Morning Ed: Health {2016.09.28.W}

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Will Truman

Will Truman is the Editor-in-Chief of Ordinary Times. He is also on Twitter.

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120 Responses

  1. Avatar Damon says:

    FDA: While the behavior of the agency is outrageous, the story gives lie to the code of ethics “professional journalists” claim to live by–but we knew that was bogus didn’t we?

    Wellness programs: Bam! Maybe they should get rid of them. Useless, like DARE and NCLB.Report

  2. Avatar Kazzy says:

    The primary (only?) wellness program I use is fitness club reimbursement. This pays out cash if you make a certain number of visits in a give time. It’s generally pretty reasonable, averaging out to 2-3 times a week. The money is decent but not lifechanging ($20-35 per month). But it’s unlikely to dramatically change anyone’s habits. I already go to the gym more or less that frequently. If anything, it’s encouraged me to game the system (“Agh… I need one more visit this month but didn’t plan to go today and the calendar turns over tomorrow. I’ll just swipe in and fill my water bottle.”), which I doubt is consistent with the program.

    Maybe it is a nudge for people who are almost there but not quite, but how cost effective is that? There are probably many more people like me (i.e., getting paid with no change to my health) than people who are slightly altering behavior (i.e., upping from 7 visits a month to 8) and I’m not sure anyone is dramatically altering behavior (i.e., going from the couch to 2-3 visits per week).Report

    • Avatar Damon says:

      My old company had several programs. In addition they had a “ride share”, discounted transit passes, only paid non manager’s parking for 9 out of 12 months (to encourage you to use alternate modes of commuting), and participated a “bike to work” program. I always laughed at the last one. When people asked why I said “You want me to bike to work over 30 miles on tier 3 roads that people routinely do 70 miles an hour on (speed limit being 30), in the dark? Yeah, that’s smart”.Report

      • Avatar dragonfrog says:

        Clearly you were not one of those likely to bike given a little bit of encouragement.

        Probably more useful to encourage folks would be a place to store their bikes safe from theft and out of the weather, and somewhere to shower and change clothes.

        Discounted transit passes would be nice. My work used to have those but stopped.Report

        • Avatar Kolohe says:

          Depending on how long ago that was, they changed the tax break for that around the beginning of the decade, but now iianm have changed it back.Report

      • If you’re a 60 mile r/t from work you’re not the target audience for biking to work. The people who mocked you for your sneering about it were most likely aware of that.Report

      • Avatar Kazzy says:

        NYC allows you to buy transit passes pre-tax which is a really nice benefit. But I’m not sure I see how that is a “wellness program”.Report

        • Avatar Burt Likko says:

          LACO has a similar program for its employees, and I think the city does too. That’s not to promote wellness, it’s to get cars off the freeways.Report

          • Avatar Kazzy says:

            That is what I figured but I thought maybe Damon knew something I didn’t about the intention.

            The funny thing about the NYC program is I venture to guess the vast majority of people who take advantage of it would buy those passes anyway. Now, maybe my Westchester/Manhattan bias is showing and I’m discounting its impact on more car friendly areas of NJ and the outer boroughs. It is essentially a discount plan — and a very welcome one! — but as we all know when you use tax breaks to provide people discounts, someone ends up having to pay for it.

            Are LACO’s exempt from all taxes? I believe that NYC’s are.Report

            • Avatar Damon says:

              Yes, this wasn’t a wellness program, but my company had lots of “incentive” programs: transit, wellness, and volunteerism. The transit stuff was partially subsidized by the county/state to do as Burt said-get cars off the road.

              The volunteer deal was nice. 2 days paid to volunteer. Until they made it a “goal” to have a certain number of hours volunteered as part of your performance goals.Report

            • Avatar dragonfrog says:

              “but as we all know when you use tax breaks to provide people discounts, someone ends up having to pay for it.”

              Usually? Transit is a bit of a special one that way, because a lot of transit systems would still operate at a net savings for the city even if they didn’t charge for tickets at all. Usually any trip that would otherwise have been by car, that a city can turn into a trip by foot, bicycle, or transit, saves the city money in decreased wear and tear on road infrastructure, and reduced need to accomodate so many cars in motion on the road and at rest in parking facilities.

              So, yes, somebody has to pay for it – but they may have to pay considerably less than if you hadn’t used transit at all, at any price.Report

              • Avatar Kazzy says:

                @dragonfrog

                But it is the taxes that go missing, I assume. I think the MTA still gets my $250. But the government is only taxing me on $X-250 instead of $X. So the government is losing about, what $65 (divvied up among the various places tax money goes)?Report

              • Avatar dragonfrog says:

                Exactly – the questions are
                – how much do the various levels of government save for each trip taken by MTA instead of by car?
                – how many more trips get taken by MTA instead of by car, if they give up on $65 of taxes per MTA pass sold?
                – how many MTA passes get sold, overall?

                If the product (trips converted from car to MTA X savings per trip conversion) is greater than the product (MTA passes sold X $65 in taxes not collected) then it’s a net saving.Report

              • Avatar Damon says:

                Don’t forget fuel taxes lost if using transit.Report

              • Avatar Stillwater says:

                … and taxes on tire sales, sales taxes on normal maintenance, registration fees, taxes on the vehicles themselves…

                If you love America, you’ll buy a new car and drive!Report

              • Avatar Kazzy says:

                @dragonfrog

                At the risk of exposing myself as ignorant, how does me taking the train instead of driving save any level of government money?Report

              • Avatar dragonfrog says:

                More people driving means bigger roads need to be built, which costs not only the construction and maintenance costs, but also the loss of the home or business tax that asphalt covered space could have generated. More miles driven typically means more car crashes, with all the associated social costs. And it definitely means more about and those health costs.

