“Settled Science” Fiasco Remembered

 

As a medical doctor I’m trained in scientific methods. I learned that science is always discovering new information that challenges or refutes our earlier understandings. So declaring anytime that the “science is settled” is just unscientific.

The latest example of such a fiasco is the fifty-year anniversary of the publication of Stanford biologist Paul Ehrlich’s book The Population Bomb. In 1968 Ehrlich was convinced the earth couldn’t sustain the growing population and he predicted a global cataclysm if something wasn’t done about it. (Does this sound familiar?)

William McGurn, columnist for The Wall Street Journal, says, “The book sketched out possible scenarios of the hell Mr. Ehrlich believed imminent: hundreds of millions dying from starvation, England disappearing by the year 2000, India doomed, the average American’s lifespan falling to 42 by 1980, and so on.” (The average American’s life span in 2017 was 78.6 years.)

Ehrlich certainly got a lot of people’s attention – he sold three million copies of his book. His false scientific assumptions became an unquestioned orthodoxy for the technocratic class that seems to welcome such cataclysmic scares as an opportunity to tell the rest of us what to do.

Robert McNamara, former Defense Secretary under Presidents Kennedy and Johnson, who was largely responsible for escalation of the Vietnam War, later went on to become President of The World Bank. McNamara would declare that overpopulation was a greater threat than nuclear war – because the decisions to have babies or not were “not in the exclusive control of a few governments but rather in the hands of literally hundreds of millions of individual parents.”

McGurn goes on to say, “In his day, Mr. Erhlich’s assertion about the limited “carrying capacity” of the Earth was settled science (emphasis mine). Never mind that it is rooted in an absurdity: that when a calf is born a country’s wealth rises, but when a baby is born it goes down. Or that the record shows that when targeted peoples resist the prescription – don’t have babies – things quickly turn coercive, from forced abortions in China to contraceptive injections given to black women in apartheid-era South Africa.”

This “settled science” was challenged by Julian Lincoln Simon, a professor of business and economics at the University of Illinois – at Urbana-Champaign. Simon wrote a counter-argument book called The Ultimate Resource. Simon recognized that human beings are more than just mouths to feed. They also come with minds.

Simon believed that human beings were able to adapt to their circumstances in a way that Ehrlich discounted. He believed that human ingenuity could turn what were once luxuries into everyday amenities. That’s why he called the human mind, “The Ultimate Resource.”

Fifty years has demonstrated that Simon won this argument with Ehrlich and the “settled science” is no longer settled. In 2011, David P. Goldman published a new book called How Civilizations Die. The opening words of his book paint an entirely different picture compared to that of Ehrlich’s book fifty years ago:

Population decline is the elephant in the world’s living room. As a matter of arithmetic, we know that the social life of most developed countries will break down within two generations. Two out of three Italians and three of four Japanese will be elderly dependents by 2050. If present fertility rates hold, the number of Germans will fall by 98 percent over the next two centuries. No pensions and health care system can support such an inverted population pyramid. Nor is the problem limited to the industrial nations. Fertility is falling at even faster rates – indeed, at rates never before registered anywhere – in the Muslim world. The world’s population will fall by as much as a fifth between the middle and the end of the twenty-first century, by far the worst decline in human history.”

 

The reason for this population decline is declining fertility rates, not starvation or overpopulation. Changes in the cultures of the world have led to fewer women having babies – as a matter of choice.

Mr. Ehrlich remains impervious to the false science he perpetrated on the world fifty years ago. McGurn says Ehrlich gave an interview to the Guardian just two months ago in which “he decreed the collapse of civilization a “near certainty” in the next few decades. Which may be a good reminder that skepticism is in order whenever someone waves the flag of “science” to justify the latest antihuman nostrum.”

Some people never learn.

Drug Ads Disservice to Patients and Doctors

 

They were once illegal and now they’re ubiquitous. I’m talking about pharmaceutical company advertisements on television.

If you watch television at all you know what I mean. It used to be that you went to your doctor to discuss medications that might benefit your health. Now you’re inundated with ads trying to lower your cholesterol, your blood sugar, and your “A1C” or raise your sexual performance. Worst yet, you’re told which cancer therapy drugs you should be taking if only you have the exact type of cancer they’re describing in terms you can’t understand!

As a doctor I can barely make sense of these ads so I wonder how the average consumer could possibly understand them. Then there’s the litany of side effects and complications they’re required to mention, so by the time they’re through you wonder why anyone would even consider taking them!

Who Benefits?

It’s hard to see how consumers benefit from this kind of advertising. They really can’t understand the medical language used to describe the condition nor the complex issues hastily covered in a few seconds. Yet many come to their doctors with unreasonable requests based on these misleading ads.

Dr. Melissa Young, writing for PhysicianPractice.com, says:

“I don’t like direct-to-consumer advertising of medications. It’s not the same as advertising for other things. There’s a difference between choosing which laundry detergent to buy and which drug is most appropriate.

On the one side, sometimes patients come in with vague requests. “You know that drug they keep advertising on TV? You know, the one that’s supposed to lower your a1c.” Um, you just described every diabetes medication.  Other times they are very specific, “Can I take drug W for my diabetes”. 

Sometimes the answer is yes, but most of the time the answer is no, because a) you don’t need it, b) you are already on something identical to it, c) you tried something like it before and had a reaction to it, d) you cannot be on it because you have kidney/liver/heart/etc. problems, or e) you said you can only take generic drugs due to cost (trust me, if it’s on TV, it’s expensive).  The bottom line is if I thought you should be on it, you’d be on it by now. 

