It’s not the Insurance Companies and Big Pharma and fast food that are killing us, it’s the gun and driving while Twittering. Bet that guy heard from his local NRA lobbyist on that one! Wonder if he’ll have to apologize.

On Health Care Reform:

I hope that Health care reform will find an appropriate path to determine “Effective” medicine. Like, good guidelines such
as “Don’t prescribe antibiotics as “why nots”, instead save their effectiveness by using judiciously). Dont’ image for fun
or profit, but insist that insurance companies pay for it when required for diagnosis.

This whole EFFECTIVENESS of medical treatment thing seems really tricky it seems to me. I’m kinda worried about it. Thing about Effectiveness analysis, is that it’s important not to confuse correlation with causation. Correlation is a powerful thing, and it surely takes legitimacy from meta-data stores well enough. But Medical Effectiveness assessments of a given treatment protocol based on correlation have an implicit fatal flaw.

Suppose for instance, a study finds a high correlation between unsatisfactory outcomes for shoulder surgery from patients with workman compensation claims.

What does that correlation say about the Effectiveness of the procedure to treat shoulder damage in that Meta-group?

Herein lies the trap.

For the next move from proof of correlation, to assessment of effectiveness, makes an unspoken, unseen, potentially even inchoate or worse, irrational leap through unproven causation.

One might interpret dissatisfaction by Workman Compensation claimants after their surgery to be evidence of their malingering on the government dole. One might then say to oneself “they’re never going to be satisfied”, we might just as well have denied the claim. Or less meanly, simply said out loud, Since Shoulder surgery isn’t “effective” for this group, it ought be removed from coverage.

On the other hand, maybe the reason for dissatisfaction by these claimants is because their work put greater stress on their joints, they had to return to that physical activity before healing, OSHA adjustments to workplace practice that could have reduced risk of re-injury were never implemented, they had less access to physical therapy to improve surgical outcome, ,….

Without surgery they may not ever be able to work again, with it AND better post operative treatment, they might
gratefully work to long life, supporting their families and communities. Which is more productive or EFFECTIVE to society? Presuming a citizen will always be dependent because they’re lazy, or presuming a citizen wants to be able to work?

Here’s another case:

Suppose there is a high correlation between dissatisfaction for the same surgery from elderly patients (Senior Citizens).

One may interpret their dissatisfaction by this meta-group to be that their inactive life style didn’t utilize the strength
or range of motion surgery was intended to restore. Since they didn’t use the joint much, they did not notice or benefit
from the improvement. Or, one might suggest that dissatisfaction was a function of senior depression or boredom. In either case, one might question the Effectiveness of the surgery. One might even conclude that since even degraded performance without surgery might be sufficient to an inactive life style, surgery is contra-indicated for seniors.

Except, maybe dissatisfaction for the same surgery from Seniors was because, after a lifetime of work and stress, the joint has accumulated more damage, surgery must be more extensive to repair it, and healing takes longer. Perhaps therapy teaching different ways to less stress fully manage physical activity with a post-operative joint would dramatically change outcome but are neglected because of a presumption of inactivity.

Which is more productive or EFFECTIVE to society? Presuming a citizen is now, and will always be inactive and dependent because they’re old, or presuming a citizen wants to be able to work?

We speak blithly of ‘delaying retirement’, asserting it an option to us all to continue to work in our later years. Such a presumption implies, however that we are kept physically capable of remaining productive.

It would be really unfortunate if we end up with health care reform that creates more dependency and less productivity
through meta-economic correlation effectiveness analysis. I mean, whatever happened to “tax the rich” to pay for quality
national health care?

Frank, a failure to see the potential synergies is to your credit. But as a think tank scholar, I see them immediately. It’s not a pretty vision, however no one ever expected this to be easy.

We must keep more weapons at home, where they can be used — admittedly in a counterintuitive way — to reduce the depressing rate of mortality. Some would call this psychotic, barbarism, social darwinism and so forth, but it boosts the economy in addition to removing the vulnerable from the, er, body count.

I speak, needless to say, of a life-affirming cull. Best of all, it can be run on free market principles.

The vulnerable, by definition, are those who take no precautions against the cull and demonstrate no willingness to participate. The impecunious will be encouraged to resourcefulness should they wish to eschew either extreme. Those already in a position to participate enthusiastically, mostly by outsourcing, thus creating non-farm payroll jobs, are those whose health care is already carefully tended. By virtue of remaining unculled, they help everyone out. The metrics are clear on that. The mistakes and excesses will be self-correcting, albeit mainly in a statistical manner, after a decent interval allows new numbers to be calculated.

We can win this one, Frank. I feel it in my bones.

san marino ! ? !