                A good exploration of some of t this here http://spacing.ca/vancouver/2015/04/06/full-cost-commute/Report

              • Avatar Kazzy says:

                Very helpful… thanks!Report

              • Avatar dragonfrog says:

                “more about and those health costs” should have been “more smog and those health costs”

                Yeah, the main things a city can do to encourage transit use are probably not fare-related. Improve the transit system, stop subsidizing parking, etc. But fares help some.Report

              • Avatar Kazzy says:

                And as I said earlier, I’d take the train regarless. And I think a lot (maybe most?) people wouldn’t change their habits if the tax break went away.Report

            • Avatar Burt Likko says:

              Sorry. “LACO” = “Los Angeles COunty.” That may not have been clear.

              I’m not (yet) paid through the County, so I don’t know all the nuts and bolts. (Hopefully soon!) I do know it’s paid for with pre-tax dollars.Report

              • Avatar Kazzy says:

                @burt-likko

                I figured as much. Ours works essentially like an FSA. A pre-tax deduction from my paycheck goes into an account linked to a debit card. I can only use that debit card for approved transportation purchases.Report

              • Avatar Francis says:

                I think that judges are on the State’s payroll, not the County’s.

                If you do get the nod, please let us know when your induction ceremony is.Report

              • Avatar nevermoor says:

                CA judges are on BOTH state and county payrolls (though, at least in my neck of the woods, the comp split is nothing like 50/50).

                Interesting upside of that is they can pick between benefit plans (like health care)Report

  3. fillyjonk fillyjonk says:

    My workplace has a few “wellness” things in place now. I HATE them. The worst is the “fitness challenge,” where the first two weeks of the semester, we are bombarded by video e-mails. (I’m sorry, but if you cannot WRITE IT OUT I am not going to spend five minutes of my life watching something I could read in 30 seconds or less). There’s food-shaming (“Donut-free zones!”) and exhortations for people to exercise during the workday, with exercise times scheduled when those of us in the lab sciences are in class.

    My major objection? I’ve been exercising on my own, for anywhere from 40 minutes to an hour a day, for more than 20 years, but because it’s not “official,” it’s not monitored by a fitbit (I refuse to wear one, I refuse to have what feels to me like an electronic leash), it’s not in the “official” spaces exercise is done (I work out at home, to a video, or on a cross-country ski simulator), it probably doesn’t count, and if the program becomes more draconian, I will have to find time to run around the track here on campus just to please some admin.

    There’s also the “carrot” of getting a one-time, $250 reduction on our health insurance deductible if we fill out a long health assessment and agree to be spammed with messages about our particular “health concerns.” I don’t LIKE being nagged – I know I’m overweight. I know my blood pressure is too high unless I take meds for it. I know I don’t handle stress as well as I could. Guess what? Nagging me will only make my stress worse.

    A colleague took the assessment. He is less paranoid about these things than I am and HE said it was “intrusive,” so that tells me I don’t want to do it until we get to the point of “Fill out the assessment or you can find your own health insurance on the ACA exchanges….”Report

    • Avatar Morat20 says:

      They send us videos. We get annual training that has videos.

      My PC doesn’t have speakers. I was not given headphones (what, you think I’m going to plug my personal pair in?). I can only assume they’re not that important to watch.Report

      • Avatar Michael Cain says:

        Back in the day, the giant telecom where I worked sent us annual training videos. I worked in the R&D labs, where almost everyone asked, “Why can’t you send us text, that I can read much faster?” I asked that question when I was a designated person for providing input to HR. The answer was that too much of the field staff was not functionally literate at a level that made Legal happy, so the only approved way to distribute the training material was by video.

        There are days when I live in fear that we’re headed back towards “I’ll meet you at the Potted Swan for beer after work,” and the pub will have an appropriate sign hanging out front, but no text.Report

        • Avatar Kim says:

          literacy has increased with the advent of cellphones and standard daily computer use.Report

          • Avatar Jaybird says:

            There are all kinds of literacy.

            1st grade reading levels, 5th grade reading levels, 9th grade reading levels, so on.

            I would be willing to agree that literacy has increased if we’re talking increases from “functionally illiterate” to “1st grade reading levels”.

            If we’re looking at some of the commanding heights to the right of the 9th grade stuff, though… it wouldn’t surprise me to see that those are evaporating.Report

            • Avatar Kolohe says:

              By 2019, corporate training will be entirely conducted in memes and emojis.

              (For real, there is a US Navy tactics training out there that uses Domo Kun)Report

              • Avatar Jaybird says:

                I’ve heard that Air Force/Navy training requires 9th Grade Reading Level and Army/Marine training requires 5th Grade Reading Level.

                If true, no wonder we aren’t capable of fighting cyber stuff.Report

              • Avatar Kolohe says:

                I’ve never heard that, but without doing any serious math, that may very well be close to the weighted mean of individual MOS/NEC (i.e. specific job title) training across the services.

                All kidding aside, there’s a vast difference between the training given to a person to do their ‘real’ job, and the general training given for higher up CYA purposes. Though, as former middle management who can tow the company lion with the best of them, the value in the latter training isn’t really to ‘teach’ anyone anything, but rather repeated exposure to a certain way of thinking may provide an Inception type experience to the individual members to be better about, say, EEO things, and recognize when other people are way out of line.Report

              • Avatar Kolohe says:

                As far as fighting cyber stuff, the military itself was never really the lead government agency for that kind of stuff. (You see the recent video about the nuke weapons system that uses 5 1/4 floppies?)* The poobahs certainly tried to get in on the game in the 00s as bureaucratic empires were being built and money was flowing freely, but still the military is not the lead dog in cyber security.

