From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med,misc.health.alternative,talk.politics.medicine
Subject: Re: cancer drug warrants healthy skepticism
Date: 6 Oct 2005 17:30:31 -0700
Message-ID: <1128645031.617650.168790@o13g2000cwo.googlegroups.com>

fresh~horses@despammed.com wrote:
> There's more than enough shame to go around. It's not healthcare
> anymore. It's business. It's not journalism anymore. It's business.


Both of these have always been business, for as long has they've been
around (along with the usual collection of amateurs, as with any
profession). All that has changed in the modern age (ie, the last
century or so) is the *scale* of the businesses. Newspapering evolved
from sole proprietorships ala Ben Franklin to Hurst yellow journalism.
But that was quite a while ago. Medicine's evolution to large
corporation is a later development. The evolution of (paper) journalism
has been driven mostly by economies of scale in paying for reporting,
and (later) in paying for expensive color printing and distribution.
Medicine's evolution into multipartner entities and HMOs is mainly
driven by need for economy of scale in holding up under regulatory
burdens, which in turn have been due to second-party payor systems
which were answers to the problems of how to pay for high technology
which is used (relatively) rarely.

SBH

From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med,misc.health.alternative,talk.politics.medicine
Subject: Re: cancer drug warrants healthy skepticism
Date: 6 Oct 2005 23:40:26 -0700
Message-ID: <1128667226.353186.271570@g44g2000cwa.googlegroups.com>

Rich wrote:
> > Medicine's evolution into multipartner entities and HMOs is mainly
> > driven by need for economy of scale in holding up under regulatory
> > burdens, which in turn have been due to second-party payor systems
> > which were answers to the problems of how to pay for high technology
> > which is used (relatively) rarely.
> >
> > SBH
> >
>
> Thanks for a good analysis. The "relatively rarely" bit is a sticking point,
> though. Once that high technology cames available it can quickly become
> "standard of care." For example, when computerized tomography was new, it
> was used only when there were good indications that CT would isolate a
> diagnosis from the differential. Now we are obligated to CT every head bonk,
> every abdominal pain, and damn near every headache, just to protect
> ourselves from the lawyers. Emergency MRI will probably become a routine
> middle-of-the-night procedure, too.
> --



COMMENT:

Yep. Once the system is in place to pay for rare expensive stuff, it's
too easy to just turn the crank and make it pay for more routine
expensive stuff, like angioplasty stents and MRI for midnight
backpains. Thus does the fraction of GDP that pays for medical care
increase. As I've pointed out a sickening number of times, the increase
in the last 20 years has not gone to doctors or hospitals. Most of it
has gone to high tech and an aging population (over 65 you need 3 times
as much of everything, including medical dollars, as the average of
everybody younger.)  Only 20% goes to drugs, and that fraction hasn't
increased that much.

We really screwed the pooch when we decided to pay for those MRI
machines by payroll deduction. Which, in effect we did. Once you do
THAT, you've had it. And we've had it.

SBH

From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med,misc.health.alternative,talk.politics.medicine
Subject: Re: cancer drug warrants healthy skepticism
Date: 9 Oct 2005 16:19:01 -0700
Message-ID: <1128899941.077032.159590@g49g2000cwa.googlegroups.com>

fresh~horses wrote:
> Steve Harris wrote:
> > fresh~horses@despammed.com wrote:
> > > There's more than enough shame to go around. It's not healthcare
> > > anymore. It's business. It's not journalism anymore. It's business.
> >
> >
> > Both of these have always been business, for as long has they've been
> > around (along with the usual collection of amateurs, as with any
> > profession).
>
> Amateurs at "business"?


COMMENT:
Don't make me laugh. Business has as many amateurs as any other human
activity. Pros do it to for a living, amateurs do it for love (hence
the word). Even in businesses that make their owners a living (which
many don't), quite often the players and owners have far more money
than they need to make a living, and thus run business as a game--
money being merely the way they keep score. You think Warren Buffett's
in it to make a living? I think we need a new word for this-- what to
call a pro that keeps going past retirement, for reasons that have
nothing to do with money or making a living?


