With wealth comes the advantage of being able to afford the services of a topflight criminal defense attorney who can negotiate a great deal.

Posted June 27, 2006 11:57 PM by Richard Parker

So it looks like Limbaugh loses his deal on his previous charge, too.

We'll see how much justice he can afford this time.

Posted June 28, 2006 12:04 AM by Seth Breidbart

it just goes to show that justice, especially on drug cases, belongs to the rich and well-connected. If you're poor, screw it, you're going to prison no matter what you try and do. Your legal-aid lawyer will either be a drunk/drugged ne'er do well or non-existant because of budget cuts.

good luck.

Mr. Limbaugh (the professional comedian per Jon Stewart) should have known better. I always have my drugs bottled in their right bottles when I go through airport security, especially internationally. When I get to my destination I sort them back out into the Sun-Sat pillbox (in my credit, I only take two blood pressure meds daily plus an as-needed asthma inhaler that are presciption only). If I'm crossing borders, I also make sure my generic benedryl is in the right bottle and my ibuprophen is in the right bottle. Mr. Limbaugh is an idiot as far as I can tell and he just added to his stupidity in my eyes.

Posted June 28, 2006 12:36 AM by Paula Helm Murray

If you're part of the right-wing upper eschelon, you're allowed to get away with anything at all, because, hey, you support the right wing "cause" -- family values and all that. Not that you have to actually practice family values yourself. You just support them. For other people. You're already one of the annointed ones so you don't have to participate like all those little people out there.

This is all so, so twisted.

Posted June 28, 2006 12:40 AM by Writerious

Assuming for the moment that Rush is guilty of illegally procuring V*gr*, how many brain cells does it take to go out and buy some inkjet labels? It's not exactly rocket science to peel the label off a pill bottle, scan it, and substitute your own name. (I don't know about you, but if I was facing an expensive trial and possible imprisonment for a drugs possession offense, I'd have a strong incentive to make any subsequent compulsive infractions inconspicuous -- and having the right labels on the bottle to pass a cursory inspection is a good start.)

In fact, it sounds as if Rush got caught because he was breathtakingly stupid. I mean, how hard is it to get a private prescription for the aforementioned substance? Even from a court-approved doctor who's monitoring your compliance with a probation order? The stuff's not exactly illegal in and of itself ...

Posted June 28, 2006 5:53 AM by Charlie Stross

We should be reminded that 'privilege' originally meant 'private law', i.e. the exemptions from common or civil law possessed by some persons because of their wealth or status. There have always been some people who have believed that wealth, fame,or status should mean that they are above the law. It isn't surprising that a blowhard like Limbaugh is in that category.

Posted June 28, 2006 7:23 AM by Fragano Ledgister

Of course Rush is blindingly stupid--he always has been. He was raised in a town in Missouri where his father was someone important, grew up with the conviction that he was entitled to better treatment than other people, and never got behind the idea that he would have to work to get anywhere in the world. He dropped out of the local state university after one year, because they expected him to show up to classes and do the work necessary to pass them. He would still be an announcer at some small radio station in the midwest if he hadn't become blindingly lucky, and if he hadn't been helped along by people who knew a useful tool when they saw one. He's a spoiled brat who has never absorbed the concept that the rules that apply to me and thee must also apply to him.

Make up a fake label for his pills? That's work! As far as Rush is concerned, work is something other people do.

Posted June 28, 2006 9:13 AM by fidelio

Damn, Richard. I was so hoping your second link would point to The Chewbacca Defense.

Posted June 28, 2006 9:19 AM by Skwid

Just as much as the next liberal, I like seeing Rush made miserable, but I also just want to point out here that a significant chunk of what's making him miserable here is laws that make a whole lot of other people miserable too.

Does it strike anybody else here as odd to have to sort and package your medications for the convenience of and inspection by people whose business it really shouldn't be? That obsessing about what pills people might be bringing into or out of a country is somewhat tyrannical?

Posted June 28, 2006 11:02 AM by Avram

Avram: yes. (It's one of the secondary reasons why I'm not a pharmacist any more.) Obsessing about what pills people are taking -- beyond the degree that's necessary in order to impose quality control on substances that can be quite toxic if misused -- is repugnant. It's like earlier generations obsessing about what other people are doing in bed, and with whom -- or about what language they use to recite their prayers in private (to the same god, no less! Just using the wrong language was enough to get people hanged in this country, only two and a half centuries ago).

Unfortunately it's a situation we're stuck with, and Rush -- as a beneficiary and booster of the status quo -- should be no less constrained by it than the rest of us. See definition of "privilege" above ...

Posted June 28, 2006 11:15 AM by Charlie Stross

Avram: hear, hear!

Perhaps the best thing that might come from this sleazy little case is a re-examination of the monstrous system that produced it.

Yeah, right, and maybe they'll count all the votes in November.

Posted June 28, 2006 12:24 PM by John M. Burt

Does it strike anybody else here as odd to have to sort and package your medications for the convenience of and inspection by people whose business it really shouldn't be? That obsessing about what pills people might be bringing into or out of a country is somewhat tyrannical?

Yes.

I had to explain my medical conditions in grim detail when I crossed the border this time, admittedly to a pleasant and kindly lady who did NOT make me feel like a criminal for having to carry that much medication for two week's travel, and who was perfectly okay with me having the prescription bottles in the suitcase and a mixed pillcase in my handbag.

It still irked hell out of me.

Posted June 28, 2006 1:43 PM by Marna

My prescription 'medication' is a very expensive machine - and I just adore watching the security personnel thump it around and pack it back up by jamming it in its case backwards.

Posted June 28, 2006 1:54 PM by Margaret Organ-Kean

I know someone who had severe spinal damage years ago (fractured vertbrate, compressed disks, back brace for a year) and is suffering nearly constant pain now. And this person is always having trouble with the doctors trying to cut off their pain medication. I suggested kneecapping the doc in a dark alley so they may understand that even though you can't see pain, you can still feel it. There's a lot of cover-your-ass stupidity around meds.

Posted June 28, 2006 2:00 PM by Greg London

I think that it is especially delicious to see that "what comes around goes around" when it happens to a proponent of a particularly unjust law.

I'm not real patient with the drug laws in this country, gods know, but I don't feel any logical or emotional connection between the injustice of those laws and watching Rush hoist by his own petard. It has the same special charm as catching Jimmy Swaggart in a cheap motel with an even cheaper whore. How can you not take a deep, abiding satisfaction in watching the self-righteous bastard take it in his moral shorts?

The drug laws are evil. What they do to people who aren't Rush is evil. The contrast between the two is evil. But the embarrassment that Rush is experiencing is satisfying.

If only they'd put Rush's ass where his mouth was. But that's an issue of law and justice. It's not karma.

Posted June 28, 2006 5:25 PM by Lydia Nickerson

Margaret-

See my post on the other Rush thread. From the link I found, you definitely have the right to be present when they inspect your equipment. They are required to change gloves- put on fresh gloves- when touching your equipment if you request it.

I have also seen, but can't find a link, the possibility of a rule that says you have to be the one first opening up your equipment, not them.

Of course, the 20 minute question is how do you ask security to follow the rules without them getting snippy. (There's always the ones who want you to not only be polite, but to be subservient in the face of the TSA.) I'm going to ask that on the other thread.

Posted June 28, 2006 9:12 PM by kathryn from Sunnyvale

If you've traveled with "exceptional supplies" (medical, fragile, photographic),
And security asked to search it,
And you got security to follow the rules,

how did you do it? What phrasing did you use to request that the TSA follow their own rules without the TSA agent getting snippy and angry?

For example, you can ask for the agent to put on fresh gloves before searching your medical equipment. I bet many people want to ask for this, but are afraid of what could happen. How would you / did you phrase this reasonable request?

Posted June 28, 2006 9:17 PM by Kathryn from Sunnyvale

Just as much as the next liberal, I like seeing Rush made miserable, but I also just want to point out here that a significant chunk of what's making him miserable here is laws that make a whole lot of other people miserable too.

Yes, Avram, and he's strongly in favor of those laws--when they are making other people miserable.

Hoist on his own petard--except that, somehow or other, he won't be. He'll get off.

Posted June 28, 2006 10:32 PM by Lis Carey

It is ridiculous how so many things are judged one way or another depending upon who they are or aren't, and how much "justice" they can afford. In deifferent places all over the country, you can do one thing and go to jail and then another be applauded.. it's crazy really.

