Unintended Consequences

So many times we hear of laws or regulations having unintended consequences, and though unintended, in hindsight many of them seem totally predictable. I was reminded of this when I heard politicians in Washington suggest that the voting age be lowered to sixteen.

The whole argument as to whether sixteen-year-olds have the maturity and judgment to vote is a good debate for elsewhere. After all, the eighteen-year-olds who are allowed, even encouraged, to vote cannot legally buy alcohol. They may not buy lottery tickets in a few states. And here the USA Today advocates, “Raise the federal minimum legal age for tobacco, e-cigarette purchases to 21.” Furthermore, since 2009 “you must be 21 years of age to get a credit card in your own name, unless you have a cosigner or can show proof of steady income.” All these laws and proposals speak to the maturity and judgment of 18 year-olds.

Note: The voting age was lowered to 18 during the Vietnam War on the somewhat skewed reasoning that if you are old enough to go to war, you are old enough to vote – as if following orders and fighting in combat require the same skills as voting. But what of lowering it again to sixteen?

Implied with lowering the voting age is also lowering the age of majority, that is, when you are considered an adult. One of the problems comes back to that question of the draft. Along comes the USA Today again with a suggestion to “Include women in Selective Service registration.” Would that mean boys and girls must register when they reach their 16^th birthday? (Of course, they would not be considered boys and girls anymore, but men and women.)

Another issue is the protection sixteen- and seventeen-year-olds enjoy in courts and criminal proceedings. Debates sometimes break out over whether certain juvenile criminals should be tried as adults. Should they be eligible for the death penalty in states that allow it? Police don’t release names, and the press doesn't publish the names of minors involved in crimes. With such a new law it could be argued that they are adults and must forfeit all this special consideration.

Yet another issue would be activities and purchases other than alcohol and nicotine products where normally an adult must sign for the youth. This might include medical procedures and vaccinations, high school field trips, youth sports, legal contracts and a host of other transactions. How would all these parental permission issues be affected?

If some of these examples seem extreme, consider the college orientation briefing I attended with one of my sons years ago. While they were explaining how parents could afford all the fees and tuition to send their children to college, they added that to see how the students were doing the parent had to deal directly with them. Since they were adults, some privacy regulations prohibited the school from sharing report cards with parents (those same parents whom they assumed would be responsible for paying). Imagine having such privacy restraints applied to a report card for a junior in high school!

I’m sure there are other considerations that I have missed, but predicting, or at least anticipating, unintended consequences is a good exercise in critical thinking.

Real Medicine

There is no such thing as alternative medicine.  There is only medicine that works and medicine that doesn’t. (Paraphrased from Dr. Harriet Hall’s excellent lecture series on YouTube.)

 I’m reminded of this wisdom when I hear news like this from NBC. “Complementary therapies may sound good, but they don't cure cancer.” Last Thursday researchers published the results of a study showing that “cancer patients who choose alternative medicine over standard, proven cancer treatments are more likely to die.”

The practice of using herbs or meditation is fairly common among cancer patients and may make them feel better and more at ease; but it does nothing to cure the cancer. People who rely solely on complementary medicines are more likely to opt out of proven treatments and twice as likely to die from the cancer.

The study also found that those who relied on alternative cures tended to be younger women with more education and more money. This is an exception to data showing that the poor generally have worse outcomes. It is only natural to look for a gentler, less intrusive solution, but better-informed people should know that doctors and the FDA “have warned for years that unproven treatments may lure patients away from legitimate therapy that can save their lives.”

That last sentence is interesting in light of another recent piece of medical news. “The Center for Inquiry has filed a lawsuit in the District of Columbia on behalf of the general public against drug retailer CVS for consumer fraud over its sale and marketing of useless homeopathic medicines.” Their objection is that CVS sells homeopathic products side by side with scientifically proven medicines, leading customers to believe that the products are as effective as standard remedies for pain, insomnia, and cold/flu symptoms.

The Center for Inquiry (CFI) characterizes homeopathy as “a total sham” and explains their reasoning. Of course, they are a skeptical group, and this opinion would be expected. However, the experts come down on their side. “The FTC declared in 2016 that the marketing of homeopathic products for specific diseases and symptoms is only acceptable if consumers are told: ‘(1) there is no scientific evidence that the product works and (2) the product’s claims are based only on theories of homeopathy from the 1700s that are not accepted by most modern medical experts.’ And last year, the FDA announced a new...policy of regulatory action against homeopathic products.” (It's only the CAM lobby that deflects stronger action.)

 Isn’t this CVS that seems to endorse homeopathy as legitimate medicine the same CVS that made headlines a few years ago by refusing to sell tobacco products, because they cared so much about our health?

That’s right. And now they are trying to take credit for a 1% decrease in the number of packs of cigarettes sold in 13 key states where they do business. But critics of the CVS claim see it a little differently and don’t think CVS should get much credit for the improvement.

