[p2p-research] Rhetoric of Rationing Health Care Overlooks Reality - NYTimes.com

[Paul D. Fernhout]

Nathan-

That's a great point; you really need to look at the entire social/physical 
system to understand how to make it as healthy as possible.

Compulsory schools are one of the biggest ways flu gets spread. Compulsory 
work is one reason parents have to rely on the compulsory schools in the 
USA. (In places with better social networks and family ties (overall) like 
Mexico, there are relative to help out with child care, so it is easier to 
close schools.)

Would the world be a healthier place if social interactions in relation to 
providing food and goods were optional? Like if people could print stuff at 
home? Bryan Bishop raises this point about our inability to know how to do 
local life support. But, even then, the issue isn't necessarily absolute 
independence or dependence, but the time constant of dependence. Grid power 
makes you dependent on the power company second-by-second, but you might 
only need to buy solar panels from a big company once every thirty years; so 
there is a real difference in freedom and independence with such a change, 
even if a big company was involved either way. Buying your produce at the 
store is a daily or weekly interaction, but growing your own vegetables 
means just one trip a year for supplies. There can be a huge difference in 
levels of required interactions if you rethink the infrastructure, even if 
there still is material dependence. (Of course, education at home through 
the internet and food delivered by robot delivery vans would remove the 
face-to-face aspects of those thing in crowded situations.)

Some vaccinations for children (especially something like flu vaccination) 
are justified in practice so the parents can keep working and so the schools 
can keep schooling (assuming they really worked and did not cause more 
illnesses down the road in other ways). What are the odds that one year 
there may be a really bad batch of flu vaccine and the CDC has to explain 
why it suggested everyone now get at least 80 flu shots in an 80 year 
lifespan? That's a lot of shots, when just the physical risk of a shot 
exists (like if the substance is injected into a vein, or the needle is not 
sterile, or if the health practitioner sticks themselves afterwards by 
accident, or people get flu waiting in line for flu shots, and so on.)

It's one thing to argue risk/reward for an injection about avoiding 
meningitis or polio; it's another to argue risk/reward for an injection 
about avoiding the flu. Most flu deaths are of the very old, people, who 
will, sadly die one way or other. Much of the arguments for vaccinating 
young kids is also about protecting the old (who seem to get little benefit 
from direct flu vaccination), so there is a case here of the young taking a 
risk and paying a cost to help the very old. The theory is, if you keep kids 
from spreading flu to each other in schools, that the elderly will benefit. 
This smacks of the ongoing age-wars in the USA of how the old in the USA 
have universal health care through Medicare and Medicaid but the young have 
to pay for it and have no guaranteed access. Now the young kids get to take 
it on the chin (or in the arm) for grandma, too:
"Doubts Grow Over Flu Vaccine in Elderly"
http://www.nytimes.com/2008/09/02/health/02flu.html?_r=1&oref=slogin
"A growing number of immunologists and epidemiologists say the vaccine 
probably does not work very well for people over 70, the group that accounts 
for three-fourths of all flu deaths. The latest blow was a study in The 
Lancet last month that called into question much of the statistical evidence 
for the vaccine’s effectiveness. ... Not everyone is sold on the 
significance of the Lancet study. “I think this is another study that 
provides interesting findings and raises questions,” said Dr. Kristin 
Nichol, chief of medicine at the Veterans Affairs hospital in Minneapolis. 
“I don’t think we know yet what the final word is on influenza vaccinations 
in the elderly.  “I really feel, and I feel very strongly about this, that 
the public health message should be that vaccines are effective,” she 
continued. “I don’t think that science is necessarily best hashed out in the 
media.” ... In 2005, Dr. Simonsen, who was then at the National Institute of 
Allergy and Infectious Diseases in Bethesda, Md., published a paper in The 
Archives of Internal Medicine that found something odd: even though the 
percentage of older people who got an annual flu shot more than tripled from 
1980 to 2001, there was no corresponding drop in the death rate. ... Despite 
these findings, Dr. Shay said the C.D.C. had no plans to change its vaccine 
recommendations, though he added that the agency had financed studies to 
look for more effective influenza vaccines for the elderly."

It's amazing how all medicine is "safe and effective" until it is not. And 
even when it is suggested by what seem to me to be irrefutable statistics it 
is not "effective" in some way that was claimed (reducing the death rate of 
the elderly), policy does not change.

Nonetheless, and maybe it shows my being too much of a cynic/pessimist, but 
I'm still amazed how much the grassroots pushback is going viral all of a 
sudden. :-) Must be some exponential trend I did not notice. Catchy rap tune 
on the video here:
"Parents Say No to Forced and Compulsory School Vaccinations "
http://www.allvoices.com/contributed-news/4022316-health-alert-parents-say-no-to-forced-and-compulsory-school-vaccinations/video/37766578
"I'm writing because I'm extremely concerned about reports that the schools 
are going to force parents to have their children vaccinated for the H1N1 
swine -avian-human flu"

We're seeing a sudden swirl of p2p activity related to the intersection of 
technology and society and economy and schooling.

Whatever one may say about whether vaccines ever work or not, clearly the 
hierarchy that surrounds them (at least in the USA) is fundamentally broken 
in terms of encouraging trust of it. So, some more people are resisting the 
compulsion to stick their kids with even more needles to stick them in 
school (still not questioning the school part, much, though).