Posted June 29, 2006 4:07 AM by Jessica

I have a document, a couple of decades old at this point, that was prepared for me by the staff of the neurologist who formally diagnosed me as having narcolepsy. It's a "to whom it may concern" letter, on his formal letterhead, which explains that I really do have narcolepsy, and that there really are legitimate therapeutic reasons for me to be carrying whatever medications I'm currently using. This is on top of having legitimate, fully labeled prescription packaging for my drugs. It's to keep some border official from deciding on his or her own steam that nobody takes those drugs for any but recreational purposes.

Patrick's had long frustrating phonecalls with people at insurance companies, and wound walking them through the PDR to get to the paragraph in the description of one of my drugs that lists "narcolepsy" as one of the conditions for which it's prescribed. They'd up and decided on their own that nobody takes those drugs for legitimate therapeutic reasons.

When I'm medicated -- and boy, is that a sore point right now -- doctors habitually underprescribe, to the detriment of my life and health, because they get harassed by law enforcement officials who want to make sure that narcoleptics aren't getting more drugs than they strictly need. In consequence, we get less drugs than we strictly need.

Greg London's friend who's in constant pain from his seriously messed-up spine, and who's constantly threatened with having his pain medications withdrawn, is living with the same problem I do. He's far from being the only one I know of who's in that position.

We all live with the constant, artificially imposed need to calculate how and where to allocate inadequate doses of essential medications. Some of us scrounge extras from kindly friends. As far as I can tell, we all anxiously hoard little stashes of extra medications against the day the pharmacy unexpectedly closes early, or our physician takes off on a long vacation without writing our latest round of standard prescriptions, or some dorkbrain at the insurance company decides our standard meds aren't eligible for standard coverage, and until we can get that misunderstanding cleared up, we're faced with the choice of either paying for our prescriptions out of pocket, or paying our rent.

We live on a short leash. Our class of medications -- the ones where the prescription has to be written out on multicopy NCR forms -- are hedged around with massively inconvenient restrictions. I used to have to spend one entire workday per month picking up my new prescriptions from my neurologist up in White Plains, then getting them filled by a pharmacist in the Bronx, when I lived in Staten Island. Trips lasting more than a few days always have the potential problem of overlapping the end of one prescription-month and the beginning of another. Can I get it filled early? Don't even ask.

The best pharmacist I've ever known gets a lot of business from NYC kids who have sickle-cell anemia. It's a very painful condition, and it takes major painkillers to treat it. But if a seventeen-year-old black kid walks in the door of a pharmacy with an unquestionably legitimate prescription for Vicodin or Oxycontin, he's likely to be turned away without his meds. This pharmacist I know has sickle-cell patients coming in from all over the city, just because he'll scrupulously fill a legit prescription no matter what it's for or who brings it in. (And why was I there? Same reason.)

I think the drug laws are stupid. I think our emphasis on interdiction, rather than treatment, is stupid squared and cubed. I think forcing health care professionals to be drug enforcement agents is insane. But Rush Limbaugh is exactly the kind of drug abuser all this BS is set up to catch. He's the reason the rest of us have to live with it.

The extent of Limbaugh's Oxycontin abuse was seriously nontrivial. He was doctor-shopping, and he got off absurdly easy. And now he's turning up with a bottle of prescription meds written from one doctor to another, not to him. After all that's happened, this man is still playing games with the system. I have no sympathy, none, zero, zip: no sympathy whatsoever.

Posted June 29, 2006 8:24 AM by Teresa Nielsen Hayden

Teresa -- This kind of thing makes me want to bite someone. I think you should explain to Tom Doherty that swimming pools in Montreal are free. Then he might be persuaded to move all of Tor here, including your job, and you could have access to a less stupid medical system. (Not perfect, but less stupid about this stuff. A friend of mine from Boston was visiting, and she was part way through a course of prescription anti-biotics for a tooth infection. She'd forgotten to bring them, so we went to a walk-in clinic and explained. The doctor gave her a prescription and asked her if she needed a prescription of something for the pain as well. She was astonished that this was offered.)

Posted June 29, 2006 8:39 AM by Jo Walton

I'm with Jo Walton. No, it's not perfect here. I've heard that patients are still under-treated for pain (although for different reasons than they are in the U.S. I think), but at least the war on drugs hasn't made everybody completely insane.

*pets Canada*

Posted June 29, 2006 9:40 AM by Hamadryad

(hears purring sound coming from the north)

Posted June 29, 2006 10:10 AM by Greg London

Thanks, Avram. That expanded nicely on how I feel about it.

I'm not sure how one balances respect for the rule of law (something I'm pretty ambivalent about) with very bad laws.

Would it be excessively obnoxious to suggest to Limbaugh that he reconsider his stand in favor of strict enforcement of drug laws?

If you want to keep track of outrageous enforcement practices (frequently about drugs) check out http://www.theagitator.com.

I believe that the drug plan system is going to be a much livelier black market in prescription drugs. There is *no* *way* that people can predict a year in advance which drugs they're going to need, and the drug plan system is new enough that this hasn't really begun to kick in yet.

Posted June 29, 2006 10:24 AM by Nancy Lebovitz

I think forcing health care professionals to be drug enforcement agents is insane.

That is the root cause of the problem. Some bureaucrat, hiding behind a desk, buried in some office, decides that they know better than a suffering patient or their doctor and decrees that its better that some people suffer than to have even one Rush Limbaugh get his fix.

It's better that ten guilty men go free than to have one innocent man go to jail. But for some reason, it's better to have ten people who need medication be denied than to have one addict get drugs.

Fat Bastard should go to prison, not for the drugs he abused, but for being an over-inflated windbag who caused real suffering for countless people who had legitimate need for meds and were denied because of his hypocritical self-righteousness.

Hm, I like the sound of that. Rush Limbaugh: the new Fat Bastard. Pass it on.

Posted June 29, 2006 10:28 AM by Greg London

How come nobody is asking what Rush was doing bringing Viagra to the Dominican Republic, a notorious destination for sex-tourism, including underage sex-tourism? Was he travelling alone or with female company? Are any reporters interviewing the local prostitutes to see if any of them spent a night with a fat American blowhard?

Posted June 29, 2006 10:51 AM by the exile

Well, the rationale for the tight restrictions on some drugs is pretty easy to understand if you look at it from the right angle. After reading a great deal of drug-war propaganda, much of it can distilled to the following precepts:

1. People who abuse drugs are defiling the temple that is their body and are bound for hell.

2. People who aid and abet such drug abusers make the baby Jesus cry and are likewise bound for hell.

I remember reading somewhere that in the late nineties the city of San Francisco was spending six million dollars a year treating infected needle sites alone, never mind incidental costs associated with IV drug abuse. That problem could have been reduced by a factor of twenty with a needle-exchange program, but that would "send the wrong message".

People denied medication live in pain and die early. But they're going to heaven! And most importantly, so are the people who make the rules!

Reason #11,004 why the religous right makes me gag.

Posted June 29, 2006 11:06 AM by alex

Teresa, thank you for the excellent point that manipulative abusers like Limbaugh are the reason that those who a real need for potentially-abusable drugs have such a hard time getting them.

That angle hadn't occurred to me at all.

Posted June 29, 2006 2:21 PM by Jacob Davies

(I quoted it - with a link - in a discussion of this on the Well. Hope that's okay.)

Posted June 29, 2006 2:34 PM by Jacob Davies

the exile:

It's been speculated on multiple times here.

I think the reasoning was to avoid clogging this thread with the discussion from that thread.

Posted June 29, 2006 2:58 PM by Lenora Rose

After all that's happened, this man is still playing games with the system. I have no sympathy, none, zero, zip: no sympathy whatsoever.

I have no more sympathy than you. And yet I must say that the absolute value of my sympathy is far, far greater than zero!

Posted June 29, 2006 2:58 PM by Xopher

Nobody gets justice from the current set of drug laws. But rich people can often buy their way out of much of the injustice, and well-connected people can often use pull to get themselves out of much of the injustice.

Rush Limbaugh is a pretty uniformly bad influence on the world, and I wouldn't be sad to see him unable to find work on the radio. But he absolutely shouldn't go to jail for this nonsense, any more than anyone else should. Similarly, if he's found having sex with a man, he shouldn't be jailed for sodomy, even if he supports such idiotic laws.

