[quote]DrSkeptix wrote:
“In theory.”
Yogi Berra, every bit the wordsmith that Keynes was, opined, “In theory, there should be no difference between theory and practice. But in practice, there is.” [/quote]
Because the theory is obviously wrong.
[quote]LIFTICVSMAXIMVS wrote:
DrSkeptix wrote:
“In theory.”
Yogi Berra, every bit the wordsmith that Keynes was, opined, “In theory, there should be no difference between theory and practice. But in practice, there is.”
Because the theory is obviously wrong.[/quote]
RIght or wrong, a theory is irrelevant; it is the practical application that counts.
Berra would agree with Pauli, “[This theory] isn’t true, it isn’t even false.”
I am not interested in discussing economic theory; it is like discussing religion; pointless. And in local particular cases, it is.
[quote]DrSkeptix wrote:
PRCalDude wrote:
DrSkeptix wrote:
Ron Paul? Uh…what medical insurance does he have, again?
I dunno. Point?
…[/quote]
You will note:
- 75% of the premiums on Congressmen’s insurance are paid by taxpayers…forever.
- Only one Congressman has declined to enroll, on principal. And guess what, it was NOT Dr. Ron Paul, but another erstwhile physician, Dr. Kagan of Wisconsin.
[quote]DrSkeptix wrote:
LIFTICVSMAXIMVS wrote:
DrSkeptix wrote:
“In theory.”
Yogi Berra, every bit the wordsmith that Keynes was, opined, “In theory, there should be no difference between theory and practice. But in practice, there is.”
Because the theory is obviously wrong.
RIght or wrong, a theory is irrelevant; it is the practical application that counts.
Berra would agree with Pauli, “[This theory] isn’t true, it isn’t even false.”
I am not interested in discussing economic theory; it is like discussing religion; pointless. And in local particular cases, it is.[/quote]
See, a lot of people believe that.
They would not say that about gravity, but when those pesky economic laws come around and kick them just as hard and predictable they do not even know hat hit them and blame the market.
LASIK surgery prices have dropped over 40% in price, and that is in nominal terms. Cutting costs in half in 10 years.
That is the kind of innovation and progress we would expect from the computer or cell phone industry.
That could have been cancer or diabetes treatment but thank God government saves us from unbridled capitalism in that highly sensitive area or else people with profit motives might make a buck off of us.
[quote]orion wrote:
LASIK surgery prices have dropped over 40% in price, and that is in nominal terms. Cutting costs in half in 10 years.
That is the kind of innovation and progress we would expect from the computer or cell phone industry.
That could have been cancer or diabetes treatment but thank God government saves us from unbridled capitalism in that highly sensitive area or else people with profit motives might make a buck off of us.
[/quote]
And why do you think that those “pesky economic laws” do not apply to “cancer and diabetes” as to Lasik; does government or insurance risk-pooling explain it all?
Is it the difference between purely elective and the obligatory in medical treatment?
My premise has been that insurance and government underwrote a large part of the risk of the development for cancer and heart disease; therefore we do not buy the same product now as before. (Private capital alone could not have done so. It would not have made sense to do so in the 1990’s; there were better risks and rewards out there.) Lasik, is, well, Lasik, and has not changed substantially.
[quote]orion wrote:
DrSkeptix wrote:
LIFTICVSMAXIMVS wrote:
DrSkeptix wrote:
“In theory.”
Yogi Berra, every bit the wordsmith that Keynes was, opined, “In theory, there should be no difference between theory and practice. But in practice, there is.”
Because the theory is obviously wrong.
RIght or wrong, a theory is irrelevant; it is the practical application that counts.
Berra would agree with Pauli, “[This theory] isn’t true, it isn’t even false.”
I am not interested in discussing economic theory; it is like discussing religion; pointless. And in local particular cases, it is.
See, a lot of people believe that.
They would not say that about gravity, but when those pesky economic laws come around and kick them just as hard and predictable they do not even know hat hit them and blame the market.
[/quote]
Everyone sees “economic laws.” I see tools. Your buddy, LM, says that human behavior is not predictable. There is simply no reason for me to discuss dogma, you can do that quite well on your own.
