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Wednesday, August 26, 2009


(In the flurry of the last post's comments, Deb seemed to be indicating some nihilism. She described some family health history and her subsequent decision to pass up some examinations and lab work. So she will now be yelled at; resignation will not be tolerated.)

WHAT THE HELL ARE YOU THINKING?!?!?!?!?!? You call the mammography clinic tout suite and set up an appointment today. NOW! You tell them your concerns that you're at high risk. If the current Majesties are considering treason, send them to the guillotine (they can always be succeeded by silicon Pretenders).

You will also call a cardiologist. The Ticker can commit treason in many ways. What could be more annoying than dying from something avoidable (or delayable)? Maybe you didn't inherit any heart issues and you're making yourself terrified for no reason. Maybe you need to get a pacemaker installed or carry some nitro; very tolerable compared to fearing the unknown.

HONESTLY! What is this hiding away like a scared rodent business about? Fight like a bad-tempered badger!! Even if you have to pay out of pocket, get the best science there is to prolong your existance. Make this your QUEST, dammit!

(Lord, its exhausting making people see reason. Luckily its my Quest ;) )


Debra said...

I am not resigned. I am AMBIVALENT. They're not the same thing.
Remember... YOU GUYS are living in the country where young women with those genes get mastectomies and then reconstructive surgery to give them as good as new breasts. Comments, Thai ?
Nobody I know over here has even REMOTELY considered the idea of having this kind of surgery done because over here we are... reasonable (LOL LOL LOL) people who have not gone collectively nuts yet.
Something about the fact that Europe's population went through two world wars on their soil (and not in a foreign, far away country...) MAY have contributed to keeping us a little bit MORE sane for a little bit longer than you guys over there.
I think that MEMORY of what war is for a culture has a somewhat sobering effect on everyone, and reminds everybody of just what MORTALITY IS, when infant mortality has plummeted in recent years.
In my book, this "memory" could have a considerable restraining effect on collective hubris.
By the way, for a while I entertained the cute delusion that my many years in psychoanalysis COULD protect me from Mom and/or Dad's fate. (The reasoning/rationalization is rather complicated ; I'll spare you that.)
Now that I'm really adult, I've realized that when you get down to it, THERE IS REALLY NO INSURANCE ANYWHERE. When your number is up, it is up. It could be tomorrow, walking out of the house, right ? For any of us ???
Don't mistake me. I don't go courting death. Not at all, by the way. I'll probably continue my mammographies for a while, but no anticholesterol meds, or exams or anything. Beurk, as we say.
I love my food. And I HATE having a moralizing medical caste tell me what's good or bad for me.
You guys should check out Moliere's "The Hypocondriac". Molière HATED doctors.
When you consider that the doctors of his time were earnestly treating patients with leeches, and IN TOTAL CONFIDENCE/FAITH in their own competence, it makes you think a little bit, doesn't it ?

Anonymous said...

Got News

They're still using leeches and swearing by them; it's scientific! No further comment necessary except to say that this is not my usual joke, it's true. Go figure.


Thai said...

Dink, amen and thanks. As I recently commented on Hell's recent melodramatic triade tonight:

"The strength of a country comes from the strengths of its peoples and their ability to cooperate (like any good football club, it is all about the quality of its players and their ability to play well together). It is/has and always will be about teams and cooperation, plane and simple."

SS- Thanks!

And you are absolutely correct! We do still use leeches. Further the anticoagulant in their saliva may have other uses (though I can't recall whether the recent trials were positive or negative- remind me to look this up if I forget- I think the compound is known as hirudin if memory serves me correctly).

Deb, most of the stuff you are saying is simply bunk and not worth even responding to. If you want to eat, do so. But your other arguments are simply silly. If you have a good quality of life and you can reasonably maintain this, why would throw this away?

Science/medicine has not really increased humanities overall lifespan, we have just increased the % of that lifespan that remains high quality.

I am the first to agree with those who say not all life is worth saving- I apply this to myself selfishly for my kids- and as I said before, I strongly disagree with many of the lifer nuts that seem to reside in such high numbers 30 miles south of me in SS's neighborhood, but your logic Deb is disturbed to say the least.

It is all about quality of life. That is why we do what we do.

Go get your silly tests. They don;t take much time. They are not that invasive and you have a little girl who will tomorrow want to share her children with some of the joy she has known with her mother with them.

Stop being so selfish ;-)

Thai said...

