Friday, February 27, 2015

None of Your Business!

A few days ago I received in the mail a health questionnaire from my insurance company asking me a bunch of questions about my general health, number of prescriptions, health conditions, whether I had visited an Emergency Room in the last year, and what help I needed taking care of myself.  My first reaction was that it was none of their business.  I wanted to ignore it and toss it out.

When I thought about it from an economic understanding point of view, I changed my mind.  Unless I am willing to pay for my own medical costs it is their business.  Not only that, it is everyone else’s business as well.

Years ago thinking changed in America and elsewhere.  It was accepted that people should not have to pay their medical costs.  The employer or the government should cover some or all of the cost.  The result was an economic isolation of doctor and hospital bills.  From a very high level the costs of every office visit, hospital stay, medical procedure and Emergency Room visit, no matter how urgent or trivial, go into a big imaginary pot.  That pot of medical costs is then divided up among all the payers - insurance companies, employers who are self-insured and the government.

From an economic understanding point of view, none of those primary payers has any money of their own; they just administer, process and move around the money they collect from us, as taxpayers, customers and premium payers.  There is no magic money tree to cover any part of those bills.  That imaginary pot is filled with money that gets there indirectly from our pockets.  And as was pointed out very bluntly in the aftermath of the Affordable Care Act, healthy people must be forced into the system to subsidize the unhealthy.  No one is allowed to opt out of coverage that doesn’t apply.  That is the only way to keep the overall costs down.

The only reasonable response then, is that my health and the lifestyle required to maintain it are not only the business of my insurance company, but also of every other citizen.  Do they have a right to tell me that I should be losing weight or eating more fruits and vegetables or exercising more?  It certainly seems like they should.  Do they have any mechanism to enforce that right?  Not yet.  There probably will never be a time when your neighbor is obligated or even allowed to stop you at the checkout and insist you return that bag of chips; but, as the imaginary pot grows out of control, will the government decide that mandatory labels and sage advice not enough and begin to ramp up regulations that become more and more personally restrictive and intrusive?  Transfats and soft drink sizes may be just a start.  That is more likely to happen and something to seriously consider.

Another point that I’ve made in several past examples is that when you give up responsibility, you leave yourself open to losing some freedom.  In this case turning the responsibility of paying your doctor over to others results in having to follow their rules and sometimes fighting with insurance companies or Medicare to receive what you think is due.  It involves confusing paperwork, loss of the ability to buy only the types of insurance you need and eliminates the option of being uninsured. 

Monday, February 23, 2015

Questioning Ancient Wisdom

It’s hard to say how some subjects creep into daily conversation, but I have heard in the past and again recently about the practice of ear candling as a safe remedy for ears plugged with wax.  The theory is that putting a special candle in your ear and lighting it will draw the wax out.  It is also promoted as a remedy for earaches.

It may sound a little strange, but many people believe in it.  These candles and kits are available at national pharmacies and discount stores as well as specialty shops.  The Internet provides instructions on how to make your own ear candles.

A website dedicated to the practice warns not to trust the critics and skeptics.  According to them it is a “therapeutic relaxation technique similar to acupressure, acupuncture, and aromatherapy” highly recommended to those “within the Holistic and Natural Health Community.”  The practice dates back “many thousands of years and has been found in nearly every culture since the beginning of civilization” with “archeological evidence of stone pottery cones in antiquity” for this purpose.  In addition, it boasts that “humans have been coning or candling for eons.”  

The website goes on to defend the practice against its critics saying that it is misunderstood as are many other “Alternative lifestyle practices” that have been “passed down through the generations” and praises it as another rediscovery of “ancient wisdom” as we “attempt to remain connected to the teachings of our past civilizations.”  It goes on to question and criticize the findings of the FDA that there is “no valid scientific evidence to support the safety or effectiveness of these devices for any medical claims or benefits.”

Well, it seems the FDA is not alone.  They are even milder in their criticism of ear candling than many others.  WebMD quotes Jennifer Smullen, instructor of otology and laryngology at Massachusetts Eye and Ear Infirmary in Boston.  "You can actually lose your hearing from ear candling.  I've had to treat bad consequences of ear candling, including burns in the ear canal and on the eardrum." notes the large number of websites on the subject.  “Many present reasonable and rational information warning those contemplating this activity of nonexistent benefits in tandem with significant potential for serious injury. The medical literature has clearly demonstrated ear candling has often caused serious injury without evidence of benefit (Zackaria and Aymat, 2009).”  [Emphasis added.]  They conclude: “Ear candling is dangerous (even when used as directed by the manufacturer) and serves no legitimate purpose and there is no scientific evidence showing effectiveness for use.”