                And one can make the case that it shouldn’t be – we don’t have Marines guarding the physical DNC Hq, after all.

                * it may have even been 8 in disks.Report

              • Avatar Kim says:

                Sure it was, way back in the 1940s.Report

              • Avatar Kolohe says:

                Revising and extending my remarks, the military (well, Grace Hopper) was certainly innovative in the early days of electronic computing, and you can even maybe pin the transition of Arpanet going from mil focused to edu focused in the 70s as a defining change.

                But all the way up until the 90s, physical security *was* cyber security, and it wasn’t the military or even the government that changed this paradigm, it was the people that started to make money on and from the internet that changed it.Report

              • Avatar DensityDuck says:

                The issue is that if interference with foreign network operations is considered to be a military act, then it needs to be performed by uniformed members of the armed services in order to be constitutional. The only way that civilians can engage in military activity against another sovereign state is through a letter of marque, and those can only be issued as a formal act of Congress.Report

              • Avatar Kolohe says:

                Somebody needs to tell the CIA they need a letter of marque to do funky stuff against foreign governments.

                But really, your probably right about Title 10 vs Title 50, but that’s not the constituional limit per se, just what Congress has set as the rules of the game. Congress could always change it. (And uniform vs non uniform only really matters for Geneva conventions which in turn only matter if you have actual humans on on above foreign soil)Report

              • Avatar J_A says:

                “Somebody needs to tell the CIA they need a letter of marque to do funky stuff against foreign governments.”

                The CIA fully knows that.

                That’s why when foreign governments capture American spies, they have all the right in the world to imprison them as common criminals, which they legally are in all jurisdictions, as we are able to do here with foreign spies.Report

              • Avatar Kolohe says:

                I think back in the day if a privateer had a commission against country Red, and country Red caught them, country Red would not make the distinction between pirate and privateer – but I could be wrong, the internet isn’t clear.Report

              • Avatar J_A says:

                Lettres de marque were probably much more useful as an affirmative defense against charges of piracy in your own country (*) than against Country Red’s authorities, but a lot depends on the status of war -or not- between country Red and country (Blue??).

                It there is war between the countries, then the privateer is de facto assimilated to Country Blue’s naval forces, and the laws of war applied.

                If there was no state of war, country Red would argue either, that there had been an unprovoked military attack on Country Red by Country Blue (war without formal declaration), or, if Country Blue maintained that there was no such war, then Country Red would argue (reasonably) that the privateer had no legal cause against them and they were just pirates, to be judged as such.

                (*) Piracy has always (since Roman times at least), considered a crime against humanity (hostis humani generis) or a crime of outlawry (outside the protection of the King’s Law, subject to the violence of anyone) in common law. As a Blue born pirate, even if you only attack Red vessels, if captured by Blue authorities you are subject to anti piracy laws. Lettres de Marque would “make you lawful” for the purposes of Blue law officers (but not Red law officers in peace time)Report

              • Avatar Gingerbugjones says:

                This is why I love this site.Report

              • Avatar DavidTC says:

                Somebody needs to tell the CIA they need a letter of marque to do funky stuff against foreign governments.

                The CIA has *plenty* of uniformed service people. That’s the entire *premise* of the Special Operations Group! They have their own spec-ops setup! (In addition to the military’s.)

                That said, I have no idea where in the constitution is says civilians cannot be used in a war. We’ve used *plenty* of them before, in all sorts of wars.

                The danger is that non-uniformed people don’t get some Geneva protections, but that hardly seems to matter in *cyber* war where it’s unlikely they will be captured.Report

              • Avatar Kim says:

                So that’s why the Marines decided to blow up a datacenter!Report

        • Avatar dragonfrog says:

          There are days when I live in fear that we’re headed back towards “I’ll meet you at the Potted Swan for beer after work,” and the pub will have an appropriate sign hanging out front, but no text.

          I would love that. Not the functional illiteracy part, but the practice of business signs that use pictures only.

          There’s a bar near here called “The Hat” – not only does their sign have the words “The Hat” in fancy-ish calligraphy, it doesn’t have a picture of a hat at all. How boring is that? Wouldn’t it be much more fun if the sign was just a giant model of a hat?Report

  4. Avatar Kim says:

    Ours has “health coaches” who are not medical professionals, yet somehow still paid to offer advice. Call one up, ask stupid questions like, “If I climb stairs and my knee hurts, should I stop?” get told “go talk with a doctor.”

    I think the actual strategy is “these are people who will listen to you bitch so the doctor can deal with real patients.”Report

  5. Avatar Richard Hershberger says:

    The doctor lying in a medical malpractice case is sadly unremarkable. Here is a story I have heard many times from potential clients: He underwent some procedure that was utterly botched. Of course he was never told that it was botched, but offered an endless series of inadequate remedial measures. Finally, often following a strong yet deniable hint from the botching doctor’s nurse, he goes to a different, better doctor. The new doctor opens him up, swears under his breath at what he sees, and does what he can to undo the damage and redo the original procedure. Total time elapsed: typically a year or two of going through hell.

    Having finally realized what happened, he seeks legal advice. Does he have a case? Maybe, maybe not. Odds are the latter. Lots of things are look like obvious malpractice to you or me aren’t cases. But the question at hand is whether the second doctor, who knows perfectly well that the first guy did a complete cock up, will be willing to testify? The answer is almost certainly not. The medical profession’s reflex is to circle the wagons, regardless of the facts.