Sometimes they are misled by the advertisement, or perhaps I should say, they misunderstand what is stated in the ad.  “I want to take the shot that’s just once a day.” You are already on a shot you take once a day, that’s your long-acting insulin.  “But I need to take the other shot before each meal.”  Yes, that’s your mealtime insulin, which you will still need to take even if you switch to the one in the ad.  “But the ad says you only need to take it once a day.” That is true, you only need to take it once a day; you still need your mealtime insulin.

Other times, since ads need to be “fair and balanced,” patients say, “I don’t want to take that drug, did you see the commercial? It says it can cause pain and bloating and infections and heart attacks and DEATH! Why would I take something that could cause death?”

Here are some other physician comments in response to her article:

“It was against the law when I started practicing; as was lawyer and doctor advertising! We should go back to the GOOD OLD DAYS!”

“I agree completely.”

Some disagree:

“It is a natural off-shoot of a for-profit medical system. Would we have many new medical treatments if the government ran it?”

Fortunately, in my practice of orthopedics I haven’t had many patients grill me on the drugs being advertised – because they aren’t in my specialty. But I’m sure internists, endocrinologists, cardiologists, and urologists must be inundated with the questions and requests. Perhaps oncologists must bear the largest burden of trying to explain why Drug X is not the cure for their cancer.

I’m all for informed patients who ask meaningful questions and I have a reputation for taking more time than most physicians to answer those questions. But I believe that these pharmaceutical ads, and internet medical web sites, actually undermine the trust between physicians and their patients.

Every patient needs to find a doctor they can trust for their medical decision-making – and then let that doctor guide those decisions. Drug ads aren’t helping that goal.

What’s Wrong With Taxpayers Financing HealthCare For Unauthorized Immigrants?

 

Last month I discussed how American taxpayers are paying $18.5 Billion to finance the healthcare of illegal (unauthorized) immigrants, according to the work of Duke University economist, Chris Conover. (How Taxpayers Finance Healthcare For Unauthorized Immigrants) Today, we’ll discuss Conover’s four reasons why this is a bad idea.

  • Federal tax financing is unconstitutional
  • Federal tax financing is unnecessary
  • Federal tax financing is immoral
  • Federal tax financing is inefficient

 

Federal Tax Financing is Unconstitutional

This is a simple argument. There just is nowhere in the Constitution that authorizes or requires Congress to appropriate funds for this purpose. Since all federal funding requires Congressional appropriation, any such funding is unconstitutional.

In fact, Medicaid and ObamaCare expressly forbid funding of healthcare for illegal immigrants – though it happens anyway. The prime example of this is in the State of California where the Health For Kids Act allows state Medicaid funds to be used for healthcare for unauthorized immigrant children.

Federal Tax Financing is Unnecessary

Since Federal taxpayers finance $11.2 Billion of the $18.5 Billion needed to cover healthcare for unauthorized immigrants, state and local governments would need to pick up this additional expense if federal dollars were excluded. Conover says this would only require a 0.2% increase in state and local taxes – a nominal additional amount.

Having state and local governments pick up the tab would be a good thing since it would incentivize them to be more efficient in the spending of these dollars. It would encourage innovative thinking to lower expenses and improve efficiency and quality of care.

Voters in each state could determine their willingness to provide such care and this would likely lead to redistribution of residents according to the election results. This is currently happening as a result of the new changes in the Trump Tax code. Voters have already shown wide variations in their willingness to pay for expanded Medicaid under ObamaCare.

Federal Tax Financing is Immoral

One way of financing healthcare for unauthorized immigrants might be charitable donations. But if such funding proved inadequate, would we consider it moral to seize the same money involuntarily from American taxpayers? We don’t consider it moral to force taxpayers to pay for abortions, so why should they pay for healthcare for illegal immigrants?

There is a prevailing attitude among some Americans that we are obligated to provide the same standard of living to the rest of the world that we enjoy here in America. Such people are welcoming the caravan of illegal immigrants storming our southern borders in California as I write these words.

But America cannot take on the troubles of the whole world lest we have the same troubles here in our own country. Conover says, “A claim that Americans have some sort of obligation to level up the entire world to the same standard of care as we are willing to provide to our poorest citizens, i.e., those on Medicaid, is fiscally untenable. Medicaid spending per enrollee was $5,736 four years ago. That’s only about 71% of overall U.S. health spending per capita. But more than 70 percent of the world’s population live in nations with health spending per capita below 10 percent of U.S. levels. Ten percent of U.S. levels in 2014 would be $800. Even if we assumed the U.S. spent twice what it needed to on Medicaid, closing the gap between America’s poor and the rest of the world in terms of healthcare would imply spending about $2,000 per person for 4.9 billion people. That would be 9.8 Trillion dollars – more than half the nation’s GDP in 2014.”

In other words, we literally can’t afford it! Taking on a debt you can’t afford to pay is immoral itself.

Federal Tax Financing is Inefficient

Some might argue that collecting taxes to pay for the $11.2 Billion in federal financing of unauthorized immigrant healthcare is more efficient than increasing charitable giving. But Conover points out the fallacy of this argument. He says that there is a 44 cents/dollar expense collecting federal taxes. If the federal government was considered a charity, in the parlance of CharityWatch, the federal government would be given an efficiency rating of D.

In other words, the federal government is very inefficient about the way they collect and spend your taxes. Surprise! There are many charitable organizations that could do the same job much more efficiently – and therefore more cheaply.

If we want to provide charitable donations to support a cause we believe in we can always do so without government intrusion. Support for the victims of hurricanes is a prime example. But federal taxpayers’ dollars shouldn’t be used to support programs or people who are breaking the laws of the same government.