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"Little else is requisite to carry a state to the highest degree of opulence from the lowest barbarism, but peace, easy taxes, and a tolerable administration of justice" - Adam Smith

Beware of healthcare populism

Written by Dr Fred Hansen | Tuesday 22 January 2008

cholesterol.jpgThe temptation of politicians to twist public policies for short-term gains in order to win votes is well known. Policy on cholesterol (pictured) is one such example. It turns out, according to accumulating evidence, to be a rather simplistic public scare. Reducing 'bad cholesterol' has been the mantra for decades and statins, which are just doing that, have earned $27.8 billion in sales in 2006. Little wonder since 13 million Americans and 12 more millions worldwide are using them to prevent heart attacks.

Because it attracts large numbers of voters, politicians keep shifting health resources to disease prevention – and thus draining away vital resources from the chronically ill, who are always a small minority. Yet new research shows that only one in 100 people, or according to some research even one in 250, who take statins over five years have any benefit whatsoever.

One reason is that healthy people have a different metabolism than chronically ill patients. Another is that bad cholesterol levels may no longer a reliable risk indicator for heart disease. For instance, Australian Aborigines have low cholesterol but high rates of heart disease. Spaniards have as much bad cholesterol as Americans but only half as much heart disease and the Swiss have even higher cholesterol but lower rates of heart disease. And now a different enzyme, called Rho-kinase, has been found that predicts heart disease much better.

This is just one example that exposes how government healthcare policies lag hopelessly behind science and are prone to blunder public health issues. And it will probably take much longer for government health programs to change course than the market would need to correct obviously biased research.

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Blog Review 483

Written by Netsmith | Monday 21 January 2008

Installing metal detectors in schools: according to one teacher they'll manage to get the pupils in at about the moment when it is time to break for lunch.

Another rejection of the idea: on principle, not simple empirics. 

Comparative advantage , cooking and satirical argument. Is it really the business of society to iron out the unfair advantages of endowment? 

Comparative macro-economics. Germany has a budget surplus: not a bad thing to have at the beginning of a world-wide (possibly) economic turndown.  Something of a pity that the UK's economy wasn't managed similarly.

It would appear that physicists, when publishing papers, understand markets better than economists do when publishing papers: 

In addition, physics has a laissez-faire attitude about publication,
believing that it is better to err on the side of letting as many new
ideas in as possible, and to let the market eventually decide what is
good and what is bad through a Darwinian process that selects what is
useful and forgets what is not.

Hugo Chavez seems (again) to be picking every bad economic idea from around the globe to impose upon Venezuelans. We've known that this would all end in tears but it seems to be accelerating. 

And finally, the great econblogging debate of our times: did Adam Smith actually visit a pin factory or not? 

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Educating Teachers

Written by Tim Worstall | Monday 21 January 2008

teacher.jpgI'd not heard of Teach First until Andrew Leigh referred to it. Put simply, the idea is to take bright graduates, give them a few weeks of training to polish their educational skills and then stick them into bad schools. The schools that they find it very difficult to get fully trained teachers to go to.

On the face of it this seems absurd: for as we're constantly and consistently told, teaching is a profession, one which requires either a full degree in the subject or at minimum a one year post-graduate course after a non-education major degree. How could merely clever people pick it up in weeks?

Quite how well can they? Results from the American equivalent show: 

...research on Teach for America that suggests these teachers outperform other starting teachers, and even the more sanguine evidence (eg. work by Jonah Rockoff and coauthors) has Teach for America teachers being no worse.

So we seem to have a situation where an absence of specific training in education produces better educators: or at the very least, ones that are no worse. 

An excellent result I think all can agree: the policy implication is therefore clear, make teacher training a 5 or 6 week course, close the vast majority of the educating to educate system, save a great deal of money and possibly improve the education system, or at least leave it no worse.

And remember, we're doing it for the children. 

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Joke of the Day

Written by Jokesmith | Monday 21 January 2008

A guy was walking down the street and saw Little Johnny smoking a cigarette.

He said, 'Kid, you're too young to smoke. How old are you?'

Johnny said, 'Six.'

The guy said, 'Six? When did you start smoking?'

Johnny said, 'Right after the first time I got laid.'

The guy said, 'Right after the first time you got laid? When was that?'

Johnny said, 'I don't remember. I was drunk.'

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Common Error No. 14

Written by Dr Madsen Pirie | Monday 21 January 2008

14. "The state is right to protect people from themselves."

the_state.jpgPeople? That means you. Would you like to be protected from yourself? In the first case this means that the state has to take the decisions about what we do or do not need to be protected from. One step down this road and you are lost. The state might decide you need to be protected from smoking. If its scientists tell it that refined white sugar and salt are bad for people's health, it might protect people from those too. Maybe saturated fats, such as butter, as well. Maybe it should protect people from the physical inactivity which might harm them?

After deciding what it considers injurious to us, the state then takes the decision to protect us. It does this by preventing us from doing what we would otherwise have done. It can only do this by force, sanction, or the threat of the same. So the state takes away our freedom to do what we decide to do, and then uses force to make us do what it wants us to.

John Stuart Mill thought that only if someone causes or seriously risks physical harm to others should the state stop them. Should it prevent them using a dangerous bridge? No, he said. It can provide them with information, put up a sign and even urge them not to cross. But it is up to people themselves to assess the risks and take the decision. Some claim that the state knows better than we do. Unlikely, since there is no shortage of media sources telling us about what dangers we face.

And what about non-physical harm? People might be deeply distressed by your non-attendance at prayers, but that does not give them the right to constrain you into worship. The only safe rule is listen to advice, but make your own decisions and take the consequences.