    Part of the problem, I think, is that there are a lot of urban legends within the medical professional about malpractice litigation. They for the most part haven’t a clue what is and is not actionable. They therefore regard it as a mysterious arbitrary action that they can’t control, and therefore resist automatically. Add to this financial incentives. We hear about “defensive medicine,” meaning ordering a bunch of expensive but unnecessary tests so they can’t be sued for not doing them. The thing is, this is bullshit. “Standard of care” is an overwhelmingly strong defense in a med mal case. If you can show, and you probably can, that the standard of care did not include those tests, given what was known at the time, the you just won the case. This stuff isn’t made up on the fly. The profession has established standards. Follow them and you are in the clear.

    But you know what else, about those expensive unnecessary tests? Someone is making money from them. Follow that money and much is explained. Note in particular if the doctor ordering them is paid on a fee-for-service basis. The persistence of the defensive medicine urban legends suddenly makes a lot of sense.Report

    • Avatar Michael Cain says:

      Note in particular if the doctor ordering them is paid on a fee-for-service basis.

      Displaying woeful ignorance here, but how much is the doctor reimbursed for ordering the test?Report

      • Avatar Richard Hershberger says:

        I have no idea, though he has to not only order the test, but review the results afterwards, and if the test in performed within the practice, there is that.Report

      • Avatar InMD says:

        The basic answer is that it depends on the payor (i.e. out of pocket, commercial insurance, or a government program). The whole industry is supposed to be moving away from fee for service but there is a lot of inertia and regulatory issues that make it slow going.Report

    • Avatar dragonfrog says:

      IANA Medical Anything, but as I understand it, part of the hesitancy to support malpractice suits, or blame-pinpointing in general, is viewed as part of a mechanism for actual improvements in care.

      That is, as I understand it, when something goes wrong, the process of figuring out what, why, and how to prevent similar cases in future, is structured to carefully avoid placing blame. This is so that every participant will be willing to be open and honest.Report

    • Avatar Morat20 says:

      I’d like to point out that anesthesiologists are an example of a specialty getting it right. Back in the late 80s, I think, they sat down and said “We’re getting sued a LOT. Like a lot more than most specialties”. So they (if I recall correctly) started collecting data — not just the lawsuits, but data on complications and the like, parsed it, and came up with some big changes to common practices that drastically reduced the risk of anesthesia.

      And the end result, by starting with “We’re not perfect, either individually or as a field, we really need to rethink out best practices stuff” — they got results. Full sedation is a lot safer, fewer people die, and they get sued a lot less.Report

      • Avatar Oscar Gordon says:

        Full sedation, or conscious sedation? I thought full sedation carried more risk.Report

        • Avatar Kim says:

          He’s speaking about general anesthesia, I think.Report

        • Avatar Morat20 says:

          General anesthesia. It’s still more risky than other forms (that’s why they prefer not using it), but it’s a LOT better than it used to be — and not all because of newer drugs and gear.

          Although medicine is always improving like that. My dad had his gall bladder out a decade or more back, and his was laproscopic — in the early days of it. A friend of his had his out 2 years ago. The difference in methods was…profound.

          Same for heart stuff (my dad and his dad both had a mostly blocked artery. One got a double bypass, the other a stent.), same for anything really.

          I keep putting off LASIK becau it keeps getting quicker, better, less side effects….and also because it’s expensive and involves eyeball surgery. (Even if now it’s a tiny nick and peel operation run by a computer, with lasers that do on the fly alterations to correct for the tiniest of individual variations — they map right ahead of “alter”. They laugh at your astigmatism, and fix it in passing….)Report

      • Avatar Burt Likko says:

        This is how the tort system is supposed to work.

        Also, everything @richard-hershberger said, plus doctors enjoy inherent popularity with juries, assuming their lawyers are able to keep the doctors’ personalities within the realm of humanity.Report

      • Avatar Kim says:

        And yet… we still get instances of:
        “What do you mean it’s not supposed to hurt??”
        “Well, we gave you anesthesia…”
        “I… don’t… think… it’s… working.”
        “On the bright side, you’ll probably pass out sooner that way!”

        (Some doctors make mad scientists look sane. This was “lifesaving” surgery, so they weren’t about to stop simply because of pain.).Report

  6. Avatar Jaybird says:

    What are Clinton’s internals saying?

    Democrats target Libertarian ticket

    Brother Jason Kuznicki links to this BHL thread explaining that, all things being equal, if Johnson increasing his vote-share helps Clinton then that entails that Johnson being in decline is something that helps Trump.

    I still don’t think that Johnson will break 3%.

    But it’s interesting to see the Democrats acknowledge a third party, here. And not in the “Hey, if you don’t like Trump, look at Johnson (muh hah hah hah!)” sense of acknowledging it.Report

  7. Avatar Jaybird says:

    Good news! Twitter removed the offensive picture comparing Skittles to refugees from DJT Jr’s tweet!Report

  8. Avatar DensityDuck says:

    RE: Wellness programs.

    There’s “average population”, and there’s “average of self-reporting population”. If you suddenly inject a bunch of new information without compensating for it, you get trouble if you’d based your procedures and metrics on the previously-established average.

    There are people who suggest that the introduction of fetal heart rate monitors coincides with a sharp increase in the rate of C-sections, because all the FHM does is give doctors enough information to scare them.

    There’s a similar argument about breast-cancer screenings–that the rate of actual cancer hasn’t increased and wasn’t going to, but now people see lumps they wouldn’t have seen before and flip out.