With such a small percentage of the market, most analysts don’t believe the CVS claim that smokers made the switch from cigarettes to “mostly ineffective nicotine patches and quit smoking. [It] only illustrates how little the company knows about the difficulty of quitting." With so many smokers trying to quit anyway, it’s hard to believe the CVS decision had much influence.

CVS counters that their studies show an impact on public health. Also, a spokeswoman adds that the company is trying to drive impulse buying away from the traditional junk food by “placing healthier foods – such as yogurt and fresh fruit – in key locations in the front of the store.” But they still place homeopathic products under signs that imply real curative power when CFI, the FTC and the FDA see a problem with that.

CVS and many others try to convince us that they are really interested in our health while they sell ineffective homeopathic products, dietary supplements and "alternative" medicines.  I wouldn’t trust them with my health decisions, but I’m a critical thinker.

Paying Attention

We start with a CNBC story about a new miracle product advertised to help people achieve optimal human performance – whatever that is.  A reader sent me an email with the subject line “If only people read your blog” along with the link to that story.

The headline reads:  “This start-up raised millions to sell 'brain hacking' pills, but its own study found coffee works better.”  So what do conscientious business people do when their own study shows that pills they are selling for $40 a bottle are “less effective in many ways than a cup of coffee”?  They try to “delay publication of the study and asked researchers to change the name of the product [studied] to distance it from the analysis.”

The company claims their “supplements such as chewable caffeine pills help the human system become ‘quantified, optimized, and upgraded’…and that they may unlock the ‘next-level thinking’ that will be key to humanity's evolution.”  Pay no attention to that pesky research comparing it unfavorably to coffee or to the general lack of scientific evidence backing their claims.  The news report concludes with information that one month after receiving the results of the study, they changed the company name and hired a scientist, as neither co-founder “has a scientific background.”

Of course these products are marketed as dietary supplements to sidestep FDA regulations.  They are therefore only subject to investigation after problems are reported.  Problems may include illness, injury or major physical side effects; the financial side effects of tossing away $40 for a bottle of chewable caffeine pills are left to the individual.  (For a more in-depth discussion of the problems with nutritional supplements in general, see my comments here, here and here.)

What is frightening is that they are selling millions of dollars of these products to people who should know better.  (But that’s a drop in the bucket compared to the revenue generated by the supplement industry as a whole.)  P. T. Barnum was right!

And speaking of people knowing better – after much legal foot-dragging, stalling and negotiating by the defendants, a Federal Judge has ordered tobacco companies who lied to the American public about the dangers of cigarette smoking to take corrective action.  They are forbidden to use any health descriptors including "the words ‘low tar,’ ‘light,’ ‘ultra light,’ ‘mild,’ ‘natural,’ and any other words which reasonably could be expected to result in a consumer believing that smoking the cigarette brand using that descriptor may result in a lower risk.”  In addition, they’ve been ordered to undertake a broad campaign, advertising the dangers of smoking including: website postings, labels on cigarette packages, and newspaper and television ads.

That’s all fine, but a few weeks ago I was out with my granddaughter on the day after my birthday.  She asked how old I was now.  When I told her, she said, “It’s a good thing you didn’t smoke or you would be dead already.”  So if a five-year-old can figure it out and express it that clearly, I think it’s more a matter of motivation than information for teens and adults.

A little critical thinking and paying attention goes a long way to making us healthier and wealthier.  Isn’t it worth a try?

Shame on Us!

As I pointed out a couple of weeks ago, critical thinking provides a balanced view of pride, how it can be effective as a motivator but makes no sense when applied to something you can’t control.  It’s healthy to be proud of accomplishments, but foolish and delusional to be proud of characteristics you were born with such as eye color, left-handedness, sexual orientation, height, race, or nationality.  As a left handed person, you can be proud of the accomplishments of other left handed people, but that seems like a waste of time since it has no bearing on your own accomplishments.  As we pick someone to model ourselves after, why do they have to have similar physical characteristics to us?  Wouldn’t it be wiser to model ourselves after good role models regardless of appearance?

On the other side of the coin is shame.  In today’s society, there is no place for shame, embarrassment or failure.  Kids are told they are special and unique, which is true, but they are told this to the point where it overrides the learning available from missteps and failures.  They are praised for everything they do.  They grow up to be disappointed when professors, employers and their social networks don’t pick up where their parents left off with praise and awards just for participating, regardless of results or effort.  Some parents are afraid or too involved in other activities to properly discipline their kids.  It makes a cute news story, recognized in Time magazine and other places, when a convicted drunk driver uses his creativity in a mug shot.

Here is an excerpt from Quiet:  The Power of Introverts, by Susan Cain.  “Consider the mechanism by which kids acquire their sense of right and wrong.  Many psychologists believe that children develop conscience when they do something inappropriate and are rebuked by their caregivers.  Disapproval makes them feel anxious; and since anxiety is unpleasant, they learn to steer clear of antisocial behavior.  This is known as internalizing their parents’ standards of conduct, and its core is anxiety.  But what if some kids are less prone to anxiety than others?  … Often the best way to teach these children values is to give them positive role models.”

