Ian Welsh

The horizon is not so far as we can see, but as far as we can imagine

Category: health care Page 23 of 35

Taking the Coronvirus Seriously

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On March 11, 2020

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Covid Fatality from Bloomberg

Three weeks ago, Italy had almost no cases of Coronavirus. Today the country is on lockdown. There are so many cases that doctors cannot put ventilators in everyone who needs them, and are having to choose who gets them, leaving many to die who might otherwise live.

Covid-19 has an exponential spread if it is not handled correctly. Donald Trump and the US have chosen to not manage it properly. In fact, in most cases the US has chosen to not even test. We do not know how widespread the Coronavirus is.

Trump is acting like the average American CEO, he is managing the numbers, not the underlying reality.

That may get you killed. Maybe you’re young and healthy, then it may kill your parents, grandparents, or other older people you care about.

You should assume, at this point, that there will be an epidemic in the United States and you should prepare for one. Buy the necessary supplies for staying in place for at least two weeks if you have not already. Include any medications if you can. Get some non-prescription anti-virals if you can (raw garlic and bee propolis are decent), because while conventional medicine is superior, you must assume that there will not be enough ventilators, for example, to go around. Heck, there may not even be even be enough beds.

British readers should take note as well.

A lot of organizations are cancelling meetings, there are planes flying entirely empty, school is being cancelled, and so on. All of these things are good.

Note that the fatality rate soars if the spread of the disease is not slowed, because if there are too many cases all at once, and hospitals are overwhelmed. The chart going around to illustrate this follows.

 

The US isn’t going to have a better curve. So assume that you aren’t going to get good hospital care, and that you might not get hospital care at all.

All of this is, of course, a bad case scenario. But that scenario is happening, right now, in Italy. If you make preparations and you don’t need them, that’s not a problem. If you do need them, you’ll be glad you did.

This virus specializes in older, unhealthy people. But young people are carriers, even if they don’t die. So if you don’t have to, you should probably be avoiding older people for the duration.

Social distancing is not a bad idea. If you can work for home, you probably should. Employers which can have their workers work from home should do that now. Schools should be sending students home, conventions should be cancelled, etc.

In Italy, the government has cancelled mortgage payments. I would suggest that other governments consider the same and do something similar for renters, while also cancelling utility payments, with the government directly compensating utilities. Other similar measures can be imagined.

The American government’s inclination will be to give money to rich people through the Federal Reserve, but it is poor people who need to be convinced they can afford to stay home, and not go to work and keep spreading the disease.

Remember that the virus has a five day average incubation period. You could have it now and feel fine. Further you can have the virus and never get symptoms, but spread it. This is especially likely if you are young and healthy.

So, take this all seriously. It might save your life, or it might save the life of someone you care about.

As for the politics, it all depends. If it’s not too bad, Trump can keep the lid on it. People will die, the media doesn’t really report it, he survives. If it truly breaks out, and people are sharing videos of their grandmothers dying without health care because hospitals are overwhelemed, he’s going to get the blame–quite deservedly so. Of course, most politicians, including Trump, Biden, and Sanders, are old, and are at high risk to get the disease and die. Trump, in particular, is obviously not healthy.

The Coronavirus is not a hoax, it is deadlier than the flu, and the response has been bungled.

Edit: One of the symptoms is coughing blood. An herbalist I respect has suggested Dragon’s Blood (Sangre De Grado) might help with that. I pass this on very tentatively, I’m not a doctor and don’t play one, but I have ordered some for myself. It’s not expensive. None of this is a substitute for hospital care, of course, but hospitals may be overwhelmed.

The results of the work I do, like this article, are free, but food isn’t, so if you value my work, please DONATE or SUBSCRIBE.

Preparing for the Coronavirus

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On February 25, 2020

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I haven’t written about this because others have been dealing with it well and pandemics aren’t something I know a great deal about.

It does look, now, like the Coronavirus stands a good chance of turning into a pandemic, and I think we should discuss preparation a bit.

Our world produces most goods in a highly fragile, just-in-time production chain. There may be multiple inputs to a finished good, but the parts are made in a very few places. Most countries do not produce everything they need, there are not many sources of key goods and warehouses do not keep large inventories; production tends to run just ahead of need. This is efficient, but it also means that any serious disruption to production can produce shortages almost immediately.