Psychoanalysis will not save your fro a heart attack.

Lipitor can (even if yoyomo think the drug companies are evil)

Thai said...

Dink, feeling chatty tonight and I being a sci fi geek I thought you might appreciate a little more of my favorite subject

Be well

Thai said...

FYI- Tomorrow night mars will be the closet to earth that it will be in the
next 60,000 plus years at 12:30 am. (eastern standard time). If you have a +75 telescope it
will be as big as the moon.

Thai said...

Never mind. I got fooled by one of my family members who should have known better.

Debra said...

Thai, you didn't respond to what I said about those young women getting mastectomies. There are probably not tons of them doing this, but the culture seems to encourage it..
For the leeches, yes I know that we are using leeches in a "correct" fashion now. But sticking them on people who were on their last legs when you couldn't figure out what else to do, well, that was taking it a bit far.
What I love in Molière is that you can SEE the birth of the medical caste in western society, and it goes way back (who knows, even to classical Greece ?).
If you had to listen to YOUR father in law's wife swear by what the doctor says, abdicating all personal thought and responsibility, you would get pretty irritated too.
Selfish, me ? Probably. Aren't we all ? I don't believe in most of the tests. They're interpreted ONE way for every so long, and then ANOTHER way. That makes me really suspicious. (And I DON'T really believe in progress.)
I've eaten a Cretan diet (without knowing what it was...) for the past twenty years or so.

Dink said...

@ Deb,

So I hope our various tirades have provoked you into action. I'm reminded of a great t-shirt I once saw that stated "I yell because I care" ;) I noticed your Dylan Thomas quote on SD (rage into the night) and am taking it as a positive sign. P.S. Moliere lived before the scientific revolution...

@ SS,

And maggots! I suppose if nature has already provided a solution to the problem, we should go with it (and try not to throw up).

@ Thai,

Fantastic link! I generally start backing out of the room after conversation goes past the 4th dimension and am at a full sprint by string theory; any meds available for cowardice ? ;)

Well, actually perhaps LSD and the ocean. Besides the 8th dimension guy, didn't Kary Mullis try this combo for inspiration? Nice!

Speaking of sci-fi, I cracked open Neal Stephenson's Quicksilver . I have no business doing this; there is no time for this. But its historical fiction about the Royal Society ignited the scientic revolution and its freaking brilliant. Snow Crash and Diamond are shorter and also classics, but I'm already 50 pages in..

Debra said...

So, dinky, just who says that Molière was before the scientific revolution ?
As though... BLING !!!!!....
All of a sudden God said "let there be a scientific revolution", and the scientific revolution WAS ?

Debra said...

I just thought of you guys while coughing my head off at home...
While y'all are chiding me to get those exams done, just what should I do about..
the fact that my home town is one of the most polluted areas around, and I have chronic respiratory problems ?
So... while the "collectivity" has been nice enough to come up with those oh so sophisticated exams to take my temperature whether I want it done, or not, it hasnot been NICE enough to keep those smog emissions down to a point that will NOT shorten my lifespan for a few years, since I suffer more from respiratory problems, than from any effects of "hereditary" conditions.
Yep, every advantage sure has its disadvantage.

Dink said...

"who says that Molière was before"

Well, he was contemporary to Descartes, but it doesn't appear that they ran in the same circles. Per wiki, he died of tubercular hemorrhage while performing his comedy "The Hypochondriac". Something tells me he would have "sold out" to science if he had had access to today's doctors ;)

"All of a sudden God said "let there be a scientific revolution", and the scientific revolution WAS ?"

If you insist.

"it hasnot been NICE enough to keep those smog emissions down to a point that will NOT shorten my lifespan for a few years"

We all saw Beijing's air during the Olympics. They say China is building once coal-burning power plant a week. They are screwing themselves over at a much faster clip than America has/is. Perhaps each empire will reach its peak faster than the previous one. Which I guess makes sense since it has access to all the tech from the previous empire.

Thai said...

SS, I thought you might find this interesting to help in your thoughts around health care. As I am sure you would quickly discover, Carpe Diem is a conservative blog.

This issue gets so darn complex it makes my head spin and it is zero sum (or as Deb says every advantage has its disadvantage and vice versa).

I think the comparisons of Japan and Singapore vs. almost any western country seems the most significant lesson to me: countries that in general live healthy lifestyles and don't shoot each other and don't get into too many drunk driving accidents have much lower health care bills than those hat like to behave like Bacchus.

