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Science in the News The Town Voice The Complex Made Simple

Health Care Reform versus Math and Science

By Arlon Staywell RICHMOND — Mathematics, physics and chemistry are sciences, medicine is not. Of course medicine involves a great deal of math, physics and chemistry. There are some exceptional scientific facts in medicine. #1 People deprived of oxygen will quickly die. #2 People deprived of large quantities of blood will quickly die. (Blood is responsible for delivering, among other things, oxygen to the rest of the body.) #3 If certain areas of the brain are damaged (especially those in control of respiration or circulation) people will quickly die. #4 The heart (being largely responsible for the circulation of blood) if significantly damaged will lead to quick and certain death. #5 People deprived of all food or water will slowly but certainly die. There are several others. Some diseases can be caused by infection by microorganisms, some broken bones can be healed if not too shattered and if set properly. And there is the fact that life begins at conception, but more on that later.
It is remarkable how recent this science is. One of the more famous paintings of all time, An Experiment on a Bird in the Air Pump by Joseph Wright shows the reaction of various onlookers to the death of a bird in a glass chamber with controls over what gases might go in. It was painted in 1768. Of course the general apprehension of the importance of air or something in it to life had already been for centuries, but the scientific fact that oxygen is necesary for some forms of life took more time.
It might well be true that there is a significant number of established, truly scientific medical facts, but recent health care reform, these two and a half centuries later, has nothing at all to do with any science.
Do Seat Belts Cause Lung Cancer?
Because people who wear seat belts might be more careful generally and less likely to, for example, smoke, their data set might have less incidence of lung cancer deaths. Then it would seem statistically that seat belts prevent cancer.
Or rather because some of the people who do not wear seat belts die from car accidents instead of getting cancer their incidence of lung cancer deaths might be lower. Then it would seem statistically that seat belts cause cancer.
Or a study might by chance have a balance of those two and show the rate of lung cancer deaths is the same whether seat belts are worn or not, that there is no statistical link. And while seat belts might prevent deaths from car accidents they have no effect on lung cancer.
So in the third case we might have the correct answer, that there is no statistical link between seat belts and lung cancer, but we arrived at it by chance, not science. There is no rule or operating principle that requires any balance in the various influences one way or the other that seat belts really do have on lung cancer deaths. A common assumption of those who overvalue statistics is that if you just get enough samples, enough cases, those errors have to balance. They do not. They will likely not. However genuine and universal the intuition that seat belts have no effect on lung cancer, there is no way to prove it scientifically without a society so totalitarian as has never been conceived.

Consider reports that yearly mammograms reduce the risk of death in women aged 50 to 64 by 26 percent. That percentage is too low for any certainty at all that mammograms can reduce the risk of death at all. Why? Even with "randomized clinical trials," the best kind, there are severe limits on just how "randomized" or "clinical" they can be. Truly randomized trials are possible with cockroaches and mice, but nearly impossible with humans. And they can be quite difficult with chimpanzees. You can't just tell a human they've been randomly selected to receive free mammograms. The researchers do try, but necessarily, anyone getting the mammograms is going to be closer to health care in general than anyone not getting them. That doesn't necessarily mean they believe they work, only that they choose to err, if at all, on the side of caution. With that and many other factors too numerous to count a mere 26 percent apparent reduction in risk of death is not more than a statistical wash.

Science Overthrown
An often quoted line from President Obama's inaugural address is, "We will restore science to its rightful place, and wield technology's wonders to raise health care's quality and lower its cost." Is it a "wonder" that people need oxygen to live? Is it a "wonder" that unless profuse bleeding is stopped people die? However "wonderous" the science at one time was, it is much the province of the average fifth grader today. Of course it would be quite "wonderous" if cancer were completely understood, but it still is not. One hundred percent of birds put in glass chambers without oxygen quickly die, not one has ever lasted more than minutes, that's the science. Much work needs to be done on cancer. Some people with lumps have no cancer, some people without lumps get cancer, removing lumps, even early, doesn't always work. Some people who smoke heavily get no cancer, some people who do not smoke get lung cancer. Obviously there is much more to it than is humanly known. Rather than answers what we have is a belief system. It is the position of the current belief system in America that "medicinal" wonders can cure cancer, even while people die from cancer every day. Various anecdotal stories were found in the media during these debates by people who said they "knew" they were "cured" of cancer. They believed they knew something that with current science is not knowable. Rather than restore science to its rightful place Obama's health care reform overthrows it with the rampant belief system.
Various proponents of abortion have argued that the "medical" decision whether to have an abortion should be between a woman and her doctor. Obama's health care reform puts almost all medical decisions between a doctor and your tax collector. You will be left out of the decision process entirely. You will pay for what they believe you need whether you like it or not, whether you use it or not. Various state attorneys general are considering challenging the constitutionality of the recent reforms based on their "commerce" when it seems they could as easily challenge them as morally reprehensible.