China is a lynchpin producer of a great number of goods, including medicines. Korea, which is starting to get hit, produces many goods as well. It’s hard to say who exactly produces what unless you’re an expert, for example, after Puerto Rico got hit by a hurricane the US experienced shortages of IV bags. Who knew that the primary IV bag supplier for the US was in Puerto Rico?

So in most cases I don’t think it’s worth spending a lot of time tracking specific dependencies, especially if you’re dealing with a complex chain with many inputs–hit it in one place and you can take out the entire production.

Because fighting a pandemic is mostly about isolating people, production hits are inevitable: You can’t let people go to work.

So, if there are things you need, stock up now so you can shelter in place for a couple months if you have to.

In particular, I want to emphasize looking at your health needs. Many, many drugs are made in China. If you are on something you need to stay alive, or you are on something with ugly withdrawal symptoms, like most SSRIs, drugs which affect GABA, etc, etc., go see your doctor and convince him to give you an extra prescription or two (2) months’ supply – then go fill it.

Yeah, I know this is hard, because doctors can be stubborn and stupid, and I know it may be hard for financial reasons, but if you can, do it.

I can’t guarantee you’ll need it, of course. I can guarantee that if you need it and you don’t have it, you’ll regret it.

Remember that the United States, among developed nations, is going to be uniquely shitty at public health because a lot of people won’t go to hospitals and so on because of money issues.

As for the rest: Wash your hands, don’t touch your face, etc. Remember that this is a particularly difficult bug: It’s too small for masks to work well, it doesn’t show symptoms for 5-24 days (reports differ), it lives on surfaces for days, etc. It is a fast mutating bug, and the theory is that that’s good, because it is more likely to mutate to be LESS dangerous over time–but that also means you may catch it more than once.

This bug is likely to highlight both the stupidity of and the weaknesses in how we’ve ordered production through the world. Anything that is important, any reasonably large nation should produce for itself–if can manage it at all. “Efficiency” gains or profit gains are not worth catastrophic failure vulnerability, or the political choice weakness which comes from dependence (not to mention how globalization has been deliberately used to crush labor).

Anyway, check your meds and make sure you’re not going to be undergoing involuntary withdrawal from something you need, or something with horrific withdrawal symptoms.

The results of the work I do, like this article, are free, but food isn’t, so if you value my work, please DONATE or SUBSCRIBE.

The Problem with Pharma Research

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On October 7, 2019

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Capitalism is based on the premise that profits reflect work that people want done, which is also worth more than the costs of its inputs.

The problem with this theory is that it often just isn’t so; the work being done involves a misallocation of resources.

Take pharma, for example. It is more profitable to sell someone a pill a day than to cure them.

This is simply inescapably true in most cases.

A man who needs erection pills, a person who needs insulin, are much better customers than someone who needs a single round of the latest antibiotic.

If you do have an actual cure, since you can’t keep charging forever, you want to charge as much as possible for it. So you raise the price for a Hep C cure (the majority of the research actually having been done with public money) to six figures, when it costs about a $100 to produce.

And a lot of people die or suffer who don’t have to.

The profit motive is a very blunt instrument, and it’s unnecessary for a lot of work. To be sure, no one wants to pick up garbage, but plenty of people want to be medical researchers, because it’s interesting work which does good for humanity, and a lot of people want to do good. Give them a salary sufficient to support their family and a lab, and most of them will be fine with that.

The actual manufacturing is not so fun, but that could easily be done by a range of contracting companies or even by the government.

And in such a situation, suddenly the emphasis is on cures.

If you must have big payouts, make them bounties: “Cure X, and we give you a billion dollars.”

Pharma does do a lot of research, but it wants a pill a day, it wants extensions of already profitable drugs, or it wants hugely pricey cures. It wants to create new forms of addictive drugs, like opiates, rather than just using, oh, morphine and various other forms of painkiller which work perfectly well and already exist and which can’t be patented.

None of this is hard to figure out. There’s a place for private pharma, to be sure, mostly to act as a cost check on public pharma, but as it exists now, what it’s doing is massively misallocating resources.