It is relatively easy for Japanese citizens to guarantee everything to each other when it is very unlikely they will ever have to pay much for these guarantees.

In America, the current health care debate focuses on whom to shift costs onto (remember universal coverage definitely does this).

No one want to actually tackle the issue of not needing to push costs on each other in the first place.

It is just like the energy debate; new energy sources are sexy, more efficient use of the energy we have is not. Conservation is simply never a popular/sexy issue.

... But if you are an investor, it is where the money is made. Of this I am quite sure.

Thai said...

Dink, this means that just about any country in the world would accept you as a citizen ;-)

Thai said...

Oh, and SS, in case you are wondering why I am more interested in lowering total health care costs (I know you are interested in this to find money for jobs), my motivation comes from my role as a physician looking at the data.

As I said before, I think we MIGHT already be killing more people than we should be at the level of spending we have.

It is very hard to find anything else that has looked at whether we now spend so much we are actually killing people, but the suggestion clear is there.

Anonymous said...


The Japanese and Swedes both drink like fish, way more than us. The Japanese longevity is due largely t a fish based diet, their society has an enormous amount of culturally induced stress. The Swedes have in addition to to a huge drinking problem, often associated with the long winters and isolation have a very high suicide rate. They also have a more heterogenous population than you would imagine, a lot of immigrants have gone there in the last 20 years and they accept a lot of refugees.

I'll try to find some data for you when I have some moretime.

I would hesitate to conclude that everything is a zero sum game unless there is concrete evidence to support that. As an hypothesis it is nice and simple but I think reality often escapes simple realities.

For example, in economics a sharp downturn like we have now leads to negative growth a a shallow recovery. By using a stimulus Keynisans reason that unused economic capacity caused by the downturn can be put to use rising output, employment and taxes, more than paying for itself and leading to a better outcome in terms of subsequent growth and wealth. Although disputed most economists subscribe to this view and even more implicitly rally to it.

In health care I would guess preventive care, or healthy lifestyles leads to a net gain, e.g., health money invested in preventive care leads to long run cost savings.



Dink said...

" so darn complex it makes my head spin"

Its just awful. I'm glad that you, SS, and Okie are following the issue and attempting to induce reason.

The sensationalist in me wants to talk like a Fox News pundit and say "Is the government stealing your hard-earned health and giving it to irresponsible perverts?".

And in the big picture, I could make a few arguments to defend it. But I don't think this would help anything since most irresponsible perverts don't seem to be aware that they are irresponsible perverts. Paraphrasing George Carlin, everyone who drives faster than you is a maniac and everyone who drives slower is a moron. This perspective issue, as Thai has long noticed, is the crux of many societal problems. Though I'm pretty arrogant about vegetarianism, there are vegans out there pitying my ignorance.

Arrrgh. Evolution requires a small group with a similar trait expanding in numbers while the rest of the original group diminishes in numbers. Balance in a way that also has perceieved "growth". But were so damn clever these days that no group diminishes. So were sort of still evolving, but out of balance.

And please don't read eugenics in to this. The group selection going forward is..... hazy. Which team has the best strategy. Most teams don't even realize they're a team or have a strategy or even realize that there is a game going on. Some groups are pretty organized, but inherently psychologically self-destructive (totalitarian govs, fundamental religions, etc.). Some groups are pretty psychologically healthy, but decline to really organize as a team (Holland, Sweden).

And did y'all take a look at Thai's link about other dimensions? The "rabbit holes" for the 0, 1, 1.5, and 2 dimensions are intriguing. Getting funky with electrons...

Thai said...

SS, indeed. In fact not only do they drink like fish in Scandinavia but Swedes and Japanese also smoke way more we do and both nations have a higher median national age.

... But I caution you when comparing national statistics on drugs, alcohol and mental health as the different nations have very different definitions and thus comparisons are often almost impossible.

re: suicide

If you successfully kill yourself, you show up on your countries national mortality stats but you probably won't cost your country's health care system much money.

If you attempt to kill yourself, but fail in your attempt, you will cost your country's health care system a lot (but the country's mortality stats will look better).

I suspect Scandinavians are better at suicide completion than we are but that we have a much higher incidence of suicide attempts.

I have looked for data on this and the best I have found says that data is not available so I admit I may be wrong.