    Maybe what’s going on is not that the health measures changed in any way, but now there’s a financial incentive for all the slobs who never cared about exercise to report their miserable health and rotten physical condition, thus registering an apparent sharp drop in healthiness.Report

  9. Avatar Jaybird says:

    Who has two thumbs and hit a home run on the first pitch of his first at-bat?

    Tim Tebow.

    You know what that is?

    That’s good clean living, right there.Report

    • Will Clark hit a home run off Nolan Ryan (Nolan Ryan!) in his very first major league game.

      That’s

      1. A lot more impressive
      2. Knowing Will Clark, nothing to do with good clean living 🙂Report

      • Avatar Burt Likko says:

        All the same, good for Mr. Tebow. Even if it was just the instructional league. Let him enjoy the moment; those moments never last very long.Report

        • Avatar Richard Hershberger says:

          This. A home run on your first AB is not nothing, but it is still a sample size of one.

          Though wouldn’t it be a kick in the pants if it turns out he’s a natural hitter, and has been wasting all those years screwing around with football?Report

          • Avatar Jaybird says:

            Is a baseball player who does some goofy deity crap after a homer something that will be novel?

            I mean, I don’t watch baseball so I don’t know if Tebow taking a knee will be seen as “HOLY COW ISN’T THIS CONTROVERSIAL?” or “Man, how come half the damn league acts like they’ve never gotten a damn hit before?”Report

            • Avatar Burt Likko says:

              Nah. Players cross themselves or point up the heaven to give thanks to God or other things like that all the time after knocking one out. My favorite example in recent history came, alas, at the expense of my own hometown team, although I can hardly begrudge him.

              I think there’d be a problem if Tebow took his thank-the-big-guy knee the instant after he making contact with the ball, but after he finished rounding the bases? No problem. Hell, he might not even be the first to do exactly that, and it would probably class up the Mets along the way.Report

              • Avatar Richard Hershberger says:

                These displays of piety typically take a Latino form, and are relatively unobtrusive. This is distinct from Tebow’s trademark conspicuous display, which comes from American White Evangelical Protestantism.Report

              • Avatar Burt Likko says:

                Why do you hate brown people?Report

              • Avatar Michael Cain says:

                Worth noting that, at least in Denver, to “tebow” in the verb sense was something that he did on the sideline, behind the bench, long after the play was over. About as non-public as a player could get during game time.Report

              • Avatar Richard Hershberger says:

                Yes, it was a sideline thing. No, it wasn’t a discreet behind-the-bench thing. Go to Google Images and search on ‘Tebow kneeling’ and there are innumerable examples of him doing this right on the edge of the playing area, with no one around him. This is a public display of conspicuous piety. Jesus spoke on this very topic. He wasn’t a fan. It is in the part of the Bible my church reads out loud every year, during Holy Week [correction: on Ash Wednesday]. I suspect that this is one of the many parts of the Bible that Evangelicals quietly pass over and pretend isn’t there.Report

              • Avatar DavidTC says:

                This is a public display of conspicuous piety. Jesus spoke on this very topic. He wasn’t a fan.

                I always thought it a bit petty of Jesus to single out Tebow in his speeches, especially as the man wouldn’t be born for millennia. And Jesus talking about his 2013 preseason play was just being a jerk, in addition to confusing generations of Christians. 😉

                But, seriously, yeah, Jesus said, very specifically, not to run around making big deals out of praying. It is slightly amazing how many people appear to literally read that backwards.Report

              • I suspect that this is one of the many parts of the Bible that Evangelicals quietly pass over and pretend isn’t there.

                You’re probably right, but (surprise, surprise) the Bible isn’t entirely clear on this thing. There’s the passage you refer to (I suppose about how people should pray in private?) and then there are examples of martyrs (e.g., Stephen in Acts) persecuted for their beliefs and being praised for being martyrs, although they presumably wouldn’t have been persecuted if they were held their beliefs more closely to their chests. And then there’s the “go ye into all the world and preach the gospel to every creature” type of thing.Report

              • Avatar Morat20 says:

                I always thought the gist was “Be Christians, be examples, but don’t play holier-than-thou”.

                You know, public piety for the sake of being glorified for being pious. It’s showing off, a narcissistic impulse, in which you tell the crowds “I am so wonderfully humble, you should be in awe of me”.

                I mean the line between “showing off for adulation” and “evangelizing” or simply “being openly Christian” might be a bit blurry at times, but we can all admit we’ve seen people make public displays of their piety (or, frankly, any laudable aspect) to show off their credentials.

                Speaking theologically, that becomes more about worship of self (“See how great I am”) as opposed to worship of God (“See how great God is”).Report

              • I’m torn on this.

                I think that there are contradictions in the Bible or in reasoned extrapolations thereof. There seems to be injunctions (not that I know the Bible well enough to cite any right now) to give thanks for what one has and to acknowledge that one hasn’t come by it save through a gift from god. Which seems to mean that maybe one should give thanks when making a touchdown.

                But there’s also the takeaway you point out:

                public piety for the sake of being glorified for being pious. It’s showing off, a narcissistic impulse, in which you tell the crowds “I am so wonderfully humble, you should be in awe of me”.

                and

                Speaking theologically, that becomes more about worship of self (“See how great I am”) as opposed to worship of God (“See how great God is”).

                And you’re right. But there’s also a sense that it’s between the conspicuously pious and non-humble humilitarian and his god and not between that person and a fellow mortal.

                But then why not rebuke the action and point out the inconsistency? I can’t fault Richard for doing it or you for explaining it.Report

              • Avatar Morat20 says:

                Well, I’m not Christian (I was raised that way, however) and frankly those I’ve known basically view it as “I won’t judge”.