The results of the work I do, like this article, are free, but food isn’t, so if you value my work, please DONATE or SUBSCRIBE.

 

Pharma Execs Should Go to Jail and Pharma Should Be Publicly Run

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On June 16, 2019

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*One vial of insulin cost $21 in 1996, compared to $320 in 2018. The cost of Big Pharma’s outrageous greed is American lives. If they will not end their greed, then we will end it for them.* —Bernie Sanders

Corporations are bundles of rights. The most important right is a shield from liability. Corporation rights used to be contentious–in particular, a lot of capitalists thought that it was wrong for corporate officers and owners to not be liable for wrongdoing and debts.

Corporations are given their special rights because it is assumed to be in the best interest of the public. Corporations exist, thus, to make the public better off. When they do not do so, they should be put down. (I would argue corporations have too many rights. Certainly they should not have personhood.)

(I am fundraising to determine how much I’ll write this year. If you value my writing and want more of it, please consider donating.)

So, they’re murderers. Mass murderers. They take actions they will know will kill many people.

The sane response, beyond the simple, “Get them out of the business and have government take over drug research and manufacture,” which would lead to better, cheaper drugs relatively quickly, is to throw them in jail. They kill people in large numbers, and they know they are doing so.

And, in death-penalty states, well, hang them high.

That said, again, it is stupid to run drug research and manufacturing privately. The promotion budgets are larger than the research budgets, and the incentives are all wrong, leading to palliatives rather than cures and insufficient research in important drug classes like antibiotics.

There are things markets do well, but drug research isn’t one of them. (And, in fact, a vast amount of the money still comes from government and flows through universities, but the profits are privatized.)

Lock up the murderous executives, break up their companies, and move the research to public bodies.

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The Golden Rule for Judging HealthCare Reform

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On February 12, 2019

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So, I see today that Democrat Tammy Baldwin has endorsed doing a Medicare buy-in starting at age 50.

Which means that access to good health care will remain age- and money-gated. If you’re too young and too poor, you don’t get health care, or you get worse health care.

Here’s the simple rule for a good healthcare system: The health care someone gets is based only on what they need and not on ANY other consideration.

This means everyone is treated the same. If society decides that some treatments are too expensive, then the criteria used for whether you get them is never “Can you pay?” it is criteria like “Who will this help most, medically?”

Of course, it is impossible to deal with America’s healthcare mess without also dealing with oligopoly device and medicine providers.

That means you must either regulate them (“You will make a 5 percent profit, no more and no less”) or you must break them up, or you must nationalize them.

When the price of insulin has risen like this…

… you know that the market has failed. And this is for a drug that is not patented.

A few people are getting very rich, by killing people. Those people should have their companies expropriated for nothing, and then, if any charge can be found, criminal proceedings should ensue. At the least, they should be made pariahs, and anyone who deals with them in any way should be ostracized.

But, moving back to policy, if you just give everyone health care, stop rationing based on money and age, and break the oligopolies (while fixing various other perverse incentives like doctors owning testing companies), not only will the cost of healthcare plummet (Canada’s per capita costs dropped by a third in ten years just by changing to universal care), its quality will increase.

But I still want to see most pharmacare executives in prison.

The results of the work I do, like this article, are free, but food isn’t, so if you value my work, please DONATE or SUBSCRIBE.

Tales of Canadian Healthcare and Potential Russia/US War in Syria

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On September 13, 2018

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So, posting has been, errr, non-existent for a bit as I’ve been dealing with some (probably minor) healthcare issues.

Earlier this week, I had exploratory surgery and, later, an MRI. The total time for the exploratory surgery (entering the hospital to leaving) was about five hours. The total time for the MRI was two hours, of which I spent 45 minutes semi-dozing inside the machine.

Total price? $20 for some pain killers to take home with me after the day-surgery. Oxycodone (the generic form of Oxycontin), which is the first time I’ve had it (I’ve had plenty of morphine and codeine at various points), and, ummm, I can see why a lot of people get addicted.

Generally speaking the nurses, doctors, techs, and orderlies were all polite and efficient. The nurses and doctors at the day surgery stood out as particularly solicitous, which I appreciated. I haven’t always had the best experience with surgery (understatement alert), so getting the feeling that they cared and were competent was nice.