But parasuicide is an enormous problem in the US. The people just want attention and in their desire to get attention, they spend lots and lots of money (in fact, as you can see yourself, they are the most expensive group in America right now... I am sure Deb can share stories about them with us if you want? I certainly can.)

re: europeans drinking like fish

I once read (but now can't find) a study that suggested the geography of American cities, with their low density, wide distances and poor public transportation, invited drunks to drive more to get home and thereby sadly crash whereas European and Japanese drunks could stumble home on metro.

Remember, alcohol and trauma is the most expensive form of alcohol when it comes to medical spending.

And we spend more money on trauma than other countries.

I know this because I live in the world of trauma and the amount of money I can spend in a moment decision is truly stunning (with trauma teams, helicopters, etc...).

People have simply become immune to the cost of trauma, indeed they like to watch it on all kinds of television programs with a kind of "that's cool" flare.

Thai said...

As for Keynesians, their ideas took me a little while to grasp but once I realized they were simply talking about network theory, at least for me, their ideas became easy to understand.

Please understand, while I agree with the Keynesians to a point, there is an element of magical thinking that clearly violates the conservation of energy, as Krugman unwittingly illustrates in his blog.

I hope you see that what Keynes/Krugman can propose is nothing more than a perpetual motion machine and that such an entity violates thermodynamics and specifically the law of the conservation of energy (which I keep referring to over and over). Krugman is not accounting for the cost of the energy necessary to put the bottles into the ground and this makes all the difference.

I do agree with Krugman re: Keynesian views on savings as an endogenous variable, meaning people's desire to save can change depending on their outlook of the future.

But in order for people to be willing to lower their desire to save and therefore defeat the paradox of thrift, they must believe the future looks bright. And this can only happen when we all spend our money wisely (again, because of the conservation of energy) and people see it is being spent wisely.

If we spend our money poorly, and more and more people see it is poorly spent (all the while paying for the energy needed to maintain the charade), I suspect social trust will crumble and people's endogenous desire to save will sadly increase as oppose to decrease (as it did in Japan when more and more money was wasted on bridges to nowhere).

Anyway, I hope you are well my friend

OkieLawyer said...

The real problem with Keynesian theory, as I see it, is a practical one. In theory, deficit spending is used during economic downturns to re-stimulate the economy with revenues from economic growth and increased taxation during good and "overheated" economic conditions. The problem is that politicians, who would be responsible for increasing taxes never want to do that -- even when the economy is clearly overheated.

That is why it is left to the (unelected) Federal Reserve to do Congress' dirty work and use inflationary policies so that the debt can be paid back with cheaper dollars. Inflation is good for debtors and bad for creditors, generally.

Paul Krugman has argued that it was Franklin Roosevelt's insistence on paying down the debt in 1938 that led to the second recession during the 1930s. Perhaps so. But I still think that long term, the Keynesian model would theory. But its real-world application leaves much to be desired.

Thai said...

I agree with your "in theory" comment, but I still think the caveat is IF the money is spent well.

If you get yourself into a debt problem, and then you spend the money poorly, you will pay the price.

If you get yourself into a debt problem, but then spend your money wisely (say invest for future whatever that will pay off), you will be OK... Of course the reality is this is always true whether you are in a debt problem of not.

We can never get away from how we spend our money.

I think the thing to be fair to Krugman and most Keynesians is that they would spend the money very differently than we are currently spending it.

Thai said...

SS, I agree with Ezra Klein that this article written by Atul Gawande does one of the best jobs of explaining one of the biggest causes of increasing costs in health care.

I thought you would enjoy this link to Atul's article


Debra said...

Thanks for the article, Thai. I read all the way through it, even if my mind zaps a little bit these days, computer technology oblige.
I hate to say I told you so, BUT...
Once again, the conclusion is that the problem is... MONEY. Money has become a be all, and an end all of human activity. As a symbolic system, it has completely gone out of control.
Okie, your piece about France's health care was rose colored glass, BUT... in the good old days, after 1945, during postwar reconstruction, French social security (medical care) was financed exactly the way things are set forth in the Mayo clinic : a fixed price consultation that INITIALLY made almost every doctor available to almost every patient. And it worked well for a long time. Until... the money/medical bubble started ballooning.
I'm in total agreement about the fact that MORE medical care does not make for weller people.
But our society is addicted to... MORE MORE MORE, and keeps looking for different disposable objects to stick after that "more". Our society is an addictive one. (That's why it is really rather pointless to talk about addicts in our culture...)
The key point is also... team work.
Haven't you noticed how BAD we are at forming any kind of a consensus about anything these days ?
How BAD we are at cooperating, at compromising, at anything that sacrifices the priorities of the sacrosanct "individual" ?
We are collectively finding it harder and harder to build any kind of community, and this is proving disastrous for us.
We can't deal with these problems unless we try to rebuild community ALL ACROSS THE BOARD, and not just in health care. The scenario described in this article holds all across the board for "work" everywhere.
It is difficult to cultivate the spirit of "work" these days, right ?
One small point : my GP consistently prescribes too many tests for my view of the problem. I sometimes stick his prescription... in my pocket and dump it at home.
Everybody, AND THAT MEANS YOU, is free to do the same...