                They might find it vulgar (especially the sort of ostentatious preening of one’s Christianity done by many politicians), but in general they kind of view that as between them and God.

                And even outrageous cases are pretty “eye of the beholder”.

                But in terms of sin, it’s a pretty venal one. It’s a sin of pride, it’s really subjective, and no one is hurt — the only soul damaged is yours. And not terribly heavily. No one’s going to hell, so to speak, even if you’re right and they’re showing off.

                Now gay sex and abortion and voting for the wrong politician, well — that can get the thundering denouncements going. 🙂Report

              • Avatar Road Scholar says:

                I think there’d be a problem if Tebow took his thank-the-big-guy knee the instant after he making contact with the ball, but after he finished rounding the bases? No problem.

                As long as he doesn’t do it during the National Anthem.Report

  10. Avatar Joe Sal says:

    Doom-
    It’s like we are playing biological warfare against nature and expecting to win.Report

  11. Avatar veronica d says:

    Oh gawd “wellness programs”. Good fucking grief.

    On the other hand, my office has a pretty nice gym with free weights and an on-staff trainer. It’s pretty nice. I workout there twice a week, plus a ton of walking on the weekends.

    So yeah, wellness, give me the tools. Then leave me alone.Report

  12. Avatar DensityDuck says:

    RE: FDA and media. I’ll be amused to see what Morat20 has to say about the article, given his previous discussion.Report

    • Avatar Jaybird says:

      I’m still sad that nobody answered my question… which I’ll repost for posterity:

      I mean, let’s all imagine some sort of weird situation where the people who need epipens all suddenly have a non-FDA approved connection in Germany and they get their epipens shipped to them for cost plus a bottle of something, you know, for the trouble.

      Are the people in my above example putting themselves and/or their loved ones in harms way by using devices that have not been approved by the FDA? Are these people being foolish?

      Because, again, I’m wondering what it means if our response is something to the effect of “Hey, good for that guy. I’m glad he’s able to get an epipen that way.”

      I’m guessing it’s an implicit acknowledgment that the FDA is too restrictive.

      (I mean, I can’t imagine someone saying “That person is a fool! That device wasn’t approved by the FDA! It was merely approved by the slipshod European Medicines Agency!” but, hey, maybe that’s my limitation.)Report

      • Avatar Chip Daniels says:

        I may or may not have replied, but my response is along the lines of look, the EPA is not a Rabbinical council or Papal authority.
        EPA approval only means it was tested according to some regimen and approved.

        Even an EPA approved device can be faulty and kill someone; even a Tijuana clinic approved device can be effective and safe.

        I mean, what are you looking for here?Report

        • Avatar Damon says:

          Well, it’s illegal to buy drugs outside the us…so……

          http://www.fda.gov/AboutFDA/Transparency/Basics/ucm194904.htmReport

          • Avatar Stillwater says:

            Was that a Bush era provision? My memory on that one ain’t so good, but I distinctly remember the issue of “cheaper Canadian generics” being a heavily politicized issue not all that long ago, with Congress – and the sitting president – arguing that cheaper imported generics was clearly a bridge too far.Report

        • Avatar Jaybird says:

          I mean, what are you looking for here?

          Some variant of “the FDA is too restrictive to the point where it creates a moral issue that ought to be rectified”.

          If you don’t believe in morality, maybe we can switch to some sort of calculus that discusses optimization and discuss how far from optimized the current calculi are.Report

          • Avatar Chip Daniels says:

            “the FDA is too restrictive to the point where it creates a moral issue that ought to be rectified”

            I am not sure what the word “moral” is doing in here.

            Is this restriction so tight it creates more harm that good?

            Sure, maybe. I am sure there are knowledgeable people who could take either position. I don’t really have a dog in this fight.

            Are we litigating this one isolated case, or is this some proxy for a larger issue, like “the EPA overly restrict Epipens so therefore government is an illegitimate Leviathan“?

            Because normally on political comment boards, thats the case.

            Which is why you are probably seeing a lot of denialist type resistance.

            If we you stipulate this is an isolated issue, then we* can stipulate you are probably right.

            *We = The LeftReport

            • Avatar Jaybird says:

              Well, this is why I asked the question that you dodged.

              Here, let me repeat it:

              Are the people in my above example putting themselves and/or their loved ones in harms way by using devices that have not been approved by the FDA? Are these people being foolish?

              You brought up that, hey, sometimes the FDA kills people and sometimes Tijuana doesn’t.

              But my questions were yes/no answers and the organization in question, the European Medicines Agency, is not Tijuana.

              So let me restate my questions and put finer points on them. Make them easier to answer “yes” or “no”.

              Are the people in my above example putting themselves and/or their loved ones in greater danger by using these devices than they would using those that have been approved by the FDA?

              Is your first response to hearing Vikram’s story in the original post to say something close to “Good for that guy! I’m glad he’s able to get his epipens!”? Is it, instead, close to “I would not trust that epipen, were I him. He’s risking his own life by using cheap European epipens that have only been approved by the European Medicines Agency”?Report

              • Avatar Chip Daniels says:

                You’re seeing this decision as some sort of moral binary, which is kind of weird. Its like you want me to pass moral judgment on these people, or give them dispensation.

                Getting a device approved somewhere, by someone lowers your risk as opposed to not being approved anywhere, by anyone. Getting one approved in Europe is somewhat better than Tijuana, but maybe not as safe as the EPA.

                How much that “somewhat” is of course variable. Again, Thalidomide was approved in Europe and people who purchased it DID put their families in harms way.

