Nope, but I take any 'new pronouncement' with a grain of salt,
In the article in the Jan 2003 _Scientific American_, the authors are saying that the current food pyramid is too simplistic because it seems to say "all fats are bad" and "all complex carbohydrates are good", when the truth is that "some types of fat, in moderation, are good" and "some types of carbohydrates are not very good."
and it's wise to consider even "known facts" with a critical eye (was it one this list we discussed how the "drink 8 glasses of water a day" was recently found to be based on a *misreading* of a ~1947 paper?).
Sure it wasn't an ad for American-Standard products? ;-)
> And what do we do about AIDS and other STDs? Leper > colonies on isolated islands, perhaps? Once again: educate, treat if needed (frex, it's very cheap to treat some STDs,
So far, though, not AIDS. And how about the other diseases which are spreading along with it, such as drug-resistant TB?
And speaking of treatable STDs, TB, etc., how do we insure that those who may be at risk for those diseases get tested, and if they are infected, that they follow through with the treatment? (More of a problem with things like TB which can be transmitted to "innocents" by relatively casual contact. Frex, some of the school districts around here still require anyone who applies to teach or do other work where they might come in contact with students to first get a TB test from the county health department.)
and since cost was the bugaboo that opened this up, has to factor in) and allow people to make their own choices. But AIDS is as much a social as medical problem (one frex: a woman gets it from her cheating husband - or in some societies, it is not even considered wrong for a man to go elsewhere for 'bodily needs' if his wife is ill, cycling, or pregnant. Even an _Evil_ Overlady can't fault the innocent spouse in such a case. <sad smile> And I use M->F transmission b/c it's technically more likely, not trying to be sexist).
An even worse case scenario is when a man gets it, gives it to his wife, who passes it along to their children, all before they know any of them is infected. And the husband need not be a philanderer or drug addict: maybe he is a medical worker who got exposed to the virus in the course of his work . . .
Again, what can we do to protect the innocent victims of such diseases? Preferably from getting such a disease in the first place?
> To open another COW, what do we do about conditions > which have genetic causes? Shades of _Gattaca_... > If a young person tests positive for > Huntingdon's disease, do we > sterilize that person before puberty so they won't > pass along the bad genes > and then offer them euthanasia when the symptoms > start in their 40s? How > about children with hemophilia, cystic fibrosis, or > Down's syndrome? (And > how about their parents?) Mandatory prenatal > genetic screening followed by > mandatory abortion if the fetus is not "perfect"? > And if so, where do we > draw the line on what is considered a genetic > "disease"? Homosexuality? Below-normal > intelligence? Above-normal intelligence? Now you're talking social engineering (if I understand the term correctly), which is quite beyond 'trying to reduce medical costs.'
Although one can justify intervention in at least some of those cases on the basis of the expected cost of lifetime health care for a child born with certain genetic diseases.
[Aside: How much has the missile defense program cost thus far?]
And is the possibility that the mere fact that such a thing was talked about back in the 80s might have contributed to the fall of the Soviet Union perhaps worth the cost?
<serious> As someone who does have a spontaneous mutation that, if passed on, has a 50/50 chance of causing mental retardation, various cancers and behavioral deficits, this is not an academic issue for me. At the time that I would have considered starting a family with the right man, there were no prenatal tests available; after a great deal of painful consideration, I chose not to have children. In the not-to-distant future, we will be able to prevent or treat many if not all of the diseases you mentioned.
At present, though, we can detect them but not treat them. What choices do we give parents who have a child with such a disease and no way to cover the costs of treatment to keep the child alive?
While I applaud elimination of needless suffering, I do not like the idea of "custom-designing" a child to be a blue-eyed, red-headed 6' 7" basketball player who paints and likes pythons.
Or has too much taste to like Monty Python . . .
--Ronn! :)
I always knew that I would see the first man on the Moon.
I never dreamed that I would see the last.
--Dr. Jerry Pournelle
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