I am more interested in reading practical thoughts.
[quote]DrSkeptix wrote:
orion wrote:
DrSkeptix wrote:
LIFTICVSMAXIMVS wrote:
DrSkeptix wrote:
“In theory.”
Yogi Berra, every bit the wordsmith that Keynes was, opined, “In theory, there should be no difference between theory and practice. But in practice, there is.”
Because the theory is obviously wrong.
RIght or wrong, a theory is irrelevant; it is the practical application that counts.
Berra would agree with Pauli, “[This theory] isn’t true, it isn’t even false.”
I am not interested in discussing economic theory; it is like discussing religion; pointless. And in local particular cases, it is.
See, a lot of people believe that.
They would not say that about gravity, but when those pesky economic laws come around and kick them just as hard and predictable they do not even know hat hit them and blame the market.
Everyone sees “economic laws.” I see tools. Your buddy, LM, says that human behavior is not predictable. There is simply no reason for me to discuss dogma, you can do that quite well on your own.
I am more interested in reading practical thoughts.
[/quote]
I doubt that he meant what you understood because he himself is using Austrian economics every time to predict human behavior.
I think the point that he was trying to make, when it was about Austrian economics is that you cannot f.e. build a utility curve by asking people how they might decide. Some economics do that and it is one of the central ideas of Austrian economics that you cannot do such a thing because you always act on your marginal utility and cannot predict zilch in advance.
Anyway, here is a practical idea.
Make the FDA an advisory board only. Maybe government insurance can use only FDA approved drugs, but everyone else can use what he wants if he or his insurance pays and he is willing to take the risks.
That way innovation would not come to a grinding halt while the FDA takes 15 years to approve a drug.
[quote]orion wrote:
DrSkeptix wrote:
orion wrote:
DrSkeptix wrote:
LIFTICVSMAXIMVS wrote:
DrSkeptix wrote:
…
Anyway, here is a practical idea.
Make the FDA an advisory board only. Maybe government insurance can use only FDA approved drugs, but everyone else can use what he wants if he or his insurance pays and he is willing to take the risks.
That way innovation would not come to a grinding halt while the FDA takes 15 years to approve a drug.
[/quote]
That’s nice. So an educated rational consumer could choose among alternatives, bargain with suppliers for a cheaper price.
But wait…no rational drug company would undertake the detailed expensive human studies that are necessary to provide info on efficacy, toxicity, safety. Why would they? It costs money and consumers could be provided with dubious data and still buy the product.
So, orion, you practical homework assignment is to find out whether a consumer should buy Tarceva for his pancreas cancer. But you cannot refer to any FDA-mandated studies or their foreign equivalents.
Let me know how much you would be willing to pay.
[quote]DrSkeptix wrote:
orion wrote:
DrSkeptix wrote:
orion wrote:
DrSkeptix wrote:
LIFTICVSMAXIMVS wrote:
DrSkeptix wrote:
…
Anyway, here is a practical idea.
Make the FDA an advisory board only. Maybe government insurance can use only FDA approved drugs, but everyone else can use what he wants if he or his insurance pays and he is willing to take the risks.
That way innovation would not come to a grinding halt while the FDA takes 15 years to approve a drug.
That’s nice. So an educated rational consumer could choose among alternatives, bargain with suppliers for a cheaper price.
But wait…no rational drug company would undertake the detailed expensive human studies that are necessary to provide info on efficacy, toxicity, safety. Why would they? It costs money and consumers could be provided with dubious data and still buy the product.
So, orion, you practical homework assignment is to find out whether a consumer should buy Tarceva for his pancreas cancer. But you cannot refer to any FDA-mandated studies or their foreign equivalents.
Let me know how much you would be willing to pay.
[/quote]
This is obvious nonsense because no company that wants to stay in business for a longer period of time sells snake oil. Competition makes sure of that. Even if it did not, would you buy from a company that kills its customers?
Also, I do not have to know about Tarceva any more than I do have to know about cars or washing machines. I doubt that you can tell what every piece of a car does and yet you are perfectly able to chose one that fits your needs.