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The blame game

Written by Steve Bettison | Monday 21 January 2008

narcotics.jpgThe saying "buyer beware" never rings more true than when a purchase is being made on the black market. Especially when the market in question is that of illegal narcotics.

Of course, both parties seek to benefit from any free exchange, but drug transactions carry significant risks. The dealer could be arrested, or the purchaser could have an adverse reaction. Now a further risk has been added to the mix: the threat of being sued.

A Canadian woman who spent 11 days in a coma recently succeeded in suing her drug dealer. Apparently the dealer knew that the drug was "highly addictive and dangerous" but sold it to her anyway, in order to make money. (Really? I'm shocked...) This made him negligent, and liable for damages.
In fact, the only reason why the case was successful was that the dealer refused to name the person in the distribution chain above him, thus moving the judge to reject his defence. The decision probably won't be too hard to appeal.

In any case, the person who has really been "negligent" here is surely the consumer, indulging in self-abuse via the consumption of drugs without regard to the harm that they can inflict. She should not have had recourse to sue.
That she did is symptomatic of the ever-growing need to seek restitution from others for our own mistakes. We seem to be moving to a culture of blame rather than of individual responsibility.

People need to be made aware that sometimes, if not almost all the time, the buck stops with them.

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Blog Review 482

Written by Netsmith | Sunday 20 January 2008

One view of how the political system works: an auction of other peoples' money.

Another view: you really shouldn't take the tax subsidies, for if you do, you'll end up becoming captive. 

Yet another: at some point on Northern Rock someone is going to have to say that the hole is deep enough already, so let's stop digging. 

A fourth view: sometimes it really is true that the artist brings a clarity, a purity, to the description of life.  

A markets in everything moment: a futures market for gadgetry. You can pre-sell (or rather, buy an option to do so) your electronic gew gaws as you buy them. 

Sad new, PJ. O'Rourke is no longer funny. Worse, he's actually morphed into being a writer. 

And finally, The Dissident Frogman has found a way to become stinking rich. 

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Patient patients? It seems not...

Written by Philip Salter | Sunday 20 January 2008

avastin.jpgFor ideological reasons, political reform of the NHS behemoth often seems impossible. Politicians across the spectrum, fearful to disturb the foundations upon which the NHS rests, hide behind platitudes, while MRSA haunts the hospital wards. However, cracks are increasingly showing in the system that no amount of political veneration can cover. The seeds of change are showing through, encouraged not from Westminster, but forced through by those that the NHS is supposed to be looking after: the people.

Earlier this week The Times' Daniel Finkelstein, reported the disgraceful case of Colette Mills and Debbie Hirst, two cancer patients who have both been refused the use of the cancer drug Avastin alongside their NHS chemotherapy, even though they are willing to pay for it out of their own pocket. Avastin has been shown to help cancer sufferers, but has not been approved by NICE because it is not considered cost-effective enough to be available on the NHS.

So why have Colette Mills and Debbie Hirst not been permitted to use Avastin alongside their NHS treatment? It has nothing to do with the drug's efficacy… In fact, the reason has nothing to with the drug… Actually, it has nothing to with health. According the the health secretary, Alan Johnson, they were refused because: "That way lies the end of the founding principles of the NHS". But when 'principles' stop the sick from getting life-improving drugs, are they really principles worth defending?

It has been obvious for some time that Johnson’s 'principles' are outdated. Following last year’s report entitled Free at the point of delivery: reality or political mirage, it is was generally accepted that a secret top-up system already exists. Politicians have duly responded by sticking their collective heads in the sand, preferring this to facing up to modern realities. Colette Mills and Debbie Hirst, like others before them, are seeking justice through the courts. They are unlikely to be the last. It's time the NHS's unworkable 'principles' were replaced with a more flexible and customer focused system of health care, one truly fit for the 21st century.

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Joke of the day

Written by Jokesmith | Sunday 20 January 2008

Last night, my wife and I were sitting in the living room. I said to her, "I never want to live in a vegetative state, dependent upon some machine, and fluids from a bottle. If that ever happens, just pull the plug."
She got up, unplugged the TV, and, threw out my beer.

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Common Error No. 13

Written by Dr Madsen Pirie | Sunday 20 January 2008

13, "We should create public sector jobs to boost employment."

unemployment.jpgThere are no public resources, except those which government takes away from its citizens. If government is to spend money on projects, this means that private citizens are deprived of those funds.

Government can appear to create jobs by means of public spending. They can enter the market as purchaser for certain projects, and see new jobs apparently created in response. These new jobs owe their existence to that government demand, and many depend on it for their continuation, in that unless the spending continues at that level, the new jobs may disappear.

Government funds such projects by taking funds from the private sector, either by open taxation, by stealth taxes, by borrowing, or even through inflation. Either way, it takes away the funds which sustained jobs in the private sector. People have less to spend on the goods and services of private business; they have less available to invest in it. This means that temporary, government-created jobs are at the expense of real, lasting jobs in the private sector.

Furthermore, government commands goods and services inefficiently. It costs more for government to perform many deeds than it does for private business to do the same. This is because government bureaucracy is often more cumbersome and more costly. Lacking competition, there is no pressure to make it efficient.

Government-created jobs are often capital intensive, such as infrastructure jobs in road or bridge-building, and use a great deal of costly equipment for each person employed. By contrast, the luxuries foregone when the private sector is subjected to extra taxation tend to be in labour-intensive service areas such as dining out, hairdressing, etc.

The effect is to ensure that more jobs are destroyed than can be created. The problem is that political leaders are usually praised for the visible new jobs, without being blamed for those which quietly disappear from the private sector.

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