                Is it foolishly risky?
                I don’t know, and you don’t either.

                Seriously, I don’t know what your point is here.Report

              • Avatar Jaybird says:

                Actually, I’m seeing some sort of moral threshold being crossed. It’s not binary as much as a sorites problem finally manifesting itself as a heap.

                Getting one approved in Europe is somewhat better than Tijuana, but maybe not as safe as the EPA.

                So now I’m wondering what I can find to give more information about the European Medicines Agency to overcome your skepticism. Here’s the wiki page, here’s the official page but we both know that those are useless propaganda.

                Here’s a report from the ISPOR (International Society for Pharmacoeconomics and Outcomes Research) comparing the FDA and the European Medicines Agency (the ISPOR doesn’t have a wiki page, but the ISPE does and it makes reference to its sister organization (the ISPOR) and it certainly appears to be a non-partisan organization).

                I have a handful of friends who lived in Europe for a while. Could their testimony about the efficacy of the European Medicines Agency get you to say “hrm… maybe I shouldn’t compare the European Medicines Agency to Tijuana or bring up things from the 1950’s if I am expressing skepticism about epipens.” We know that “hey, my friend said” stories are useless, though. I can’t assume that you know anyone who has ever lived in or been to Europe.

                It seems, from here, your skepticism about whether any single one of the seven epipens approved by the European Medicines Agency might not be acceptably safe strikes me as being fundamentally insurmountable.

                Like, insurmountable in theory.

                Like, I could not spend time googling and find *ANYTHING* that would get you to say “okay, maybe the European Medicines Agency is roughly comparable to the FDA and I shouldn’t compare it to whatever Mexican agency is out there that I won’t even bother naming because, hey, Mexico.”

                I can’t even get you to answer the question of whether Vikram’s European connection for Epipens is doing something that gets you to immediately say “hey, good for him” or “hey, he’s taking quite the risk merely to save a buck or two”. Just “hey, I don’t know and you don’t either.”

                I can’t think of anything that could overcome this level of skepticism.Report

              • Avatar Oscar Gordon says:

                Back when I worked at the Lazy B, airliners had to meet US, European, and Japanese regulations. If you could meet all 3, you could pretty much sell a plane in any market in the world.

                So planes were built primarily to FAA standards. The other two regulatory bodies, in order to be efficient, read the FAA regs, compare them to their own needs, and then tell manufacturers what additional requirements are necessary for them. This is generally a short list (if you meet the FAA regs, you are like 90% there for the other two). This works in reverse, by the way (Airbus, builds first to Euro regs, then figures out what the FAA needs in addition).

                This strikes me as the opposite of what the FDA does, which is that it can’t be bothered to compare the work done in, say London, with the work done in the US, and just hand over a list of additional requirements, but instead it insists that everything be replicated in the US.Report

              • Avatar Jaybird says:

                it can’t be bothered to compare the work done in, say London, with the work done in the US, and just hand over a list of additional requirements, but instead it insists that everything be replicated in the US

                It strikes me that this is an obvious harm.

                Even if I get rid of all my weird emotional stuff from this, it still strikes me that this is a grave error in the calculus that results in massive inefficiency and waste.Report

              • Avatar DensityDuck says:

                Incidentally, Conamed (Mexico’s FDA-equivalent agency) is no joke. Suggesting that the Mexican government provides substandard medical regulation is…playing to a certain stereotype, we might say.Report

              • Avatar Jaybird says:

                Well there’s a reason we don’t want those people here.

                For one thing, they’ll expect epipens to be as easily procured as in Tijuana.Report

              • Avatar DensityDuck says:

                “Is it foolishly risky?
                I don’t know, and you don’t either.”

                If your answer to “is using non-FDA-approved medications risky” is “I don’t know”, the obvious follow-up is “should the FDA make it illegal to sell things they haven’t approved”. And if your answer to that is “yes”, then maybe you need to think about why your first answer was “I don’t know”.Report

              • Avatar Chip Daniels says:

                I should have clarified that sentence to read “I don’t know what the risk is”.

                If Jaybird’s point was simply to argue that the EU approval process is as good as the FDA, heck, he should have just said so at the outset.

                I would agree with that statement!

                I’m just confused by his insistence on the binary question of whether they are “putting their family in harm’s way” and whether we should approve or disapprove.

                That frames the decision as entirely an either / or situation; But risk is not binary, its a gradation.

                Everything carries some risk of harm; The various regulatory agencies are just methods we develop to reduce and mitigate risk.Report

              • Avatar Jaybird says:

                It’s not binary as much as a sorites problem finally manifesting itself as a heap.

                We’re not discussing how the US only approved one and Europe has two that it’s approved.

                We have only approved one.

                Europe has approved eight.

                That indicates a different dynamic than merely a binary one.

                It indicates regulatory capture that is resulting in massive inefficiency and that massive inefficiency is great to the point where it is harm.

                My question is about your gut response to hearing Vikram’s story.

                Is your gut response “Good for him!”?
                Is your gut response “But that hasn’t been approved by the FDA!”?

                If your gut response is “I don’t know”, doesn’t that indicate something about the FDA?

                I mean, imagine a situation where we had approved six epipens and Europe approved eight.

                If you heard that Vikram’s friend was smuggling in one of the two that weren’t approved, would it make sense to say “man, that’s… that’s not what I’d do…”?

                I think it would. I mean, hey. *MY* response to hearing that someone was smuggling in one of the two in the hypothetical story would be one of caution.

                But when it comes to the *ACTUAL* situation that is *ACTUALLY* happening? My response is a lot closer to “Good for him! I’m glad that he has that connection.”