Posted June 29, 2006 5:16 PM by albatross

I disagree, albatross. I think the punishment he wishes upon others should be visited upon him.

No, that isn't justice. Just karma.

Posted June 29, 2006 5:30 PM by Xopher

Xopher: it's also Xianity: do unto others. He's obviously treated other people the way he wishes to be treated....

Posted June 29, 2006 11:39 PM by CHip

CHip: and "Judge not, lest ye be judged."

Posted June 30, 2006 12:14 AM by Xopher

Here's something I don't get: who benefits from the prescription status of most medication? I can see the usual drug-war issues for addictive painkillers (they have known "recreational" uses), as much as I disagree with them there as well as with criminalized drugs, and I can see good public-health reasons for restricting the use of antibiotics, but whose interest is served by making (say) Viagra or Prozac anything but a plain over-the-counter product? You can hurt yourself with it, sure, but that's not exactly a standard we apply with any consistency: see Tylenol, low theraputic ratio, overdose of, or just the fascinating toxic/caustic chemicals we sell as cleaning products.

Posted June 30, 2006 12:20 AM by Nathan Williams

Would it be excessively obnoxious to suggest to Limbaugh that he reconsider his stand in favor of strict enforcement of drug laws?

Not at all... But it would, I suspect, be a waste of time and purely rhetorical, as was, I think, your question. From what I can tell, Rush Limbaugh thinks that laws which apply to other people (and should, by God, apply to other people) should not apply to him. Fidelio's comment was dead on.

I have sympathy for many people caught in the traps our country provides for its citizens through its insane drug laws. I can't find it in my heart to sympathize with Rush Limbaugh. My bad.

Posted June 30, 2006 12:24 AM by Lizzy L

Nathan, I could maybe see a system where a person would have to consult with a doctor first, and then could get what are now prescription drugs, but I can't see a system where anyone can buy anything. It's way too easy to kill or maim yourself with the modern pharmacopoeia. Just for starters, we'd have a hellacious problem with misapplied antibiotics.

Posted June 30, 2006 12:42 AM by Teresa Nielsen Hayden

Teresa, I have to agree about that. Given the range of possible side effects and drug interactions out there, getting some input and monitoring of what you take for your condition, and whether you should be taking that, given what else you already have to take is a good plan...my hair curls at the thought of leaving it to chance, and in individual's own ideas about What Would Be Good For This, and it's pinned up in a pretty tight bun today. A pharmacist, even more than a doctor of medicine, could probably explain why counting on the experts here is a good plan, but it is.

I think our legal approach to a lot of medications is idiotic, especially painkillers and stimulants*, but I no more think I should be able to prescribe freely for myself, all across the board, than I should be expected to diagnose all of my medical problems. Calibrating the combination of medications someone with a single complicated illness, like lupus or the other autoimmune disorders will get the best results from is a complicated process that requires continual adjustment--making sure these medications don't mix badly with the others drugs the patient needs just adds to the fun. It's not a game for amateurs. Care to figure out what you need to take to treat that pesky cancer, beyond Really Good Painkillers? I'm not saying that taking what you're prescribed in blind faith, without question or discussion is smart either, of course.

And yes, I'd have liked having something more effective for the headache I had Monday than ibuprofen, without getting tagged with "drug-seeking behaviors."

*But the way we advertise medications is as bad. Grrr. Also, Tylenol: grrrr.

Posted June 30, 2006 9:25 AM by fidelio

I just saw a doctor yesterday. Hadn't seen this one before. Was referred to him via someone else. It was the weirdest thing I've ever seen. First of all, the appointment was an hour later than it was scheduled for, so I end up in the waiting room for a long time. The doctor came in with a chip on his shoulder and the attitude that started out with "what are you doing here?" When told of the first problem, he responded with "Why did you come here?" (I don't, because another doctor told me to see you) Apparently that wasn't his specialty. However, he did seem to know enough about the topic to be able to decree "There isn't much you can do about that anyway", which is always encouraging.When communicated the second issue, he said, yes, that can be fixed, you need to see this person. When I asked for further information about the first topic, he went on a pity-party telling me he was retiring soon, wasn't looking to take on new patients, and decreed again that there isn't anything that can be done anyway.

All of this delivered with an emotional subtext of "you idiot. why are you bothering me? don't you know anything?"

At first, I thought I must be reading him wrong. Then I thought he was trying to be funny in a no-skills-for-being-funny sort of way. When I finally got that he was just an asshole, I was already being hurried out the door.

I swear I'm going to get a hidden video camera and tape this crap from now on. Why he had the attitude, I have no clue, but it was clear he had it when he stepped in the room. And it may be that he wasnt' the guy to see for the problem, but why he was mad at me I have no clue.

I can only hope that on his deathbed he realizes his mistake, but can't do anything about it because he's lost the ability to speak and he's getting the same bedside manner from his doctor that he gave me.

Posted June 30, 2006 10:17 AM by Greg London

That should be:

(I don't know, because another doctor told me to see you)

Posted June 30, 2006 10:28 AM by Greg London

Your legal-aid lawyer will either be a drunk/drugged ne'er do well or non-existant because of budget cuts.

You know, I think we can talk about the imbalance in the justice system without needlessly crapping on the people who do very difficult work for very little pay under extremely trying circumstances. You also seem to be confusing Legal Aid, which is a specific, government-funded "poverty law" corporation, with the various public-defender and assigned-counsel systems for criminal defendants.

As for "drunk or drugged", if you think that's a characteristic of the idealists who scratch out a living at Legal Aid, you've clearly never seen a bunch of corporate lawyers booze it up at a Continuing Legal Education seminar.

Posted June 30, 2006 11:15 AM by mythago

Greg, my brother-in-law has had the unpleasant good fortune of being treated by a brilliant neurologist with the social skills of a seed case from a sweetgum tree, or possibly an armload of branches from a honey locust tree. He was great at dealing with the disease, but the effort involved in dealing with him was taxing. Thre are more than few physicians who meet that description out there.

As for the one you had to deal with, it sounds like it may be past time he retired. I hope you gave your referring physician an earful about the encounter.

Posted June 30, 2006 11:22 AM by fidelio

"Nathan, I could maybe see a system where a person would have to consult with a doctor first, and then could get what are now prescription drugs, but I can't see a system where anyone can buy anything. It's way too easy to kill or maim yourself with the modern pharmacopoeia. Just for starters, we'd have a hellacious problem with misapplied antibiotics."

Antibiotics aside (since they can breed superbugs that spread), why does stopping idiots from hurting themselves justify any restrictions on medicine? It's not like idiots are an endangered species that actually need to be protected.

Posted June 30, 2006 12:15 PM by Ken

Why he had the attitude, I have no clue, but it was clear he had it when he stepped in the room.

I have the good or bad fortune of having a doctor who expresses to me his contempt for patients other than me. He's actually a pretty good guy under most circumstances, but he does like to speak (generally, no names) of the dopey behavior of a number of his patients. This is generally in the context of letting me know he can say this stuff to me because I am not (at least in his opinion) one of his dumb ones. Of course, he probably talks about what a dope I am to his other patients. Which is fine with me, actually, since I don't have to experience it myself.

I did have one doctor, a specialist, who treated me like the way you describe. He was supposed to be A Big Shot In His Field. He turned out to have neglected to order one relatively minor blood test that would have given a definitive diagnosis of my problem. This was an oversight that delayed diagnosis of my condition for two years and cost my insurance company thousands of dollars in additional, very complicated tests. Most of which did not go to him, by the way. Which is to say he didn't screw up on purpose to get more money; he screwed up because he was the sort of dope he was thinking I was.

Heh. I'd love to bump into him again some day and explain to him what an incompetent, dopey Big Shot In His Field he is.

Posted June 30, 2006 12:36 PM by Michael Weholt

Ken: Antibiotics aside (since they can breed superbugs that spread), why does stopping idiots from hurting themselves justify any restrictions on medicine? It's not like idiots are an endangered species that actually need to be protected.

Because we will all be stuck with the cost of saving their idiot asses once they discover they weren't the experts in modern pharmacopoeia they thought they were?

Oh, wait. I get it. They are supposed to die of their stupidity. The invisible hand of the darwinian marketplace and all that.