Contrary to the propaganda, all of this was relatively expeditious. I don’t have an urgent problem, so the process hasn’t been super fast, but it hasn’t been slow, either.

And this is Canadian healthcare.

Regular posting should resume soon.

Idlib province in Syria is a potential flashpoint between the US and Syria/Russia. The Syrians want to clear up the Al-Qaeda subsidiary there, and the Americans want to pretend they aren’t Al-Qaeda, and have been saber rattling and stating that Assad is going to attack chemically, and the US will retaliate.

Lots of stupid here, and a small–but real–chance of starting something nasty between the US and Russia, which the US might well lose, actually, since the US has fallen behind both on missiles and missile defense technology.

Let’s hope not. Not getting into a war in Syria with Russia was Trump’s main selling point, but he seems to have since become deranged about Syria’s Iran ties, because the US’s foreign policy, apparently, is about doing what Saudi Arabia and Israel want, not what is good for the US.

Sigh.

The results of the work I do, like this article, are free, but food isn’t, so if you value my work, please DONATE or SUBSCRIBE.

Martin Shkreli Proves that Your Life Is Meaningless to Elites

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On March 14, 2018

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So, a lot of people are happy that Shkreli, the infamous “pharma bro” who raised the price of Daraprim, a 62 year old life saving drug used for serious parasite infections and to treat HIV, by 5,500 percent has been sentenced to jail for seven years.

The catch is that he was sentenced for securities fraud not for jacking up the price of the drug.

Yes, that’s because securities fraud is illegal, but killing people by jacking up drug prices isn’t.

And that’s the point.

Your betters don’t want someone cheating them, but they don’t care if you live or die.

They really, really don’t. Understand that in the core of your being.

There are others who have jacked up the price of life saving drugs. For example, Heather Bresch, the CEO of Mylan, who makes Epi-pens, isn’t in any danger of seeing the penitentiary. Then there are the jacked-up prices for insulin, which, while not quite so dramatic in percentage terms, comes to $400/month in the US, for a drug that the inventor gave away.

People have definitely died, my “favorite” was a guy begging on Twitter for people to fund him or he couldn’t afford his insulin next month.

He’s dead now.

Yeah.

Folks, they don’t care if you live or die. If dead means more money for them, they’re okay with it. This is true in the US, but it’s also true in Britain and increasingly true in the developed world.

If your masters think you’re worth more dead than alive, dead is fine by them.

The results of the work I do, like this article, are free, but food isn’t, so if you value my work, please DONATE or SUBSCRIBE.

Doctors Paid More by Opiate Manufacturers Prescribe More Opiates

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On March 13, 2018

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Quelle Surprise?

In 2014 and 2015, opioid manufacturers paid hundreds of doctors across the country six-figure sums for speaking, consulting and other services. Thousands of other doctors were paid over $25,000 during that time.
Physicians who prescribed particularly large amounts of the drugs were the most likely to get paid.

Now the article and researchers are quick to point out that causation is not proved, but…

This isn’t an unknown effect. Doctors who get paid more for surgery are more likely to perform surgery, even if non-surgical alternatives are considered a better idea. If they own a share in the institution doing the surgery, even more so.

I don’t like to get down on opiate prescribing, because I think the larger problem is all the doctors who won’t prescribe them. Even in Canada, it seems like every doctor’s office has a notice saying they don’t prescribe narcotics.

Huh? And if the patient is obviously in a lot of pain, you’re just going to let them suffer? We’re in a period of hysteria over narcotics.

That said, it’s also important to note that, yes, you tend to perpetuate the behaviour that you reward.

This is why money should largely be kept out of doctors’ decisions about appropriate care (and everyone else’s). It should not be a consideration except in the most extreme cases. A doctor with no skin in the game, monetarily, will tend to make better patient care decisions, because patient care will be their primary concern.

And, oddly, not only is that good for patients, in most cases that don’t involve end of life care, it is also cheaper, though that’s not why you do it.

Money doesn’t belong in large number of places. It should not be a concern for frontline care workers in almost all cases.

Exhibit five million somethingty.

The results of the work I do, like this article, are free, but food isn’t, so if you value my work, please DONATE or SUBSCRIBE.

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