[quote]orion wrote:
DrSkeptix wrote:
orion wrote:
DrSkeptix wrote:
orion wrote:
DrSkeptix wrote:
LIFTICVSMAXIMVS wrote:
DrSkeptix wrote:
…
Anyway, here is a practical idea.
Make the FDA an advisory board only. Maybe government insurance can use only FDA approved drugs, but everyone else can use what he wants if he or his insurance pays and he is willing to take the risks.
That way innovation would not come to a grinding halt while the FDA takes 15 years to approve a drug.
That’s nice. So an educated rational consumer could choose among alternatives, bargain with suppliers for a cheaper price.
But wait…no rational drug company would undertake the detailed expensive human studies that are necessary to provide info on efficacy, toxicity, safety. Why would they? It costs money and consumers could be provided with dubious data and still buy the product.
So, orion, you practical homework assignment is to find out whether a consumer should buy Tarceva for his pancreas cancer. But you cannot refer to any FDA-mandated studies or their foreign equivalents.
Let me know how much you would be willing to pay.
This is obvious nonsense because no company that wants to stay in business for a longer period of time sells snake oil. Competition makes sure of that. Even if it did not, would you buy from a company that kills its customers?
Also, I do not have to know about Tarceva any more than I do have to know about cars or washing machines. I doubt that you can tell what every piece of a car does and yet you are perfectly able to chose one that fits your needs. [/quote]
Oh, but I insist.
First, in the case of high technology, most snake oil goes undetected. Without the testing and data gathering madated by the FDA, how would you know the chance that the agent caused more good than harm? 3 months later, would you know if it was helping? Sorry, you are deeply mistaken as to the value of commercial competition in regard to drug and technology assessment.
If you were correct you could tell me in 5 minutes whether you would buy Tarceva, without reference to the FDA studies. (I may no nothing of automotive mechanics, but I can read the labels, there has been safety checks, and so forth. If all that were eliminated, what basis would have for my purchase.
Ok, orion, let’s say you have pancreas cancer. The median survival is about 6 months. Will you buy Tarceva? Take the 5 minutes and prove to me that your theory has practical success.
Not necessarily taking sides, but the environment for a true comparison doesn’t exist because we’ve never had a thoroughly market based medical industry.
What you’re asking him to do overlooks that fact. How can somebody explore their options without the FDA if the FDA has seen to it that no such options exist? The market has never had to handle what you’re talking about exactly because of the very FDA you’re now telling him to forgo in his research.
You’re assuming the truth of your assertion on the basis that it simply is, but that does not address what might have been in the marketplace in the absence of an FDA style agency.
[quote]DrSkeptix wrote:
DrSkeptix wrote:
PRCalDude wrote:
DrSkeptix wrote:
Ron Paul? Uh…what medical insurance does he have, again?
I dunno. Point?
…
You will note:
- 75% of the premiums on Congressmen’s insurance are paid by taxpayers…forever.
- Only one Congressman has declined to enroll, on principal. And guess what, it was NOT Dr. Ron Paul, but another erstwhile physician, Dr. Kagan of Wisconsin. [/quote]
Dr. Paul’s hypocrisy aside, the fact remains that for several hundred years of Western medicine, we had no health insurance. We also didn’t have socialized medicine. Nevertheless, infant mortality continued to decline, female deaths during childbirth continued to decline, life expectancy rose, etc. You and many other doctors seem to believe that all of this would grind to a standstill without the inflationary pressure that is government healthcare spending. I fail to see why. Why will medicine grind to a halt when it has proceeded quite nicely for the past 500 years at least?
I think this link is apropos to our current discussion:
[quote]Tiribulus wrote:
Not necessarily taking sides, but the environment for a true comparison doesn’t exist because we’ve never had a thoroughly market based medical industry.
What you’re asking him to do overlooks that fact. How can somebody explore their options without the FDA if the FDA has seen to it that no such options exist? The market has never had to handle what you’re talking about exactly because of the very FDA you’re now telling him to forgo in his research.