Posted June 30, 2006 12:45 PM by Michael Weholt

"Because we will all be stuck with the cost of saving their idiot asses once they discover they weren't the experts in modern pharmacopoeia they thought they were?"

Well, we're paying anyway in higher medical costs, plus paying for the idiots when they find some other way to hurt themselves, and paying in restricted access to medicine, plus paying ever-higher costs as society continues its futile quest to eliminate all the myriad ways that idiots can hurt themselves.

And the idiots themselves breed faster than we do, so all those costs themselves go up over time.

Posted June 30, 2006 1:36 PM by Ken

Antibiotics aside (since they can breed superbugs that spread), why does stopping idiots from hurting themselves justify any restrictions on medicine? It's not like idiots are an endangered species that actually need to be protected.

Because one of those idiots might be me. It might be someone you are fond of. It might even be you.

Medical diagnosis and treatment is at least as complicated as rocket science. While I don't support the notion that we, the patients, should consent to be passive recipients of care from the Wise Ones, when and as they choose, I do have to admit that there are moments when I should shut up and defer to expertise. I also feel, having some knowledge of the history of drug production and dispensation in the last couple of centuries, that I'd someone with a Big Stick making sure the treatments provided were effiacious and reasonably safe.

Posted June 30, 2006 1:40 PM by fidelio

I was gonna write something about how possibly the number of lives that would be saved by allowing people to buy whatever meds they wanted might be greater than the number that would be lost, as I have a vague memory of David Friedman arguing that the number of people who die due to lack of medication that hasn't been approved yet by the FDA is larger than the FDA's estimate of the number that are saved by the FDA having a strict approval process.

But while googling around for supporting evidence, it occurred to me that Friedman's argument probably rests on estimates rather than actual numbers, and besides that wasn't quite the issue under discussion.

But in the meantime, I discovered that Wikipedia's page on the FDA contains the phrase "Gansevoort Destructor Plant", which makes me feel like I'm living in a weird space opera parody. I think the next mech I design for Mechaton will be called the Gansevoort Destructor.

Posted June 30, 2006 1:41 PM by Avram

Ken, prevention is cheaper than fixing it after the fact. If you're of the "they did something stupid, so the Ship of Society gets to throw them overboard" school, please note that they don't necessarily go away; they revenge themselves on the society that abandoned them by becoming desperate criminals.

It's cheaper to stop them up front than it is to fix them, imprison them, or clean up the messes they make of OTHER PEOPLE's lives, including people who aren't stupid, and aren't related to them.

Posted June 30, 2006 1:43 PM by Xopher

Xopher:

To write a sonnet cycle with no plot
Is to be avant-garde and not mediæval,
Sticking to narrative line is simply evil,
Imperialist, fascistic, the whole lot
Of oppressive structures misbegot
Upon our language by the sickening weevil.
To tell, as we turn it on the bevel,
A story we can follow -- tommyrot!

Petrarch himself would scarcely recognise
What we have here constructed with our power
To manifest our mental lucubrations
In such obscurity that we seem wise,
The very men and women of the hour,
Keeping base novelists in their proper stations.

Posted June 30, 2006 1:59 PM by Fledgist

A few drugs seem to be prescription-only that don't really need to be, but the gatekeeper aspect that makes you consult with a doctor and then a pharmacist seems quite useful for most prescription drugs, even ones with little potential for abuse. A lot of them have interactions with other drugs or side-effects to watch for, and of course your doctor being an expert, they may have an idea as to what will work the best for you. These days you can already walk into your doctor's office with an informed understanding of what drugs might help, and in my experience at least, most doctors are quite willing to listen to that.

I don't really care about the drug-war aspects of it all, and I think we'd all be safer & better-off if you could go to your doctor and get a prescription for MDMA or LSD, should you want it that much - you'd know what you were taking was pure & what you expected and your doctor would be in the loop, just as your doctor might know about your drinking or smoking (ick - considerably more dangerous than most illegal drugs, of course, so you'd expect your doctor to try really hard to get you to stop).

Maybe the same should be true of other drugs that lack the potential for public-health harm - you could insist on being prescribed Viagra or Prozac, for example. But at least your doctor would know and have a chance to discuss it with you. Making them OTC would take that away.

Posted June 30, 2006 2:07 PM by Jacob Davies

Ken, the next time you're feverish, and not thinking entirely straight, maybe you'll be the idiot in question.

Posted June 30, 2006 2:25 PM by adamsj

Ken: To listen to you talk, you'd think the worst thing that could ever happen to anyone would be to have to pay their taxes.

Why not make all drugs OTC? Because I don't want to be the kind of person who's indifferent to the sufferings of kids whose mother made what might have been a trifling error but in her case turned out to be fatal. I don't want to shrug and write off people whose lives, and contributions to society, have been cut to a fraction of what they might have been because messed up with drugs and took out their eyesight, or their liver, or gave themselves a stroke. I don't want to have to read the childhood memoirs of people whose parents had Munchausen's-by-proxy and could get hold of any drug they fancied. I don't want to meet a car on the highway that's being driven by a person who belongs to the tiny fraction of the population that experiences wild delusional anxiety when they take a certain commonly prescribed antibiotic. I don't want to sit in a funeral home and hold the hand of someone who gave what he thought was good, solid, 100% safe advice about medications to his best friend. And finally, because I don't think we'd be better off if advertisements paid for by drug companies were the single biggest source of medical information for the general public.

Posted June 30, 2006 2:55 PM by Teresa Nielsen Hayden

Ken: Ignorance, poor assumptions, or poor research skills are not stupidity, and do not deserve to be treated as such. For that matter, stupid does not equal thoughtless, indecent, wrong, unkind, incompetent, unproductive, unloved, without family or friends, useless, criminal or undesirable. A person pretty much has to be every single one of the above before I would even consider saying "too bad, you're on your own, no safety regulations, ake whatever drugs and antibiotics you want for your condition." And even with all the above, I'd probably still err on the side of advising them to check with an expert.

There are some ways in which our society is overprotective against our many methods of idiocy. While some aspects of the war on drugs do fit under this, the entirety of the pharmaceutical system does NOT.

The pharmaceutical system is more like those annoying people who insist on certain building codes. It's inconvenient for a skilled, safe, but idiosyncratic electrician, or people who don't want to pay for a permit just to put up a garage, but you don't want the building codes to go away.

Posted June 30, 2006 2:57 PM by Lenora Rose

Why not make all drugs OTC? Because...

Game, Set, Match to Teresa.

Posted June 30, 2006 3:06 PM by mary

And the idiots themselves breed faster than we do...

Who's "we" here?

Over the years, I've been hearing more and more of this social darwinism thing so you can understand my confusion about which group of idiots is breeding the fastest.

Posted June 30, 2006 3:17 PM by Michael Weholt

a brilliant neurologist with the social skills of a seed case from a sweetgum tree

At least he was brilliant. The guy I saw couldn't do anything useful for me other than to point me somewhere else.

Posted June 30, 2006 4:39 PM by Greg London

I don't mean to pile on here , but I do want to point out that comments about idiots breeding faster than those who are not idiots can often mean: "people who have more children than I approve of are idiots."

Actually, I guess I am piling on, since Teresa has already sliced and diced the commentator into something resembling potato sticks.

Posted June 30, 2006 4:40 PM by Lizzy L

people who have more children than I approve of

I set my approval rate at .75 children per adult, but I don't think they're idiots if they break that number, I just know we all create the world that the next generation inherits. Personally, I think one-billion people on this planet would be a nice round number to make as a long term goal. But I'm not holding my breath for it.

Posted June 30, 2006 4:56 PM by Greg London

Oh, hell, I'll pile on.
Michael Weholt and Lizzie L both beat me to it - but as I'd already formulated a reply, here it is anyway:

Ken, if you're a hard Darwinist, then logically you cannot regard successful breeders as "idiots".

If you insist upon considering society from a Darwinian perspective, then the ones who actually pass their genes on are the ones who are "winning" - and the ones standing on the sidelines sneering at the intelligence of others aren't.

The part of Darwinism that you've overlooked is the part about variation: society needs everybody. We don't actually know who or why, but we need to try out as many possibilities as we can. We may even need the ones who think that "idiots" are outbreeding "us".