The fact is, whether vaccines work or not, the US medical establishment has 
brought this distrust on themselves by allowing so many conflict-of-interest 
to persist for so long in the medical establishment.

A google search I posted two days ago:
  http://www.google.com/search?hl=en&q=vaccine+conflicts+of+interest
"Results 1 - 10 of about 383,000 for vaccine conflicts of interest. (0.12 
seconds)"

Wow -- just two days ago there were only 222,000 matches. (See my previous 
post on this topic, "If vaccines were like software patches...".) So, almost 
double the matches in two days. Wonder if this is just a technical artifact 
of something about Google? Or does it show rapid exponential growth?

I'll be curious if this number changes in a couple of days.

Just to begin with, regardless of the history of vaccination, why should one 
trust *anything* about a medical care system that leaves tens of millions of 
people without ready access to health care in the supposedly richest country 
in the world? Really, it's just common sense that if you care about your 
health, you should care about the health of everyone, especially as regards 
resisting communicable diseases by staying well and having a healthy immune 
system -- well rested, well fed, nursed by WHO guidelines (two years+), etc..

Anyway, while I agree with you about the technological dimensions, I still 
feel social aspects of all this are just as important as the technology, IMHO.
"Getting to 100 social-technical points (was Re: a Change)"
http://groups.google.com/group/openmanufacturing/msg/a7abadb8867dae79?hl=en

--Paul Fernhout
http://www.pdfernhout.net/

Nathan Cravens wrote:
> Health care and swine flu, what a bunch of stupid bunkity that will leave
> the discussion once that mass media business says something else. This is
> not to speak poorly of those (dammit Paul!!) discussing these issues, but
> discussing these avoids the underlying causes of these issues: lack of
> material independence: <<< in a phrase. I'm becoming all irate just thinking
> about as such! WTF! ;p
> Okay, now I'm back to looking around at things and hand waving like any
> reasonably good propagandist!
> 
> Nathan
> 
> 
> On Sun, Sep 27, 2009 at 7:26 AM, Paul D. Fernhout <
> pdfernhout at kurtz-fernhout.com> wrote:
> 
>> http://www.nytimes.com/2009/06/17/business/economy/17leonhardt.html?_r=2&hp
>> """
>> The r-word has become a rejoinder to anyone who says that this country must
>> reduce its runaway health spending, especially anyone who favors cutting
>> back on treatments that don’t have scientific evidence behind them. You can
>> expect to hear a lot more about rationing as health care becomes the
>> dominant issue in Washington this summer. Today, I want to try to explain
>> why the case against rationing isn’t really a substantive argument. It’s a
>> clever set of buzzwords that tries to hide the fact that societies must make
>> choices.
>> """
>>
>> In the long term I don't think we will need to ration what we now consider
>> most of the basics on an individual level (food, water, healthcare, toys,
>> shelter, communications, transport, etc.; see Voyage from Yesteryear by
>> James P. Hogan for an example), but currently we are doing that, and this
>> article talks about how to do it better in the USA for healthcare.
>>
>> In general, Iain banks said: "Money is a sign of poverty". One meaning of
>> that is, if you have to ration day-to-day things for individuals, you don't
>> have enough of them because your technology is not very good. So, if you
>> have 3D printers that can print solar panels and more 3D printers just from
>> inputs of dirt, water, and air, and previously printed things (recycling)
>> then why would you need money very much day-to-day? Maybe for allocating
>> land you might need some sort of rationing, but that is such a different
>> thing from the day-to-day rationing we see in our current system revolving
>> around spending money at stores.
>>
>> I've repeatedly called dollars "ration units" to help make clear that our
>> current economic system is more about rationing than optimum wealth
>> creation.
>>
>> Anyway, one deep issue of p2p is really, how would p2p change the types of
>> rationing we do in our society? And how would p2p change how we do each type
>> of rationing?
>>
>> I've been looking more at the "Venus Project" and I think this is an issue
>> it glosses over (from what I have seen so far). Jacque Fresco and Roxanne
>> Meadows may intuitively understand that with good engineering rationing the
>> basics won't be a big deal anymore. They reference "cybernetics" as a way to
>> approach this, and I agree that's a good idea (like Cybersyn) as long as you
>> have something of a command economy or even market economy (gift economies
>> and subsistence economies may work differently with less formal planning).
>> But, the details still have to be worked out (unless they have in the Venus
>> Project and I have just not found them yet as I continue to learn about
>> that):
>>  http://en.wikipedia.org/wiki/The_Venus_Project
>>  http://en.wikipedia.org/wiki/Resource-based_economy
>>
>>
>> Even in a "resource base" economy", the society collectively makes
>> decisions about how to invest and deploy and distribute resources. Now,
>> those rationing decisions may be a lot easier the more resources we have,
>> especially once humans can easily live in seasteads and space habitats built
>> from local materials. But, even then, they will still be made. So, a big
>> question is, how to make them well? And well for whom? (Who pays the costs
>> and who gets the benefits?) And how do we get there from here?
>>
>> --Paul Fernhout
>> http://www.pdfernhout.net/
>> (I walked 0.24 miles while writing this as part of my health care plan. :-)
>>
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>