You’re assuming the truth of your assertion on the basis that it simply is, but that does not address what might have been in the marketplace in the absence of an FDA style agency.
[/quote]
What might have been in the marketplace in the absence of an FDA style agency?
Oh? OK. How another hypothetical that proves my contention?
Let’s say a woman is pregnant and has terrible nausea…a common event. In our mythical country, there is no FDA, but there is free access to new products. There is a product, which is advertized for the relief of the nausea of pregnancy. It works perfectly, and it is only a little sedating, so nightly use is possible. It has been in use in England and Europe for years, and is beating out the competition. In Canada, it is already in use and drug company representatives have started to drop off samples in doctors’ office.
So we have it all: no FDA-style agency to regulate a medicine, in use for years elsewhere, effective and beating the competition in a competitive free market. Pregnant women in the US deserve to be able to buy it as informed consumers.
…
Only this is not a hypothetical.
Thalidomide had been in use in Europe and England, it was there deemed safe and effective, and “detail men” had started sampling in Canada and the company wanted clearance in the United States. Studies in pregnant rabbits even confirmed safety.
Only one reviewer, a woman, at the US FDA stopped thalidomide. She said the information was inadequate, and she had just read some reports on a rare congenital abnormality, amelia, occurring in Europe. The drug company denied any connection.
She stopped Thalidomide from approval. (It turned out that metabolism in rabbits is different to that of humans.) The US avoided the epidemic of malformed babies.
So, there were places and times where market forces in the pharmaceutical industry were unrestrained, contrary to your assertion, and the risks of that market could not have been predicted by consumers.
I can tell you that drug companies, were they not thus contrained to perform studies and pass FDA, would be selling snake oil and thalidomide-equivalents to the unsuspecting public.
(And hence my homework assignment to orion, for which he seems to need more that 5 minutes on the internet to answer my subterfuge.)
[quote]PRCalDude wrote:
DrSkeptix wrote:
DrSkeptix wrote:
PRCalDude wrote:
DrSkeptix wrote:
Ron Paul? Uh…what medical insurance does he have, again?
I dunno. Point?
…
You will note:
- 75% of the premiums on Congressmen’s insurance are paid by taxpayers…forever.
- Only one Congressman has declined to enroll, on principal. And guess what, it was NOT Dr. Ron Paul, but another erstwhile physician, Dr. Kagan of Wisconsin.
Dr. Paul’s hypocrisy aside, the fact remains that for several hundred years of Western medicine, we had no health insurance. We also didn’t have socialized medicine. Nevertheless, infant mortality continued to decline, female deaths during childbirth continued to decline, life expectancy rose, etc. You and many other doctors seem to believe that all of this would grind to a standstill without the inflationary pressure that is government healthcare spending. I fail to see why. Why will medicine grind to a halt when it has proceeded quite nicely for the past 500 years at least?
I think this link is apropos to our current discussion:
[/quote]
I happen to agree with sci.am abstract.
Which is why your contention is misplaced.
The benefits you cite–declining infant mortality, improved life expectancy, peripartum mortality–in large part was achieved through public health measures: chiefly, sewers. And some medical interventions like hand-washing. You will note that the construction of sewers is a “collectivist” notion.
Repeating myself: medical care is different than “preventive medicine.”
OK, then, abandoning dogma, practicalities: what will happen if, overnight, insurance and government stop paying?
–I can’t afford the purchases, my services stop. I can’t afford rent, salaries, all the overhead costs. I close shop with about 200,000 others.
–People who actually need medical services to live or recover–they are s-o-l, trying to barter their way to care. Deaths and morbidity climb. (If you doubt this, read up on how medical care changed after the fall of the Soviet Union. I guess private market medicine triumphed there, too.)
–You think that prices will fall, instantly and harmlessly? Wrong again. The facilities–xray departments, labs, surgicenters, hospitals, etc.–have all been capitalized based on anticipated earnings and costs. If the earnings are not there, the interest and principal payments are insecure, and the facilities close their doors, or go bankrupt. WIll modern drugs become cheap or scarce? I vote for scarce.