Posted June 30, 2006 5:19 PM by Bob Oldendorf

One billion doesn't seem enough for the rate of progress I'd like to see. I think anywhere from five to ten billion will work out fine.

I know the um, nerdier types (which I count myself among) tend to be pretty down on population, but if a large population can be educated, liberal, and live in a fairly sustainable way (and I realize that last is the major point of contention), there are many advantages to having a lot of people. I'm pretty excited to see what China & India will be able to do with tens of millions of scientists and engineers, if they can achieve economic take-off. And of course, tens of millions of artists, writers, chefs, and god knows what other kinds of creative people; and billions of people just living happy & productive lives.

In a world of one billion, absent technological change that makes everyone able to be a brilliant scientist without needing someone to cook, clean the toilets and take out the garbage, the sheer number of people who can devote their time to progress will obviously be much smaller; in fact probably disproportionately smaller, because of economies of scale that apply when you cram a lot of people together; and the rate of progress probably disproportionately slower too because there would be fewer people to interact with. Leonardo da Vinci would have been a lot more productive if there had been five more people just like him around to talk to.

The sustainability question is the big one. I'm an optimist, and I think a determined effort to make continual progress in efficiency will let the whole population of the world (even as it grows to somewhere under ten billion) live in conditions like the West in a fairly sustainable way - or at least one that isn't always about to cause a global catastrophe. Speaking of which, most of this depends on making it past climate change in the immediate future. Fingers crossed, eh?

Um, so how about that Rush Limbaugh.

Posted June 30, 2006 6:00 PM by Jacob Davies

Anyone at all tempted to the "I can do it all safely myself" view (let alone Ken's Scrooge-like "and anyone who can't should just die and decrease the surplus population") should just take a look at what nurses have to study to make sure they don't accidentally give bad combinations of drugs that are contraindicated for specific conditions to particular patients with multiple diseases who have multiple doctors prescribing treatments for those pre-existing conditions after they've been admitted to the hospital.

The encyclopedic lists of contraindications are mind-boggling. And when they're accidentally not followed - can result in death. And yes, there are handheld computers that will help. But you have to know what the medical names of all the conditions are, and which drugs are the generics of which, and...

Posted June 30, 2006 7:20 PM by bellatrys

Oh, but TNH, that's because you're improperly soft and bleedy-hearted. Here, how about you read this copy of The Fountainhead? Then Ken's jibbering will all make sense.

Posted June 30, 2006 7:44 PM by mythago

Fledgist...*bows*

But this is the wrong thread, isn't it?

Teresa has already sliced and diced the commentator into something resembling potato sticks.

I disagree. I thought Teresa was very civil, and stuck to the points he raised. She demolished his points, but completely avoided personal attack. He's not the piñata of this thread by any means. He made a fairly foolish suggestion which Teresa showed him was fairly foolish. That's all.

I hope next time I say something dumb (which will NOT be the first time), I'm dealt with as civilly. I'm less pleased with the pileon that has followed. But then I'm one of these bleeding-heart types!

Posted June 30, 2006 11:19 PM by Xopher

why does stopping idiots from hurting themselves justify any restrictions on medicine?

Entirely apart from the arguments about people who are incompetent to take care of themselves but try anyway....

I don't want malicious people to have easy access to every drug. Roofies. Poisons. Etc. I'm perhaps slightly paranoid but I dislike the custom that lets casual acquaintances push food and drink on me as a form of politeness. It would be far worse if anybody could easily get whatever drugs they like.

The issue isn't just people who choose to self-medicate who shouldn't. The current system helps protect you from random or specific people who might choose to medicate you.

I think the current system is bad in various ways. An unknown but probably large part of our medical problems are side effects of bad medical care. Many others are caused by environmental conditions we have created in the last hundred years or so -- carcinogenic fossil fuel residues, a chemical industry that makes over a million unprecedented compounds, etc. To a large extent we'd do better to prevent the problems than to palliate them with new poorly-tested drugs.

For that matter we'd probably do better to eliminate drug patents. Fund drug research with donations and research grants, let the government do the testing. (Maybe have free government-supplied health care for anyone who wants it, except they don't tell you whether you're in the control group or the experimental group.) It's wrong to have the companies that will get giant profits from success to run the testing, and it's silly to measure progress by the number of new drugs they get approved.

The current system is very bad in many details, but I do not think simple deregulation is the answer.

There's a factoid that gets brought up every so often which claims that Christian Scientists and other people who refuse medical treatment are on average just as healthy and live just as long as people who get the latest medical technology. I haven't checked to see whether it's still true. But imagine that it is. Then our spending on pharmaceuticals, which increases considerably faster than the rest of the economy along with drug company profits, might on average be useless. For each drug that palliates an existing condition there's another that creates a new condition to treat.

I guess I'm just grumpy. A year ago I had a filling that the dentist said came too close to the pulp, she said there was a 50:50 chance it would need a root canal. It hurt a little and then completely settled down for 8 months. Then it started hurting occasionally. It started hurting when I got a sinus infection, and it stopped when the sinus infection stopped. A previous dentist had said that the roots stuck up into the sinus cavity and there was only a tough membrane separating them, and I imagined that sinus pressure might be the problem. Three times I got a sinus infection, the tooth hurt, I went to my new dentist, he said my bite needed adjusting and ground down the tooth, I'd get an antibiotics prescription, the sinus infection would go away and so would the tooth pain. I asked the dentist why the tooth would shift position and he'd shrug and say it just happened. I imagined that sinus pressure on the tooth made it change position.

The last time I took one antibiotic for two days. A few hours after I started the tooth pain stopped. A few hours after I stopped it the tooth pain came back. I took another antibiotic for 5 days and it went away a few hours after I started. I went back to the dentist and told him that. He said I probably needed a root canal, that the roots of the teeth are separated by a thick layer of bone from the sinus, that by far the most usual cause for these symptoms is a dead tooth that's rotting like a dead pig. He sent me to a specialist to diagnose.

The specialist looked at the x-ray and started to numb my mouth. I asked him what was going on and he said, "You're here for a root canal, aren't you?" I had thought I was there for a diagnosis. He said that a filling that touched the nerve always needed a root canal, it would always go bad, no point in putting it off, he'd have it done in half an hour. When I wasn't sure he said to think it over and he left the room. I felt like I'd asked my barber whether I needed a haircut, but I didn't see what to do. It made sense he was probably right. I looked at the x-rays which didn't show anything in particular to me, and told the dental assistant I'd go ahead with it. Hardly more than an hour later I had a $1400 root canal.

And now I have another sinus infection and my tooth hurts. I feel so stupid.

Posted July 1, 2006 10:09 AM by J Thomas

Xopher: My error. I was having trouble with my connection and ended up plopping the sonnet in the wrong thread.

Posted July 1, 2006 11:04 AM by Fragano Ledgister

(Coming in late, due to travel) ...

Ken: Antibiotics aside (since they can breed superbugs that spread), why does stopping idiots from hurting themselves justify any restrictions on medicine?

Because a lot of those medicines have side-effects that include impaired judgement. And a lot of those "idiots" are going get behind the wheel of an automobile and kill or maim innocent third parties.

Are you beginning to get the picture?

Medical problems have no externalities: it's one of those fields where the free market is not only not the optimal solution, but actively wrong and harmful. The invisible hand is flailing around blindly with a scalpel and if you're not lucky you'll get cut. Etcetera.

Posted July 1, 2006 11:38 AM by Charlie Stross

I haven't checked to see whether it's still true.

Or whether it was ever true in the first place. I guess it also depends on whether you think that palliative care has any value.

Posted July 1, 2006 2:37 PM by mythago

But then I'm one of these bleeding-heart types!

They have drugs to help you with that now.

Posted July 1, 2006 5:39 PM by hamadryad

Antibiotics aside (since they can breed superbugs that spread), why does stopping idiots from hurting themselves justify any restrictions on medicine? It's not like idiots are an endangered species that actually need to be protected.

Becoming a licensed pharmacist in Canada requires a Bachelor's degree, a national board examination and an apprenticeship/internship. I don't know how much training is required to become a licensed physician, but I'm sure it's no less rigorous.

Most of the people in my circle of acquaintances are not idiots. Most of them are highly intelligent. And not one of them has the knowledge they would need to be able to safely prescribe their own medicines.