Now look at how society functions as we are overwhelmed with messages about self-esteem, compassion, humanitarianism, respect, avoiding offending anyone and the plight of victims.  Whenever some one or some group is perceived as being disadvantaged, instead of asking what behavior led to those consequences and what lessons they need to learn to avoid them in the future, we choose to rescue them, negating the opportunity for learning and enticing others to follow the same path.

Except for smokers, who for some reason have been singled out for a kind of public shunning, we hop on board when others look for an excuse.  We try to blame our problems on the big institutions that talked us into the bad behavior instead of admitting that the final decision was ours.  We blame fast food, big banks, Wall Street, the rich one-percent, drug companies, insurance companies, religious extremists, and more – yes, even big tobacco, because the smokers shouldn’t really be blamed – just isolated.  Then we look to Congress and the President expecting that they will punish the evildoers and bail us, but in reality, the government can’t fix the problems because they can’t legislate good decision-making.  They don’t tell us it’s our fault, because first, they don’t get it, second, they get the same good feelings by playing the rescuer, and third, they fear offending the voters.

Like the drug abuse problem in America, we concentrate on the supply side, pursuing and convicting the pushers while supporting the users with free needles and police trained to treat overdoses.  American society shames the wrong behavior.  We instead shame and condemn the constructive feedback or even gentle criticism aimed at people who deserve that criticism for poor judgment and erroneous behavior.  To do so is labeled offensive, uncompassionate, mean-spirited, disrespectful, uncaring – but it is very much needed!  This censure of disapproval and “caring” support of bad behavior leads inevitably to more of the same.

Rewarding People for Playing Dumb

On January 11^th of this year the Surgeon General’s Office celebrated the 50^th anniversary of the initial report linking cigarette smoking to lung cancer.  Since then they have issued 32 tobacco-related reports and warnings emphasizing the dangers of smoking and tobacco use in general.  Joining them has been virtually every medical professional and fitness program.  No one advocates smoking; everyone encourages not smoking; most insurance companies, health and life, charge a penalty to tobacco users, reflecting their exposure to increased risk of sickness and death.  You would have to be living under a rock to have missed the message – or not!

The news this month includes a story about young adults who are misinformed about the dangers posed by tobacco and hookahs.  As cigarette use continues to decline, hookah smoking is on the rise.  “Hookah smoking can be just as dangerous as cigarettes, according to the U.S. Centers for Disease Control and Prevention. However, [a new UCLA] study found that many young adults believe the water pipes are a safe alternative to cigarettes.”  More than half believed that the water or the fruit flavor filtered out the bad chemicals or that they used a different kind of tobacco. 

Computer- and Internet-savvy young adults need only take a quick trip to the CDC website to get accurate information.  “Using a hookah to smoke tobacco poses serious health risks to smokers and others exposed to the smoke from the hookah.”  Beneath this headline are more than a dozen bullet points specifying the dangers.  Is this a case of sheer laziness?  More likely it’s related to the societal habit of accepting evidence from family, friends, social media or the press when it reinforces a desirable belief and disregarding even expert advice when it challenges those beliefs .  Like resistant teens, they don’t want to hear it and turn it off.  Unfortunately society not only practices and endorses this behavior; we actively reward it.

Consider the case, also this month, of a Florida jury awarding punitive damages of over $23 billion “to the estate of Michael Johnson Sr., who died in 1996 from lung cancer after years of chain smoking [cigarettes].”  The attorneys for the family contend that this will stop Big Tobacco from lying to consumers, or at least make them think twice before they continue to lie.  They must be on guard knowing that some juries will believe any fairytale as long as it give them a chance to favor the little guy against the big, evil advertisers.

How can anyone pretend to be so stupid or uninformed as to not know that smoking, especially chain smoking is bad for you?  Cigarettes and other tobacco use causes cancer.   Remember, we have known this for over 50 years.  That smoking was not a particularly healthy choice was known for many years before that.  How can juries be convinced that people who smoke are not consciously putting themselves at risk?  It would be laughable if it were not so scary.  It’s fortunate that some big advertiser is not telling people that jumping off cliffs is perfectly safe.  We might find ourselves reading about people lying dead at the bottom of cliffs with their relatives suing (and winning) exorbitant amounts to stop the lying.  If you want to talk about victim mentality, a shortfall in responsibility, this is a good place to start.

With this mindset in our society, why should we expect those young adults who socialize in the hookah bars to make better decisions?  It is apparently not their job to investigate their assumption about the safety of this different delivery method for their tobacco.  It must be up to the Surgeon General, the CDC or the hookah bars themselves to warn them over and over, and when they choose to ignore the warnings and continue the destructive behavior, they or their survivors get to blame and even sue someone else.