–Oh, yes, in the long run, the unseen hand of the market will fix all this: prices of everything (professional services, drugs, facilities, labor) will have fallen. How long will this take to occur–a year? 5 years? And in the long run, until this is all put to rights, who will have suffered?
Surely you can object, along with orion and LM, that I am pulling all this out of my ass. But then I will be in good company.
If all one has is dogmatic theory, one has no basis in saying that I am entirely wrong, and others are right. Now let’s be practical, shall we?
[quote]Tiribulus wrote:
Not necessarily taking sides, but the environment for a true comparison doesn’t exist because we’ve never had a thoroughly market based medical industry.
What you’re asking him to do overlooks that fact. How can somebody explore their options without the FDA if the FDA has seen to it that no such options exist? The market has never had to handle what you’re talking about exactly because of the very FDA you’re now telling him to forgo in his research.
You’re assuming the truth of your assertion on the basis that it simply is, but that does not address what might have been in the marketplace in the absence of an FDA style agency.
[/quote]
What he said.
[quote]DrSkeptix wrote:
Tiribulus wrote:
Not necessarily taking sides, but the environment for a true comparison doesn’t exist because we’ve never had a thoroughly market based medical industry.
What you’re asking him to do overlooks that fact. How can somebody explore their options without the FDA if the FDA has seen to it that no such options exist? The market has never had to handle what you’re talking about exactly because of the very FDA you’re now telling him to forgo in his research.
You’re assuming the truth of your assertion on the basis that it simply is, but that does not address what might have been in the marketplace in the absence of an FDA style agency.
What might have been in the marketplace in the absence of an FDA style agency?
Oh? OK. How another hypothetical that proves my contention?
Let’s say a woman is pregnant and has terrible nausea…a common event. In our mythical country, there is no FDA, but there is free access to new products. There is a product, which is advertized for the relief of the nausea of pregnancy. It works perfectly, and it is only a little sedating, so nightly use is possible. It has been in use in England and Europe for years, and is beating out the competition. In Canada, it is already in use and drug company representatives have started to drop off samples in doctors’ office.
So we have it all: no FDA-style agency to regulate a medicine, in use for years elsewhere, effective and beating the competition in a competitive free market. Pregnant women in the US deserve to be able to buy it as informed consumers.
…
Only this is not a hypothetical.
Thalidomide had been in use in Europe and England, it was there deemed safe and effective, and “detail men” had started sampling in Canada and the company wanted clearance in the United States. Studies in pregnant rabbits even confirmed safety.
Only one reviewer, a woman, at the US FDA stopped thalidomide. She said the information was inadequate, and she had just read some reports on a rare congenital abnormality, amelia, occurring in Europe. The drug company denied any connection.
She stopped Thalidomide from approval. (It turned out that metabolism in rabbits is different to that of humans.) The US avoided the epidemic of malformed babies.
So, there were places and times where market forces in the pharmaceutical industry were unrestrained, contrary to your assertion, and the risks of that market could not have been predicted by consumers.
I can tell you that drug companies, were they not thus contrained to perform studies and pass FDA, would be selling snake oil and thalidomide-equivalents to the unsuspecting public.
(And hence my homework assignment to orion, for which he seems to need more that 5 minutes on the internet to answer my subterfuge.)
[/quote]
Yes, that is their one big success story.
It does raise two questions though.
First, how many people are dying unnecessarily each year or suffer without reason because the FDA plays it extra safe? How many diseases will never be cured because it costs a staggering 1 billion dollar to let a drug jump through all the hoops?
Second, why can´t I not put into my body whatever I want if I have a serious illness? Yes, I might poison myself, but even then that might help the next person to suffer from the same thing. Especially if my life expectancy was limited, why could I not roll the dice and try to help me and others?
Why do people seem to owe it to the almighty collective to die a senseless death while the FDA tries to figure shit out?
Why can people not grasp for straws?
PS: As a PS I would like to point out that probably very few people would take something to treat morning sickness that was not thoroughly studied. Pregnant women tend to care what they put into their body.
[quote]PRCalDude wrote:
DrSkeptix wrote:
DrSkeptix wrote:
PRCalDude wrote:
DrSkeptix wrote:
Ron Paul? Uh…what medical insurance does he have, again?
