I am fairly ethically naive I must confess. I do not think this is an indictment against me so much as a strength of mine. Consider by way of an anecdote having an argument with someone. To my mind, an argument is an argument is an argument and it should be evaluated in light of its premises, necessary implications, internal coherence, logical consistency and, of course, any datum that bears on it. In this way, in broad terms, an argument can be either good (sound and valid), or bad (unsound or invalid, or both) or indeterminate (I'll leave this one alone for now). I see no benefit that enhances an argument by appending to it the label 'philosophical'. Are these arguments somehow unlike other arguments? Do they not fail or succeed on all of the criteria I've laid out?
If so, then certainly no argument is improved by calling it philosophical. Indeed, an argument is frustrated because it should immediately be called into question for not having to observe the ordinary conditions of what makes an argument. If an argument is improved by adding philosophical to it, then in addition to all of these criteria is added that isn't available to 'regular' arguments? I fail to see any benefit at all in adding that label - except, perhaps, in the ego of some minds as setting out some esoteric bar that lesser intellects should take notice not to dare apply tension. Of course, I don't find this a strength, but I am aware there are quarters in the world where obscurantism is a sign of enlightened thinking; I'm looking at you postmodernity.
Showing posts with label medical care. Show all posts
Showing posts with label medical care. Show all posts
Thursday, October 27, 2011
Sunday, August 28, 2011
Good Grief
I didn't want to clutter up Abbie's place with a discussion on something that's entirely off topic. To that end, here's the comment to which I'll be writing a response:
First, Woden, I understand that medical practitioners are trying to serve a lot of masters with perfect success all the time. I am unsympathetic to say just about the least of it. If the difficulty in providing medically indicated treatments because of having to perhaps justify them during a diversion audit is remotely inconvenient for physicians, they should perhaps choose a different line of work. We all have people to whom we report who ask/demand explanations from time to time on what we do. For what physicians make per year, I can't begin to care that some laws annoy them. Particularly since the medical/pharmaceutical lobbies are exceptionally strong. With respect to the central point I wish to take on, I'll direct your attention to this segment:
For the purposes of medical care, it is immaterial whether a person is a known opiate addict or not. Even if someone has a heroin addiction, say, the use of opiates are not contraindicated for medical intervention. This may well provide a physician a reason to more closely the monitor the rate at which a patient is going through a prescription, but it is not a sufficient reason to counsel against providing medically indicated treatment. It is, indeed, in my state malpractice. But that has nothing to do with leglislation.
Third, for a society that is supposedly free, there should be a compelling reason to proscribe any conduct. That some people will be harmed by abuse of an available commodity is no argument at all that said commodity requires any greater attention. It's entirely possible for people to die from antibiotics, and yet these are far easier to procure than a silly old opiate. For that matter, there's a more important reason to make antibiotics harder to get than they are already: eventually, they'll be almost entirely useless, and there seems to be a rather hard limit on the horizon to how many different ways we can make them. Opiates, therefore, aren't a threat to society-at-large.
Lastly, yes, people do bad things while on heroin, say. They do bad things to procure more of it. Were it freely available at the local store, the heroin addicts could get whatever fun they want, and a great deal of suffering could be reduced. All without requiring potentially thousands of dollars in medical bills for a person to decide that, you know, accidentally skewering their hand hurts bad enough they can medicate themselves. Or that a sprained ankle is sufficiently painful to warrant picking up some vicodin on the way back from the gym. Or a headache. Or a toothache. Or whatever. It's no one's business but that person's and his/her family and health provider what evil things s/he is doing to his/her body.
All of the stock arguments about people abusing drugs are wholly unconvincing. It is clearly not the case that having them available is detrimental to society, even though a few people here and there will die from them for lack of control. That's their decision, not the government's. I fail to see a single reason that demands these drugs specifically require so much tax money to be wasted investigating. What? Are we in such a state of affairs we have the money to burn to investigate if someone is having too much fun? If someone's broken finger is really broken enough?
What is, one wonders, this "good reason" of which you speak.
And then some links to websites showing the relative breakdown, I assume, of prescriptions written for which class of drugs. That's not relevant, so I skipped it.