> > All that has changed in the modern age (ie, the last
> > century or so) is the *scale* of the businesses. Newspapering evolved
> > from sole proprietorships ala Ben Franklin to Hurst yellow journalism.
> > But that was quite a while ago.
>
>
>
> That isn't a positive evolution. Not for young journalists (or for
> young medical students) who enter their profession with high ideals.


COMMENT:

Everybody enters ANY profession with high ideals. Youth enters the
world with high ideals! Disillusionment is synonymous with learning,
and of experience of the world of adults. You eat of the fruit of the
tree of knowledge, and as a result, you get kicked you out of the
garden you thought was perfect. Ouch--- a fall from a state of
innocence.  What, you're telling me you didn't notice that it's not
that the world has really changed any, but rather just you? Or maybe
you're one of those people who still reads (or takes) their parables
literally?  If so, I suggest a wider view.


> Journalism had a purpose: the public right to know.


So you thought in your youth. But in reality, it never had any such
thing.


> It was the Fifth Estate.

COMMENT:
Fourth estate. The Ancien Régime had the clergy, the nobility, and
everybody else. Carlyle and Burke thought the press was fourth power,
and they may have been right, but all that had nothing to do with the
right to know. The broadside pamphlets the fueled the French
revolution, whence this terminology comes, where mostly errors, venom,
lies and witch-hunting (those words define the French revolution as
well as any). And journalism hasn't changed much from then. Since human
nature has not, why should anything that humans put down on paper, be
different?

Science-journalism has problems, but lesser ones. Science as a
discipline has its share of lies, errors, venom and withhunting, but
science has three inherent advantages over pure non-tech journalism: 1)
science addresses what's repeatable, and not history 2) science is
subject to a far more stringent and slow editing process, and finally
3) science isn't primarily about entertainment, which means that
writers and editors in science actually give a shit about what's true,
because they know they'll held to answer for it later, if they err.
That's never in general been true of editors and journalists, because
too many people read their work-product in the same spirit they read
any other lurid tale or soap opera. And that's always been the case--
it's not something changed in your lifetime. Editors have never been
very responsible. Nor have journalists, unless they get caught fudging
in some very public way that publically embarrasses their editors.

You might find some parallel in medical doctors, who have only one foot
in science, and sometimes no more than a toe. And because some of what
doctors do is entertainment, as well (as Voltaire said-- entertain
patient until nature cures disease). Or if not entertainment,
diversion. Patch Adams and his clown nose is a manefesto invoking that.

> Now we have press release, event and personality journalism
> determined by the advertiser brought to us by Stone Phillips and the
> Bimbo du Jour.

COMMENT:
You mean, now that Peter Jennings is gone (big tear)? That's not
journalism, that's TV. It's even worse, but what do you expect? It has
a wider audience than print, and that audience is also composed of
non-readers. If you appeal to the middle of THAT crowd, and you have to
dumb it down even more.


> The press is owned and run by those who never had
> ideals; as is the management of medicine.


COMMENT:
Managers less often have ideals, except as relates to management
itself. As for management's relationship to the company end-product,
well, too much has already been written about that. Suffice to say, I'm
sorry to see the system of middle managers come at at last, to my own
profession. As somebody said, the hand that runs the spread sheet runs
the world (but the only entry in a spread sheet is money.)


> Hippocrates and Ben Franklin blush.


COMMENT:
Perhaps. Franklin, at least, might well tell you to lower your
expectations. Franklin was never idealistic about the press, and rarely
pretended to be anything but an entertainer, when he was printing. And
yet never was he serious in his own name. No "journalist" he-- with
Franklin it was all editorial page, and he didn't pretend otherwise.
Indeed he lived in a time when nobody drew a distinction. When Franklin
was politicking, his "press release" was by way of the pseunonymious
letter, the calculated public appearance, the semi-public salon.
Franklin may have been the first person to understand how to manipulate
the press, even when he was the subject and had no control but the
quality of his show. But nobody manipulates the press who has much
respect for the quality of information that comes out of it.