I dunno. Point?
…
You will note:
- 75% of the premiums on Congressmen’s insurance are paid by taxpayers…forever.
- Only one Congressman has declined to enroll, on principal. And guess what, it was NOT Dr. Ron Paul, but another erstwhile physician, Dr. Kagan of Wisconsin.
Dr. Paul’s hypocrisy aside, the fact remains that for several hundred years of Western medicine, we had no health insurance. We also didn’t have socialized medicine. Nevertheless, infant mortality continued to decline, female deaths during childbirth continued to decline, life expectancy rose, etc. You and many other doctors seem to believe that all of this would grind to a standstill without the inflationary pressure that is government healthcare spending. I fail to see why. Why will medicine grind to a halt when it has proceeded quite nicely for the past 500 years at least?
I think this link is apropos to our current discussion:
[/quote]
Ron Paul does not use government health care. He doesn’t even accept their pension plan.
[quote]DrSkeptix wrote:
The benefits you cite–declining infant mortality, improved life expectancy, peripartum mortality–in large part was achieved through public health measures: chiefly, sewers. And some medical interventions like hand-washing.
[/quote]
And vaccinations, sterilization of medical instruments, etc. A lot of things were invented during wars (first aid).
People didn’t wake up one morning and say to themselves, “Gee, let’s build a sewer system and see what happens!” No, they were advised by the scientific community to do so.
My point remains valid: for the past several hundred years, medicine has gotten along fine by itself.
Uh, no, I won’t.
Really? Don’t you always hear doctors advising patients to lose weight and quit smoking? There is still very little doctors can do for you once you’ve screwed yourself up. They can delay the inevitable, but not avoid it altogether. Patient behavior still has to change drastically for outcomes to improve in a good number of illnesses, especially the illnesses that have a high prevalence and morbidity in this country like type II diabetes, heart disease, lung cancer, stroke. My wife is a dietitian and she sees patients all the time with things marked on their chart by doctors like, “Patient has every known risk factor.”
Some of us, having dealt with medical doctors, are far less optimistic about what they can actually do when you’re screwed up.
OK, then, abandoning dogma, practicalities: what will happen if, overnight, insurance and government stop paying?
You’d re-open later with a new business model if you wanted to keep eating.
Are you honestly pointing to the USSfreakingR as a positive example? Russians are dropping like flies for several reasons. The fact is, Russia STILL HAS a system of socialized medicine - just an underfunded one (socialized medical systems, like government schools, are always “underfunded”).
Russians are using wire-hanger abortions as a form of birth control. That tends to lower population life expectancies, doesn’t it?
Russian men are drinking themselves to death. That affects life expectancy.
HIV is out of control there for the normal reasons HIV gets out of control. That affects life expectancy.
Russia is an ex-KGB run kleptocracy. Nothing has actually changed there since the end of the USSR, and the Russian medical system had already decayed to its current nadir PRIOR to the official collapse of the USSR (which is still very much in existence).
http://countrystudies.us/russia/53.htm
If we parse your sentence carefully, we uncover a huge part of the problem:
“have all been capitalized based on anticipated earnings and costs”
The “anticipated earnings” are based on bad assumptions and models altogether, much like the late credit default swap market that tanked the global economy. You guys “anticipate” earnings from Medicare, Medical, Medicaid, etc - earnings that shouldn’t be there in the first place due to their dependence on government meddling, robbery, and funny munny. The models upon which you base your capitalization schemes work on a “garbage in, garbage out” basis. Start capitalizing your business like everyone else and see if things don’t improve. You guys think you’re “too big to fail,” therefore you should never have to suffer the indignities of chapter 11 re-organizations like everyone else when you make bad business decisions. Now, we’re told we need even MORE government intervention to bail out the “failing medical system” - we’re going to socialize the whole damn thing. It’s the logical conclusion of your line of thinking. USSR, here we come!
The Soviet phase of the American “republic” is going to be a wild ride. I’m going to start stilling my vodka now.
Looks like another town hall meeting didn’t go according to plan.