And there is another incongruity on the left. Whence their newfound concern for human life? If they are prepared to dispatch the unborn on a whim why concern themselves with the lung cancer victim making her own choice?
And if God doesn't exist unless anyone can prove it, how do any of their "cures" exist?
Earlier Confusion in Florida
In March 2005 on talk radio the opinion was expressed that "state law says" the spouse makes the medical decisions by default and it is as simple as that in the Schiavo case. The gross error there is that a serious and legal difference exists between a medical decision and an obvious life and death decision. For example when doctors recommend a heart replacement no one is usually certain whether that is best, not even the doctors, who would inform the patient that there are serious risks in the surgery which might not succeed, might result in death. No one really knows for an absolute certain fact whether the surgery would be best. There is only the educated belief that it is likely better than not for that patient who would already be quite ill. In that case where the decision is a medical one, involving medical opinion only, then the spouse has the decision when the patient cannot communicate.
When a decision involves the obvious taking of human lives, for example dropping pianos on their heads, pushing them off steep, high cliffs or the like, that is not a "medical" decision. That would be murder. No one over the age of reason, doctor or not, believes any of those things will help in any medical way. The opinion of the doctor or the spouse is not involved.
A Glitch in Virginia Law
Another striking example of false science is the new (2009) law in Virginia banning smoking in restaurants without separate ventilation systems for non smokers. It hasn't been enforcced as some believe it should and there were recent threats to invoke the health inspector clause in the law. Is there scientific evidence that second hand smoke is a greater health risk than carbonated soft drinks or tapioca pudding? No, of course not, but the law makes it appear there is by asking health inspectors to enforce that law. An interesting question there is why they need to use health risk as a justification. Local Virginia communities have banned noise without regard to who might go deaf. At levels far above those regulated there might be health risks, but the regulation appears based on the simple fact that so many people just don't like noise.
Even Math Overthrown
Even more alarming is the failure of so many Americans to understand how insurance works. For simplicity consider insurance against one disease. Assume that the observed pattern over the years is that about one in every hundred people gets that disease every year. Assume that the cost of treating the disease is $500. In order to remain solvent the insurance company must charge $5 per year to cover that disease. Actually they need to charge slightly more to cover the operating expenses of the business.
A striking indicator that too many do not understand the principle occured years ago when they wanted insurance to cover mammograms and for the mammograms to be mandatory. Obviously if 100 percent of insured families or of insured female individuals needs mammograms the insurance company has to charge each insured the full cost of the mammogram. Then too, there is the operating expense of the business, so by making insurance cover mammograms and making them mandatory the cost goes up not down for each individual.
Another common mistake especially in the recent debates is the assumption that by insuring more people costs can go down. If the likelyhood of a person getting a disease is one in a hundred as above it doesn't matter if one thousand are insured or a hundred thousand, the likely cost to the insurance company is $5 per insured. If one thousand are insured and pay $5 there will be $5000. Ten will likely get the disease at a cost of $500 each or $5000. If a hundred thousand insured pay $5 each there will be $500,000. A thousand will likely get the disease at a cost of $500 each or $500,000.
Of course there is the common belief that "economies of scale" can drive costs down. So called "mass production" can lower costs significantly when more than a few items are produced. After that the returns diminish. Two thousand units usually cost about twice as much as one thousand units to produce. In other words the cost per unit is about the same, not lower. The savings from mass production disappear at higher and higher production levels. When production equipment wears out or requires extensive servicing the skill level required means it can cost less to replace the equipment, which puts you back at square one in terms of mass production.