                And that, to me, indicates a deep structural problem.Report

              • Avatar Chip Daniels says:

                My gut reaction is the same as if someone said they were in a hurry to get to work, and traffic was light, so they blew through red lights.

                My reaction is to shrug.
                He had a need, determined the odds of risk, and made a decision.
                This doesn’t call for my judgment, at all. It may have been a wise risk evaluation, or stupid. I can’t say.
                So if we are only talking about Vikram’s friend, I can’t say one way or another.
                But if we are talking about the wisdom or foolishness of running red lights, I can say clearly that traffic laws, like drug testing regulations, are a good idea.

                So what is this structural problem you are talking about?
                Can you state it clearly?
                Because honestly, I’m not sure.Report

              • Avatar Jaybird says:

                I can say clearly that traffic laws, like drug testing regulations, are a good idea.

                We need you over in the “Updates On Police Shoo…No, Wait, Now Alfred Olango Is Dead” post.

                Sam Wilkinson apparently needs it explained that civilized society requires a police force.Report

              • Avatar DensityDuck says:

                If red lights are so easily blown and with no consequence other than “increased risk”, then why do we even have ’em?

                Or is the threat of legal sanction for blown a red light just a “risk” in your calculation, here?

                Which seems an error in your thinking, because if I run a red light and get T-boned, there is an obvious harm that I suffered as a result. But if I run a red light and no harm occurs either to me or to anyone else–if I run a red light and nobody was within ten miles of me, even–I can *still* get caught by a traffic camera and charged hundreds of dollars in fines, and if I don’t pay those fines I go to jail. Despite no harm having come to anyone, and in proveable fact not even any potential harm in the “nobody within ten miles” instance.Report

              • Avatar DensityDuck says:

                Oh, by the way:

                “He had a need, determined the odds of risk, and made a decision.”

                You just answered Jaybird’s question, and you answered “yes, buying the European epipens is more risky than using American-manufactured ones”.Report

      • Avatar greginak says:

        It would depend on the pen now wouldn’t it. As i remember a couple of the pens not approved here were taken off the market here were due to potential issues. But it could be fine, it would be up to the person to find out about the pen and there were any concerns about it.

        But i do remember people saying there is no way the FDA could possibly be too restrictive. Well okay lots of people said that was very possible. But at least we can agree there should be some sort of regulatory body overseeing meds. We just don’t want it to go overboard.Report

        • Avatar Jaybird says:

          It would depend on the pen now wouldn’t it.

          I’ve already stipulated that it’s one of the seven pens that the European Medicines Agency approved.

          But i do remember people saying there is no way the FDA could possibly be too restrictive. Well okay lots of people said that was very possible. But at least we can agree there should be some sort of regulatory body overseeing meds. We just don’t want it to go overboard.

          Is the fact that the European Medicines Agency approved eight pens to the FDA’s single approval indicative that the thing that was very possible HAS ACTUALLY FREAKING HAPPENED?!?Report

          • Avatar greginak says:

            And it’s already been stipulated, to sound all legally, the FDA could be to restrictive. But at least we agree there is a role for a regulatory body to oversee this stuff.Report

            • Avatar Jaybird says:

              And I’m back to asking “what would it take to move you from ‘could happen’ to ‘has happened’?”

              Because this seriously feels like arguing against a global warming denialist.Report

            • Avatar Stillwater says:

              But at least we agree there is a role for a regulatory body to oversee this stuff.

              I hear ya greg, but I have to disagree in this particular case. My understanding is that epipen “patent” involves some of the most basic, easily replicable, commonsensical stuff in the medical world.

              I’d also add that there’s a difference between a bare minimum of regulation which ensures that normal safety standards are met (“sterilize those needles, dammit!”) and enforcing that a simplistic delivery device persistently deserves patent protection (add: to the exclusion of any alternative).

              Maybe those last two are in different domains, tho…Report

              • Avatar DensityDuck says:

                but the fda did something and they wouldn’t do something unless they had to do something because they’re the fda and therefore there was something because they did something and they wouldn’t do something unless they had to do something because they’re the fdaReport

      • Avatar Damon says:

        I see no moral or legal violation by obtaining products in this way (what the FDA things isn’t relevant to my opinion, just whether or not I’m likely to be jailed for doing it) If the FDA is too slow, too bureaucratic, captured by the industry, paid off, etc. is not relevant. If the product is essentially the same thing that’s trying to be offered here, I’d probably take the risk, especially if it’s really important for my health.

        Case in point. Silvadene used to be prescription only, or scrip only for a higher % of the medicine. This stuff is great for all kinds of burns and I’d get it out of the country if needed and I have.Report

      • Avatar DensityDuck says:

        “I’m still sad that nobody answered my question…”

        Here’s a useful answer, since apparently nobody else wanted to try:

        http://www.rfa.org/english/news/china/clinical-fakes-09272016141438.html

        “A recent survey of clinical trials in China has revealed fraudulent practice on a massive scale, according to a government investigation. China’s food and drug regulator recently carried out a one-year review of clinical trials, concluding that more than 80 percent of clinical data is “fabricated,” state media reported…”Report

  13. Avatar Oscar Gordon says:

    This is only related to Health in the sense of playing with these compounds is bad for it, but Dr. Lowe is always an entertaining read.

    But that latest paper builds off the question “How do we cram more nitro groups into this thing?”, and that’s something that wouldn’t have occurred to me to ask. Saying “this compounds doesn’t have enough nitro groups” is, for most chemists, like saying “You know, this lab doesn’t have enough flying glass in it” – pretty much the same observation, in the end.

    Report