The Mayo Clinic weighs in with further warnings.  “Research shows, however, that ear candling is ineffective at removing earwax. In fact, the technique can actually push earwax deeper into the ear canal. Ear candling can also lead to: Deposits of candle wax in the ear canal; Burns to the face, hair, scalp, ear canal, eardrum and middle ear; and Puncture of the eardrum.” 

Finally, a highly recognized ENT physician put together this YouTube video to demonstrate that ear candling, when used to remove earwax does exactly the opposite of what it is purported to do.  The ear candle is placed in an empty glass and lit.  Instead of creating a vacuum to draw the wax out of the ear, deposits of soot and wax from the candle form in the glass and on the inside of the tube.  Adding more debris to the ear canal can be dangerous, but the deposits inside the tube give the false impression that wax was drawn out from the ear.

Here again we find trigger words: ancient wisdom, holistic, natural health, alternative, reconnects with the past, and belief.  These are sure ways to win over many who inclined not to be skeptical.  These words sound nice and gentle and friendly, almost magical.  Science is so impersonal and objective.  All it takes is a recommendation from a neighbor, relative or a social media contact, who says they tried it and it worked.  That really means they didn’t hurt themselves and experienced subjective feelings of improvement, possibly driven by the Placebo Effect.  At this some people are willing to throw out the research and warnings from professionals, or more likely, not do simple Internet research on their own to confirm safety and effectiveness.  They trust unqualified promoters of so-called ancient wisdom more that the doctors.  (Do they only reject the use of leaches because it can’t be traced to the Orient?)

I’m not trying to be a party pooper and condemn everything alternative and natural.  I’m just asking that we raise our standards.  Require proof beyond the sample size of one or two and the feel-good hype associated with these products and practices.  In so many cases, these are just more examples of “snake oil” that do nothing but enrich the promoters while diverting money from practical uses like debt reductions and saving for retirement, while in worst cases endangering the patient.

Friday, February 20, 2015

Refresher II

Has America peaked?  This question is on the minds of many citizens.  A standard question on opinion polls over the past 20 years has been some variation of:  “Do you think the country is headed in the right or wrong direction?” The answer to this question has been, for the most part, consistently and overwhelmingly negative.  Gallup has not gotten a positive answer since January 2004 and the result for all major polls has been about 75% negative going back to the early 1990s.

Why would Americans be so discouraged?  Look at the messages we get every day from the media and politicians. We are constantly confronted with news of failures, dangers and crises:  our education system, retirement insecurity, the disappearing middleclass, childhood obesity, healthcare costs, gasoline prices, food contamination, campus violence, climate change, epidemics, frivolous lawsuits, Internet scams, teens not getting enough sleep and many more.  Meanwhile, advertisers play on our fears and insecurities to sell us stuff we don't really need.

This dissatisfaction goes beyond politics or which party is in power.  What is worse, discussion of these issues often deteriorates into name-calling and accusations, because we lack a model for resolving them in a calm, objective and civil manner.

The on-line essays found here arise from the fact that our contemporary crises – what newscasters emphasize, what citizens worry about and what politicians try to fix – are not the real problems.  They are merely symptoms of an underlying problem.  The core problems can be traced to common behaviors of ordinary citizens:  what they say, what they do, decisions they make and how they react to news and advertising.

Behavior has consequences.  A good decision usually yields favorable outcomes.  Problematic behavior yields the opposite.  True of individuals, this also applies to the society as a whole.  Most of those issues and crises listed above can be traced to the cumulative effects of problematic behavioral patterns in five key categories:  Understanding the economic process, Discipline, Responsibility, Critical thinking and Perspective.

To look at the many different choices and actions taken all over America every day and classify them into these few dimensions takes some skill and practice, but doing so shows definite patterns.  Americans make poor personal choices about their health and finances, encouraging others to do the same by spreading unsubstantiated fears and bad medical advice on social media.  They waste time and money and compromise their stated values by succumbing to the lure of advertisers, the hype of pop culture and the scare tactics of the media and politicians.  They seem unaware of how financial decisions and programs can be traced through society to anticipate and predict common unintended consequences.  More and more they refuse to delay gratification and look to blame others for their failings.

By classifying behaviors into these five dimensions, it is possible to pinpoint and address core problems and to make a persuasive case that improvement in these dimensions will result in a stronger and healthier society.  Identifying and addressing only the behavior, and requiring everyone else to do so, puts an end to the bickering, accusations, name calling and insults that seem to dominate the airwaves.  It leads to a civil, more specific discussion of solutions.

The bad news is that examples abound – almost 400 posts in the last 4 years with some favorites listed below.  They appear every Monday and Friday to clearly show some of the failings that lead to nearly all our societal problems.

The good news is that we don’t have to wait for the government or any other outside resource to come riding to the rescue.  If the problems result from the accumulation of poor individual behaviors, then the answers lie in changing those behaviors.  Real American Solutions are in our hands.