Franklin did know the difference. Franklin's science survives to show
us his idea of "truth", and it stands the test of time well. Franklin
gave us electrical positive and negative, and such is the power of his
vision that we still use HIS terminology, even though we know he
happened to choose the wrong sign for the electrical fluid that moves,
in electricity. It doesn't matter. He knew that, too.

As for Hippocrates, he lived too long ago for us to know that much
about the way he practiced, but if he wasn't aware that a lot of it was
for the sake of diversion, he was a dumber guy than I suspect he was.

SBH

From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med,misc.health.alternative,talk.politics.medicine
Subject: Re: cancer drug warrants healthy skepticism
Date: 10 Oct 2005 14:28:14 -0700
Message-ID: <1128979694.493280.285350@g14g2000cwa.googlegroups.com>

fresh~horses wrote:
> > Science-journalism has problems, but lesser ones. Science as a
> > discipline has its share of lies, errors, venom and withhunting, but
> > science has three inherent advantages over pure non-tech journalism: 1)
> > science addresses what's repeatable, and not history 2) science is
> > subject to a far more stringent and slow editing process, and finally
> > 3) science isn't primarily about entertainment, which means that
> > writers and editors in science actually give a shit about what's true,
> > because they know they'll held to answer for it later, if they err.
>
> You do live in a quaint protected world. Please stop resisting not only
> knowing that Rome is burning, but why.


COMMENT:
Poppycock. I will not listen to somebody of modest means logging onto
the internet with their desktop or portable computer, to tell me Rome
is burning. Give me a frigging break. Technological progress is
accelerating, and so is standard of living. This weekend I drove to
Primm and watched autonomous robot automobiles navagate the Nevada
desert without aid, following an internal map given them 2 hours
before, and their own image systems and GPS sensors. They went though
tunnels under a highway, over hills, through dust clouds, down a
winding dirt roads in a mountain canyon. Last year they all crashed
ridiculously within a few miles. This year, 5 of them made it all the
way through 130-odd mile course. A friend of mine saw the results
posted minutes after the finish, by googling the DARPA website with his
cell phone. 12 million other people around the world were doing the
same, over the previous couple of hours. All this was pretty much
science fiction 5 years ago. As was my $30 microwave oven.

In terms of knowledge and progress, we'll repeat the entire gain of the
20th century in the first 14 years of the 21st. Then do it again in the
next seven years after that. Then again in 3.5 years. Then 1.75 years.
Somewhere about that time, either magical things will happen, or else
Skynet will wake up and terminate us. In any case, be there or be
square.

It is true that many places in this world, people breed too fast and
catch incurable diseases too fast, to be saved. It's the same at my
local animal shelter. However, that cannot, and will not, last. Global
population will probably top out at 6 billion about 20 years from now,
and standard of living for everybody will increase from there on out.
Nor does there seem to be any limit to that increase, except that
created by malevolance.

> Well for the American media, and now the Canadian that seems to be
> following and owned by it; I grant you yes. But it's not the way of it
> here until recently. In my adulthood. Sorry you don't have the
> privilege of it. Please do all you can to deep six the crap that keeps
> leaking across the border.


COMMENT:

A pretty hilarious statement from a country where most people are
jammed up against the US border with their antennas pointed South. It's
sort of like our government telling Columbia we don't want their drugs
(voice in the back of the room: "I do!")

> Another American entertainer. You really have to do something about the
> sorry state of your national culture Steve.

COMMENT:

Again, when you Canuks stop acting like a cold housecat plastered
against my outside windowpane for whatever leaks through, you can
criticize our "culture" down here. Until then, zip it.

And FYI, we have no single culture down here, anymore than you do. The
culture of people I met in the desert for the robot race, were defense
wonks, and students and profs from dozens of major US universities.
"Geek culture" is as different a culture from the people in the nearby
casino pulling slot machine levers, as you can find. And different
again from what I would have found by driving to East L.A., instead.
And different again completely from scuba culture, even in the US. You
create your culture in this world increasingly simply by who you talk
to. As for example, your presense "here." In the future, this will be a
major Rule of the Road. Get used to it.

SBH