The most bizarre example that too many do not understand how insurance works is the requirement to cover pre-existing conditions. Obviously if everyone could wait to get sick to buy insurance they would, everyone who bought it would need it, and it would cost each of them more than not getting the insurance company involved at all. Perhaps it is obvious that the Democrats are playing loose with the definition of "pre-existing condition." The real complaint seems to be with moving from one insurance provider to another. With life insurance this problem is not found so much because of "term" life insurance. A person can insure against dying within a certain term of years for far less than when no term is specified. The real solution to moving from one health insurance provider to another would be a similar arrangement of terms and costs at the outset.
Real Problems
Looking only at the gold medal counts at the Olympics a person would not immediately guess health care was the foremost problem in the United States. And indeed health care is not the immediate problem, compared with other countries in the world. Americans who think health care should be first on the legislative agenda are like Arabs who think their problem is just not enough oil. Or like Germans who think the BMW is too lame and needs to run longer and faster. Or like the French who think the Roquefort dressing and the Champagne need serious improvements.
So not only does recent health care reform present the wrong solutions, it's addressing the wrong problems.
One possible problem more in need of attention might be the financial crisis. Americans don't know how to save. If they knew how to save they would need far less health insurance. And they could pass those savings to heirs in many cases. Unfortunately we hear little about HSAs (Health Savings Accounts) in these debates.
As for opening more opportunities to the poor there is the "teaching" hospital. Such hospitals offer health care at little or no cost to people with the understanding that the person who provides the care might be doing so for the first time in his life. This helps people with extraordinarily unexpected problems and it helps the inexperienced medical personnel as well. And it usually involves more real science like stopping bleeding or setting bones.
And there seems to be a misapplication of the term "positive externalities." In economics when a transaction between parties A and B has effects on third parties as well they're called externalities. Depending on the effect being good or bad it is a "positive" or "negative" externality. A few health care transactions might well have positive externalities. If your neighbor gets a flu shot, indeed if a distant neighbor gets a flu shot, it might have benefits for you. However most health care, especially the kind in recent reforms, has no real positive externalities. Even the efficacy of recent flu vaccines is questionable. One thing that really might have enormous positive externalities is clean, inexpensive water, but where's the support for that? You have silly Democrats standing around with dollar bottles of water trying to force people to buy things they really don't need. It is most bizarre.
The Challenge Is On
Several states have challenged the reforms. Virginia however has the most serious of them all. Ken Cuccinelli's constitutionality challenge is moving forward now.
December 13, 2010
Judge Henry E. Hudson of a U.S. District Court ruled the individual mandate portion of new law unconstitutional. This is the first successfull challenge and perhaps owed to Virginia's AG Ken Cuccinelli. But the law is not "enjoined" (will still be law) yet and much more needs to be done.
January 31, 2011
A federal district judge in Florida, Judge Roger Vinson, ruled the law unconstitutional as well.
More than half the states have filed constitutional challenges, but their success is so far mixed.
May 10, 2011
The U.S. Circuit Court of Appeals for the Fourth circuit will hear the Cucinelli case and another from Virginia.

Some Important Debates

 April  21, 2011 — Legal Debate Abounds on Health Care Reform  — Here | Examiner.com
  June  14, 2011 —      Breakdown of the Atheist Dialectic     — Here | Examiner.com
October 27, 2011 — Obamacare and the Establishment of Religion — Here | Examiner.com

Further progress will be reported here when it occurs

June 28, 2012
The United States Supreme Court decided to allow the health insurance mandate and expand government control.
The estimate of the number of people who will die from cancer in 2012 is 577,190 or over 1,500 a day. Who pays for all the failed treatments? Now you will.

"Clinical" versus "Pre-clinical" trials The meaning of a "clinical" trial or study has been quite twisted lately and caution must be exercised. In science there are two general categories of studies, "clinical" and "field." The advantage of studying an organism in a clinic is that you can control all the variables. The advantage of studying an organism, such as a bird, in the field is that the organism is not disturbed or influenced by captivity.
The term "pre-clinical" has for many years meant "before symptoms occur."
Quite recently new usage is seen where "pre-clinical" means study on animals and "clinical" means study on humans. That has everything to do with advertising aesthetics and nothing to do with science. And yes there are still veterinary "clinics."

� MMX, MMXI, MMXII by Arlon Ryan Staywell

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