And now a bit of trivia, because I'm a trivia pack-rat. According to the Ontario Medical Student Association:

The average human body contains enough: iron to make a 3 inch nail, sulfur to kill all fleas on an average dog, carbon to make 900 pencils, potassium to fire a toy cannon, fat to make 7 bars of soap, phosphorous to make 2,200 match heads, and water to fill a ten-gallon tank.

Posted July 1, 2006 6:06 PM by hamadryad

Mythago, there are a collection of such factoids floating around. For example, people diagnosed as psychotic seem to recover at about the same rate on average no matter which psychiatric treatment they get, and no metter whether they get any treatment. Back in the days I associated with psychiatrists and clinical psychologists, they mostly agreed that sure, that's true on *average*, but the good ones (like them) do a lot of good and the bad ones do a lot of harm, and so the results average out.

The psychiatric studies were actually done and occasionally replicated with reasonably large samples. They don't mean as much as the factoid seems to imply. Maybe psychotics tend not to pay attention to talk therapy, which could still be good for some other problems. And the studies didn't show that no therapy made any difference. They showed only that therapy made so little difference on average that those particular studies couldn't detect the difference. Perhaps larger studies might detect a difference that was too small for these studies to notice.

My old epidemiology teacher claimed that improvements in average lifespan came from increased standard of living, and mostly not from improved medical care. At least it correlated with that much better, the improved living conditions tended to come before the increased medical care. Better water, refrigeration, window screens, gas or electric stoves, vitamins, etc. People didn't get badly sick as often and they died of their sickness at an older age. Because they were healthier generally.

Now, consider how effective the medical profession is about anything that's nonroutine. Have you ever had a nonroutine problem, and you studied up on it, and soon you found you knew more about it than all but a few specialists? You'd go to an MD who didn't understand anything? You found one specialist who knew more than you did, and that's the one you trusted. Out of a hundred people who had your problem, how many do you think found the one right guy? Mostly the system is broken for things that aren't routine.

For things that are routine we have a cost spiral. Cheap drugs that are used by large numbers of people have lots of chances for side effects to show up. That's a great opening to replace them with something new and expensive. There are tremendous financial incentives to do that. There are tremendous financial incentives to cheat on the process. The MDs are as swamped with information (and misinformation) as you are. The system is broken.

The bottom line is, as your standard of living drops your life expectancy will drop too, pretty much independent of the state of your health insurance.

But then, this is entirely a handwaving argument. It makes sense but it doesn't have to be true. Maybe the large majority of MDs are spending the 4 hours a day they need to keep up with their field. Maybe the pharmaceutical industry is run almost entirely by humanitarians who put aside self-interest for the good of humanity, who resolutely refuse to cheat on their science even when it costs them many millions of dollars. Maybe most MDs are good enough at science and statistics that they read the research closely and disbelieve incorrect claims. It doesn't have to be true just because it makes sense.

Posted July 1, 2006 6:26 PM by J Thomas

I did a bit of light websearching because I recall having heard that Christian Scientists do have a statistically significantly lower lifespan than the general population.

From http://biochemistry.louisville.edu/education/faith05.pdf (not building a link since it's a PDF) I found the following:

A 1950's study found, however, higher than average death rates due to malignancy and heart disease, and a lower than average life expectancy, for Christian Scientists. A more recent study (JAMA 262, 1657-1658 (1989)) also concluded a higher death rate.

I haven't dug deeper of found the original cite simply because I'm lazy, but I'd bet that someone with more energy than I would find really solid evidence that being a Christian Scientist is bad for your health.

For what it's worth, I not only favor keeping pharmacists as gatekeepers to the modern pharmacopoeia, I favor single payer so people on limited incomes can use ONE pharmacist and not spread their business all over town trying to save money. A few years ago, during a bit of a health-care intervention my cousin gathered up all of my grandmother's meds and took the list to a pharmacist. He immediately found a potentially dangerous interaction (which thankfully hadn't happened) and worked with three different doctors to get the whole thing sorted, even though he only got a little bit of the resulting business.

Pharmacists (except when they're anti-birth control moralists) tend to be a great resource.

Posted July 1, 2006 7:16 PM by Larry Brennan

My old epidemiology teacher claimed that improvements in average lifespan came from increased standard of living, and mostly not from improved medical care.

What, he didn't tell you the story about the pump handle? I think you are confusing 'common public health measures' with 'standard of living'. Two hundred years ago, the richest of the rich had servants, but they didn't have laws that limited the amount of lead in your water.

I'm about the last person to say nice things about Big Pharma, since I'm one of its natural enemies. But I'm also one of the last people to try and pretend that medicine and drugs are useless, and all you need is clean living and over-the-counter stuff you read about on the Internet.

Posted July 1, 2006 9:04 PM by mythago

I didn't read this discussion until today, but I have total sympathy for the poor guy with the spinal injury who definitely needed his meds for the constant pain.

One of my prescription drugs (I have a mild version of Asperger's Syndrome, and a version of ADHD) is one of the most easily-abused drugs out there, and there's even an entire illegal drug trade for this one drug. The black market for this drug is so huge that my parents' insurance companies won't cover for it. It's Adderall, which I desperately need to function properly, especially during the school year, or else I can't get any work done.

I'm 14, turn 15 in October, and start high school in September. To succeed in high school, I will need my Adderall to make myself able to focus. I know of other people who take Adderall, but I don't believe for a second that most of them need it as much as I do. I personally don't think the security at the airport would react well if they found a bottle of Adderall in my suitcase, regardless of the official diagnosis from my doctor.

If I don't have my Adderall, my Geodon, and my Citalopram, every day, in the correct doses, and take them at the right times, expect some strange behavior and spontaneous emotional outbursts. That happened recently on AW, on the day I accidentally only took 1 Citalopram pill instead of 1 1/2. Let's just say, I got confused about two rep comments I received, and posted a thread about it, which Jenna had to close. That's just one example of what happens if I don't get my medicine. If I don't get my Geodon at the correct time in the evening, I can't get any sleep at all for the entire night, or I'm a groggy zombie in the morning when I have to get ready for school.

It would be terrible if I couldn't get the correct doses legally, because my doctor's current combo of meds has made me much more stable than I've been in years. Do I still have outbursts once in a while? Hell yeah, you can never completely stop that. But because of it, I talk to other people more often, more people like to talk to me, and I have a bunch of friends, online and offline, male and female, fellow teens and other adults of a variety of ages. You wouldn't want to deprive a 14-year-old kid with Asperger's of all that, at the point in their lives where the neurological disorder affects them most negatively, and where they are getting closer to the point where Asperger's becomes much more easier to handle, would you?

Rush Limbaugh is a dirty aristocratic snothead who thinks he's above the law because of his wealth and status, and who makes people who actually desperately need their meds suffer. That poor guy who's living in excruciating pain shouldn't go to jail for 25 years. How about he goes free and gets his desperately-needed meds, and Rush gets serious major jailtime?

Ah, if only that truly happens. I really hope it does, though.

Posted July 1, 2006 9:29 PM by Alan Yee

Larry, thank you for the link!

I found only the abstract, not the actual study, or the published errata, or the published comment. I can't tell much about what the author did, except that he compared known deaths among graduates of a small college that accepted only christian scientists versus a large school that had mostly others. The obvious possibility is that the large school did not track alumni deaths as carefully.

The author of the study is a computer scientist
http://www.emporia.edu/math-cs/faculty/profiles/simpsonb.htm
who got a BA in business administration from the christian science school and a PhD in Special Studies from the second school. He is one of the data points in his own study, which was not funded.

A CDC study covered similar data.
http://www.cdc.gov/mmwr/preview/mmwrhtml/00015022.htm
They compared the same christian science school with a seventh-day adventist school. The 7th day adventist school had lower mortality even when they assumed that all the missing christian science alumni were alived but the missing 7th day adventist alumni were dead at the same frequency as the known population.

Both groups suggest no smoking or drinking, but the 7th day group also avoids some foods (pork and shellfish etc) and limits all meat to less than once a week.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=10496509&query_hl=8&itool=pubmed_docsum
Here's a phone survey of christian science and others. The CS guys report significantly less illness etc. The study has obvious errors from the abstract, but Similar proportions of Christian Scientists and non-Christian Scientists used some type of conventional medicine (74% vs. 78%, respectively), although Christian Scientists were less likely to take prescription medications than non-Christian Scientists (p = .034). These are not people who are utterly rejecting conventional medicine. Don't take the p=.034 too seriously, for another question the difference between 73% and 80% was .05 and 67% versus 42% was .00001. In this particular sample fewer christian scientists had taken prescription drugs than others, but it wasn't a whole lot fewer.