The reason that so many doctors are hesitant to write for controlled-substance pain medications is that the DEA has been keeping a closer watch on them. The reason that the DEA is cracking down is because there's been a big increase in opiate addiction rates and hospitalizations from opiate overdoses. And a large part of that increase has been due to a few bad apples (that is, some of these "pain clinics" that have been popping up all over the place, where they just sell prescriptions for controlled substances to the patients without even seeing them, or otherwise prescribe without a genuine medical need or doctor-patient relationship).
It sucks, but there is a good reason for it. About the only thing that could be done for it would be to remove or reduce the restrictions on controlled substances, which (while it *may* lead to a reduction in abuse over the long term) would result in a large short-term spike of abuse, likely including quite a few people dieing from overdosing.
I will say, though, that even with the restrictions and the hesitancy of doctors to write for them, hydrocodone-containing pain relievers are almost certainly the top-selling medication in my area, and oxycodone-containing pain relievers aren't far behind them. Granted, that is almost certainly related in part to the reason why hydrocodone has been nick-named "hillbilly heroin" ... I'm in Appalachia, which has had quite an epidemic of opiate addiction.
However, even nationwide, codeine medications are the #2 selling therapeutic class when measured by prescriptions written, with hydrocodone/acetaminophen combinations being the most widely sold prescription product in the nation by a fair margin:
First, Woden, I understand that medical practitioners are trying to serve a lot of masters with perfect success all the time. I am unsympathetic to say just about the least of it. If the difficulty in providing medically indicated treatments because of having to perhaps justify them during a diversion audit is remotely inconvenient for physicians, they should perhaps choose a different line of work. We all have people to whom we report who ask/demand explanations from time to time on what we do. For what physicians make per year, I can't begin to care that some laws annoy them. Particularly since the medical/pharmaceutical lobbies are exceptionally strong. With respect to the central point I wish to take on, I'll direct your attention to this segment:
and
The reason that the DEA is cracking down is because there's been a big increase in opiate addiction rates and hospitalizations from opiate overdoses.
It sucks, but there is a good reason for it.Second, I understand the reasoning used to justify the legislation and why this is an issue. However, there isn't a good reason for it. In particular, addiction to substances has two distinct flavors: physical and psychological. Anyone who's on opiates for any considerable length of time becomes physically dependent on them. This is easily treated, and it has a 100% cure rate: ween the person off of the relevant medication over a period of time. Psychological addiction is dicier, but as pertinent here this is irrelevant.
For the purposes of medical care, it is immaterial whether a person is a known opiate addict or not. Even if someone has a heroin addiction, say, the use of opiates are not contraindicated for medical intervention. This may well provide a physician a reason to more closely the monitor the rate at which a patient is going through a prescription, but it is not a sufficient reason to counsel against providing medically indicated treatment. It is, indeed, in my state malpractice. But that has nothing to do with leglislation.
Third, for a society that is supposedly free, there should be a compelling reason to proscribe any conduct. That some people will be harmed by abuse of an available commodity is no argument at all that said commodity requires any greater attention. It's entirely possible for people to die from antibiotics, and yet these are far easier to procure than a silly old opiate. For that matter, there's a more important reason to make antibiotics harder to get than they are already: eventually, they'll be almost entirely useless, and there seems to be a rather hard limit on the horizon to how many different ways we can make them. Opiates, therefore, aren't a threat to society-at-large.
Lastly, yes, people do bad things while on heroin, say. They do bad things to procure more of it. Were it freely available at the local store, the heroin addicts could get whatever fun they want, and a great deal of suffering could be reduced. All without requiring potentially thousands of dollars in medical bills for a person to decide that, you know, accidentally skewering their hand hurts bad enough they can medicate themselves. Or that a sprained ankle is sufficiently painful to warrant picking up some vicodin on the way back from the gym. Or a headache. Or a toothache. Or whatever. It's no one's business but that person's and his/her family and health provider what evil things s/he is doing to his/her body.
All of the stock arguments about people abusing drugs are wholly unconvincing. It is clearly not the case that having them available is detrimental to society, even though a few people here and there will die from them for lack of control. That's their decision, not the government's. I fail to see a single reason that demands these drugs specifically require so much tax money to be wasted investigating. What? Are we in such a state of affairs we have the money to burn to investigate if someone is having too much fun? If someone's broken finger is really broken enough?
What is, one wonders, this "good reason" of which you speak.
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