Dink said...

That was a well-thought out article. "Harmful financial incentives" was a phrase he used that seemed to sum up the situation. I wonder if any of those Texas doctors also invest in fast-food chains?

I read his book "Better" and was amazed by his honesty. He had an article on the difficulty hospitals have in getting employees to wash their hands every time they should; you really saw how easy it was to miss a washing even though they're fully aware of the microbiology around them. See also wrote about going to rural India for a month and how prissy and over-specialized the local doctors found him to be. Good stuff.

Debra said...

Well, Dink, as someone who spent a hell of a lot of time up there in infant ICU when my youngest was there, let me tell you, HAND WASHING in the hospital is really a DRAG.
And I wasn't even working in the hospital...
If you wash your hands with the kind of products that the hospital wants you to all the time, (like, wash your hands if you just blinked, for example...) you end up getting... dermititis in many cases.
Not very much fun. Not very sexy, a nuisance, and painful to boot.
Now you guys know why I stay away from hospitals, don't you ? Any doctor's family will tell you basically the same thing : hell, you don't want to go to hospital, people DIE in hospital, and not necessarily for the reason that they initially went to hospital, either...(and that was mentioned in that article too, wasn't it ?...)
I know I sound like a kook to you guys, but I have had a long long time to think about all of this.
As an aside, for everybody's info, here, I am seriously restraining my computer activities these days, for the reason that I am taking the piano veil, and will be consecrating 2hrs of my day to my first friend, that bourgeois object that is the modern piano.

Anonymous said...

@ Deb,

The piano is like so much better, wash your hands first, play mindfully.


Thai said...

Hey SS, reading Brad Delong brought me to this blog (I forget how). Anyway, it is clearly a conservative/Libertarian/Austrian blog but I thought you might be interested to listen to a video they link with that discusses the same issue with health insurance your Atlantic article pointed to


Debra said...

My doctor husband blandly announced to me yesterday before lunch the medical caste's recommendations that we all wash our hands several times a day.
I thought of you guys as AAAAAARRRGH ! passed my lips...
This recommendation is quickly becoming the basis for our new world community, in the face of the collapse of the one born in the aftermath of the Second World War...

Dink said...

"I thought of you guys as AAAAAARRRGH ! passed my lips..."

Strange how that seems to happen :)

I was just reading article about some new medical imaging technology or whatnot. My first thought was "I want that!". I have no need for it or any health problems to even indicate future usefulness of the data, but it was so cool. Then I thought of McAllen, TX. Sigh. If only "cool" wasn't so expensive...

There was also an show on one of the travel channels about Uganda. SO beautiful. If only "cool" wasn't so dangerous...

Thai said...

Of course physicians over ordering tests and "lookie loo" curiosity is not the only reason health care is expensive.

... I wonder if this health care reform supporter thought about his personal contribution to our national health care problem when his teeth decided to add to the problem? Indeed I wonder if he sees it now? (somehow I doubt it)

SS said...


Your husband should send you for retroactive care, and you Dink. Well you're condemned to the West Coast.

Thank god for Thai and the DAR purity commission.


SS said...


fancy that!


Debra said...

There is like some second sense, some little birdie that keeps whispering in my ears that you guys are all...
YOUNGER than I am.
I bet that's true.
While I certainly couldn't be the mother of any of you (I HOPE, at least...) age does tend to change one's attitudes on some of these questions...
And... what was "parsed" all about ???

Thai said...

Now this is an interesting article. Definitely a more optimistic slant on things.

The Most Fabulous Objects In The World

  • Hitchhiker's Guide To The Universe trilogy
  • Lord of the Rings trilogy
  • Flight of the Conchords
  • Time Bandits