I found an abstract about old amish.
Am J Epidemiol. 1981 Dec;114(6):845-61.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=7315833

Death certificates and Amish censuses were used to determine mortality risks, which were summarized using age-adjusted mortality ratio (MRs). Amish mortality patterns were not systematically higher or lower than those of the non-Amish, but differed by age, sex, and cause. Amish males had slightly higher all-cause MRs as children and significantly lower MRs over the age of 40, due primarily to lower rates of cancer (MR = 0.44, age 40-69), and cardiovascular diseases (MR = 0.65, age 40-69). Amish females MRs for all causes of death were lower from age 10-39, not different from 40-69, and higher over age 69.

I put about an hour and a half into looking, and haven't gotten anything at all definitive yet whether being christian scientist is bad for your health. It's hard to figure out what questions to ask about methodology errors without having the whole papers. So much medical research is poorly thought out....

Posted July 2, 2006 1:54 AM by J Thomas

wrt Christian Scientists: one variable the studies would need to control for is economic class. The children of the well-off, and even the doing-ok, have significant advantages: they're better nourished and aren't exposed to as many environmental toxins. (They may also develop somewhat healthier habits; I get the impression that all levels watch too much TV, but it's even more common in the poor because the TV is an affordable child-sitter. This is not a quotable statistic.) All of this makes a difference in later health and lifespan. (There were Christian Scientists in my mother's family; she commented that CS she knew (of) tended to be the well-off, who confused their economic health advantage with God's favor; cf Ann Richards's comment about Shrub being born on 3rd base thinking he'd hit a triple. This is even more anecdotal than the above.)

Popping a level: I suspect many people don't realize just how complicated prescribing the right drugs is -- or how complicated any other profession is. From a political view, I stand mostly opposite the current administration's position, and I don't have a strong logical position for it; much of their regulation is devoted to preventing people from getting high, which I'd think was no business at all of theirs* if it weren't for the fact that careless users of the most common intoxicant are known to kill other people as well as themselves.** There are plenty of useful drugs that have turned out to be dangerous; unfortunately there's no good formula for balancing danger against value. To make matters worse, the high-value drugs seem to be mostly the ones that can be prescribed for a wide-spread but minor condition (pain, weight, ...); there's less economic incentive to test a drug that is critical for a relatively small number of people. There is "orphan drug" legislation for extreme cases; I don't know where it stands or what its effect is / would-be. There's been very little government willingness to do disinterested testing even before the current all-tax-cuts-are-good-tax-cuts administration. But the market is an even worse regulator, because the market hasn't even a pretense to disinterest.

(*) cf Tom Lehrer in the intro to "Smut": "It's matter of freedom of pleasure, which \isn't/ guaranteed in the Constitution."

(**) Other intoxicants don't get a pass; IME they just aren't as well-studied because they aren't supposed to be used at all. Back when I was flying light planes one of the magazines claimed that people high on marijuana would fly a perfect simulated instrument approach because they were focused -- so focused that they forgot to flare for a landing.

Posted July 2, 2006 9:42 AM by CHip

Greg London:

"I just saw a doctor yesterday. ... At first, I thought I must be reading him wrong. Then I thought he was trying to be funny in a no-skills-for-being-funny sort of way. When I finally got that he was just an asshole, I was already being hurried out the door."

Of course, what they should do is phone the referring doctor themselves. But they won't, because they're being jerks.

When I was first diagnosed with narcolepsy, they told me as a matter of objective fact that three times as many men as women have the syndrome. They don't say that any more. It's not a gender-biased disorder. What was happening was that women were being intimidated and treated dismissively to a disproportionate degree.

Fidelio:

"Greg, my brother-in-law has had the unpleasant good fortune of being treated by a brilliant neurologist with the social skills of a seed case from a sweetgum tree, or possibly an armload of branches from a honey locust tree. He was great at dealing with the disease, but the effort involved in dealing with him was taxing. Thre are more than few physicians who meet that description out there."

You'd think that med students who don't like dealing with anecdotal data, or analyzing detailed vernacular descriptions of the shifts of tendencies and manifestations in these poorly-understood conditions, or working with patients who are sometimes hazy or confused, would pick a different specialty. If they don't like dealing with the human condition in all its pixel-by-pixel glory, clinical neurology is not where they belong.

Fledgist, that was lovely, but are you sure you didn't intend it for the Kim Stanley Robinson discussion?

Jacob Davies, a possible model I've kicked around in my mind is one where you have to go to a doctor for your first prescription for some medication, and he'd have some say about whether it could be prescribed on that occasion. Thereafter, you'd have to talk to him, but he'd have to issue you your chit for a refill. I can also see retaining the whole prescription system for classes of drugs where you really do need to be an expert to prescribe them properly.

However, there are scenarios where that model doesn't work. For instance, teenage boys have inadequate judgement about the advisability of taking steroids. People who suffer from morbid anxiety about cancer would be able to dose themselves with anti-cancer drugs, many of which are toxic. Schizophrenics are famously unable to judge which drugs they should or shouldn't be taking, and they have eccentric notions of the ills they may be suffering from. True hypochondriacs need treatment for their mental problems, not for the diseases they imagine they have. Patients with long-term infections needing consistent antibiotic treatment over long periods really do need to be monitored for compliance. Pediatric pharmacology is a demanding specialty, a whole separate thing: small children are like a different species. And then there's parental misuse of drugs for children. I know that in the 1960s, when we had a more lax attitude toward tranquilizers, some parents would casually dose their children with Seconal or the like during long car trips -- so much pleasanter to travel with kids who stay quiet all day.

We need to figure this stuff out as a society because our medicine is increasingly powerful. Having full and fair access to the full range of pharmacological options is going to matter more and more.

Mythago: "Oh, but TNH, that's because you're improperly soft and bleedy-hearted. Here, how about you read this copy of The Fountainhead? Then Ken's jibbering will all make sense."

Have you ever noticed that in Rand's universe, the good guys never get sick, or get pregnant, or suffer debilitating accidents, or even have to deal with tooth decay? You can practically gauge the state of someone's soul by looking at their complexion. Whiny collectivist thoughts will turn it sallow and saggy in no time at all.

J. Thomas, one of my dentists once talked to me about patients he gets who've been grossly mishandled by other dentists. It happens. The dentist who gave you the root canal was right. I speak here as someone who's had many, many root canals. Fillings can't touch nerves. If they do, the tooth will go bad. When they diagnosed you as needing a root canal, they were looking at your x-rays, and it doesn't sound like there was much question about what needed to be done. You should see what happens when it doesn't get treated. You can wind up in the hospital getting part of your jaw reconstructed.

Once you've had your root canal, the tooth by definition can't hurt -- they gouge the nerve out in scraps, using teeny little hand-turned steel drills. No nerve, no pain. There might be some residual tenderness from the work itself, but that's all. What you're feeling is your sinuses. They have enough nerve endings to supply any amount of pain.

Re another one of your comments, psychosis wasn't responsive to standard psychotherapy because it isn't a cognitive/behavioral condition. It's hardware, not software. At the time that that statement was formulated, narcolepsy and obsessive-compulsive disorder were also classed as psychiatric disorders. The stats on all three have improved. I know modern antipsychotic drugs do some good, just now how much, but narcolepsy and OCD are greatly improved. There've been some downright dramatic OCD cases who've been returned to something close to normal functioning.

We live in the dawn of effective, scientific medicine. Our doctors find a new button to push and they push it a lot. The 50s and 60s were way big on psychology. In some cases, it did a lot of good. In other cases, it did no good at all, because it wasn't the right treatment for that condition.

"Have you ever had a nonroutine problem...?"

Medicine nevertheless works. Not always, not perfectly, not in every case, not with every illness. But it does work. I suspect the biggest problem with epidemiological studies of Christian Scientists is that it's a religion that selects for adherents who are basically healthy to start with, and who cultivate healthy habits. If you're looking at what adherents died of, you're losing all the people who said "To hell with this, I'm going to see a doctor." And if you're studying the later lives of young Christian Scientists who are the children of Christian Scientists, you've got a sample that's skewed not only by self-selection and ingrained behavior, but by genetic inheritance.

You get the same problem with Seventh-Day Adventists, since you've selected for a population that's living a sufficiently orderly, diet-conscious life to observe that denomination's various guidelines and prohibitions.

Mormons do those studies too.

Finally, how your epidemiologist could statistically separate "increased standard of living" from "better medical care" or even just "widespread childhood immunization" is beyond my ability to discern, unless he's talking about populations living at a level where "increased standard of living" means "not so many people starve to death." I don't know of a single human population that enjoys a good standard of living but doesn't at least immunize its children, or live among people who do.

Alan Yee, that's a great, great comment. Thank you for posting it. You, and I, and all the other people we know who have chronic illnesses requiring heavily restricted drugs, pay constantly for the misbehavior of rats like Rush Limbaugh. The system doesn't just bear down on cases like that poor guy who got sentenced to 25 years for the same offense that got Limbaugh's wrist slapped, though lord knows it would be bad enough if that were all that happened.

I understand that some of the right-wingers have been comparing Limbaugh to Hunter S. Thompson, a thing they can only safely do because HST is dead. Is it not a wild piece of hypocrisy for them to forgive serious drug abuse if it's one of their guys? If Limbaugh had been poor or black, a handful of Oxycontins in his pocket would have been enough to get him nailed.

By the way, watch out for scare-tactic news stories about the "epidemic" of Adderall use among college students. I see the stories, but I don't see any hard numbers in them, and that makes me extremely wary. The powers that be have been moving generally against the stimulants. (My paranoid theory: it's because they're performance drugs. Only people in power are entitled to a boost.) It can do you and your parents no harm to make sure your doctors know that Adderall is not an optional drug for you, and that wheedling down your dose is not on the menu either.

Posted July 2, 2006 3:42 PM by Teresa Nielsen Hayden

There's an ongoing controversy about drug qualifying chess players mostly using Olympic standards. Many chess players consider such testing both intrusive and irrelevent to chess playing skills.

Others say that using chess players as a field test to find drugs that improve mental performance over the length of a full match sounds like an idea more to be encouraged than discouraged.

Drug testing has dominated.

Posted July 2, 2006 4:56 PM by Clark E Myers

"Rush Limbaugh is a dirty aristocratic snothead who thinks he's above the law because of his wealth and status, and who makes people who actually desperately need their meds suffer. That poor guy who's living in excruciating pain shouldn't go to jail for 25 years. How about he goes free and gets his desperately-needed meds, and Rush gets serious major jailtime?"

No, it's the people who think that it's worth paying any price, including condemning innocent people to needless suffering and death, to stop people like Rush Limbaugh from getting his jollies, that make people who actually desperately need their meds suffer.

Now any large system will have cases where things go wrong and people suffer. But I maintain a system where people are more free to solve their problems is superior to a system where people are less free to solve their problems. A system where people who need medicine are never prevented from getting it, but some who are determined to misuse it are not prevented, is superior to one where everyone is protected against their will and a number of people will be deprived by law of treatment that exists and that they can pay for.

Nothing in a deregulated system would prevent people consulting doctors and getting advice on treatment. People who are not smart enough to be their own doctors would be smart enough to consult doctors and take their advice. As for people who won't even use the common sense to do that, it's unfortunate if they hurt themselves, but protecting people who would otherwise be so willfully stupid does not justify condemning anyone who will actually try to solve their problems correctly to excruciating pain, unemployment, mental disability, or other treatable condition.

Posted July 2, 2006 7:44 PM by Ken

I hear a great whooshing sound, as if millions of nuanced points suddenly soared overhead, and were silenced.

-r.

Posted July 2, 2006 8:30 PM by rhandir

TNH writes:

"Once you've had your root canal, the tooth by definition can't hurt -- they gouge the nerve out in scraps, using teeny little hand-turned steel drills. No nerve, no pain. There might be some residual tenderness from the work itself, but that's all. What you're feeling is your sinuses. They have enough nerve endings to supply any amount of pain."

This alas, is only the usual case. It is possible to have two root canals on one tooth, even with a very competent endodontist. All that needs to happen is, for example, new decay to open up a new pathway to the root, ending up with an abcess somewhere along the root.

Or, somewhat worse, an apicoectomy (think sideways root canal, through the jaw). I had the later, probably due to a decidedly mutant root with a right angle in it, which was not visible on x-rays. Since I had a crown & titanium post in the tooth, my endodontist was not gung ho on drilling up through the tooth again.

If you have pain in along the roots of a tooth, visiting a good endodontist (get a recommendation from friends or your dentist) is a good idea. They're trained to sort out whether you need a root canal for an abcess or if you have some other problem - TMJ or bruxism for example.

Posted July 2, 2006 9:15 PM by Margaret Organ-Kean

Rhandir, I believe I'm hearing the same sound.

I've mostly been reading this and nodding my head and rolling my eyes in about equal amounts, but people have been making my points for me.

I'm taking a slew of drugs, about half of which are for tweaking side effects for other drugs. Most of them are for high blood pressure and diabetes, but I have two scripts for class 2 drugs: Adderall, strangely enough, and Hydrocodone. Those are the two for which the dosages are stable and the indications straightforward, and the two which I could probably competantly supply for myself, given a libertarian pharmacy.

The others are another matter: I need regular lab work and office visits to monitor whether the drugs are doing what they're prescribed to do, and just that, and neither more nor less than the degree of effect I need. Even with home testing gear, problems can sneak up on me. Since I'm a patient of that evil collectivist organization, Group Health of Western Washington, I get print-outs from the pharmacy telling me when I need lab work.

Given that I'm trying to keep up with an environment which is unpredictable and prone to sudden crises ("life on the farm is kind of laid back" my saggy middle-aged ass) having somebody else keeping track of these things is a necessary component of my health-care; it's tricky enough to deal with keeping my food intake and excersize balanced on a day-to-day basis.

I manage the trees, in other words, and the experts look after the forest.

That's the aside. The point about Rush is that he is a party to a legal agreement under the existing body of law, and by carrying improperly labeled prescription drugs, he has violated his end of that contract. Any discussion of the shoulds of drug policy and regulation is external to his responsibility in the matter.

Posted July 2, 2006 9:35 PM by JESR

That clattering sound you hear is the scales falling from my eyes.

Oh my. That is a piñata.

Posted July 2, 2006 9:57 PM by Xopher

Reasons why your tooth might still hurt after root canal work, apart from referred pain from your sinuses...

Unusually long roots, and the dentist didn't go quite deep enough, resulting in redoing the filling. More than the usual number of canals, especially if you have very narrow canals anyway and they're difficult to spot. An impacted wisdom tooth pressing against the tooth, slowing down or preventing healing of the post-operative tenderness. Nerve damage from removing the wisdom tooth, leading to referred pain and/or phantom limb pain in the treated tooth. A cracked tooth, leading to stress in the ligaments that hold the tooth in the socket.

Go on. Ask me how I know. :-( The extra canal was ruled out during the refill, and the crack was confirmed by the fact that the acute pain rapidly reduced within a few hours of the crown going on (the standard treatment). The rest was never confirmed or eliminated. But yes, if a filling is touching the nerve, you need a root canal filling. Because it can get *much* more exciting than all of the above if you don't have one.

Posted July 2, 2006 10:52 PM by Julia Jones

Another note about root canals: I had one, and my tooth continued to hurt. Long story short, it turns out that it's possible to have more than the usual three roots in a tooth, and they can be faint and hard to see on an X-ray, and someone who's not expecting to see the extra ones may not do so.

Posted July 2, 2006 10:52 PM by Adina

People who are not smart enough to be their own doctors would be smart enough to consult doctors and take their advice.

It's beautiful in its own jaw-droppingly clueless way, isn't it?

I presume that Ken is also in favor of a fully-subsidized medical system, so that "people who need medicine are never prevented from getting it". After all, we wouldn't want anyone prevented from getting medicine just because it costs more than their income.

Posted July 3, 2006 1:08 AM by mythago

The dentist who gave you the root canal was right. I speak here as someone who's had many, many root canals.

You seem to me to be generally competent in a wide variety of areas. I pay careful attention to your opinions. But in this