William M. Briggs

Statistician to the Stars!

Podcast Radio Show – Episode #3: Call the Health Police!

[podcast]http://wmbriggs.com/audio/wmbriggs_com_07oct2009_0003.mp3[/podcast]

On today’s episode:

What is health? Herr Mencken, the Sage of Baltimore: “a degree of adaptation to the organism’s environment so nearly complete that there is no irritation.”

Health insurance is a gamble Insurers are assisted in their own demise when they automated. Nobody knew the costs of a visit, so when costs multiplied, nobody knew what was happening. Plus, more and more people started visiting the doctor more often and for smaller complaints.

Who’s afraid of the flu?
Rates of death in NYC in the late 1800s

This picture is from the New York Academy of Medicine, where I attended a conference recently (another, better view, from reader Sean). “The Conquest of Pestilence in New York City” showing rates of death per 1000. It is behind glass and while my photography skills are obviously near zero it is still clear enough to read the major bumps.

Cholera caused appalling death rates, but yellow fever ran a close second. What caused the surcease of these dread maladies? Sewers and clean water, bar none, the most effective public health measures of all time. In small print, it says “1910: chlorination of water”, and after that pasteurization of milk and clean milk stations.

The most important feature is the blip in 1918, the flu pandemic that is oft touted, but is a mere piker compared to brute cholera. The mortality rate of the flu was about 17 per 1000, or 1.7%. Near as I can discover, the current swine flu pandemic spawns a mortality rate no higher than 1 per 1000, and probably it’s one-third of this, or about 0.5%, which still feels high (the denominator in this ratio is underestimated to a larger extent than the numerator). Cholera at its peak was 50 per 1000, or 5%!. That, my friends, is a lot.

Don Walser homepage. Where to buy.

Moral obligation There is no escaping that arguments for or against “government”-run health care are moral. Do I have the moral obligation to pay for the health care of another for a malady I wouldn’t try curing in myself? What about self-inflicted injuries like alcoholism or drug addiction or obesity? What about everyday complaints like zits or headaches? Is this another so-called tragedy of the commons?

And what responsibilities come with these new “rights”? Can I then require my neighbor to stop smoking, stop eating what I don’t want him to, or think thoughts that are distressing to his mental health? Call the health police!

Link to Consumer Freedom.com, a site that’s taking on the NYC Health Department: 10 dumbest food cop ideas.

Mark Twain “There are people who strictly deprive themselves of each and every eatable, drinkable and smokable which has in any way acquired a shady reputation. They pay this price for health. And health is all they get for it. How strange it is. It is like paying out your whole fortune for a cow that has gone dry.”

It should be the quality of life that counts, not its quantity. And I should have a lot of say about what quality means, not a centralized half-wit bureaucrat.

Questions/Comments I’m away at a conference and probably won’t be able to answer most comments or questions until Monday, 12 October.

Right click to download

20 Comments

  1. Fair points all, Briggs. But should not

    “It should be the quality of life that counts, not its quantity. And I should have a lot of say about what quality means, not a centralized half-wit bureaucrat.”

    actually read

    “It should be the quality of life that counts, not its quantity. And I should have a lot of say about what quality means to me, not a centralized half-wit bureaucrat.”

    Generally I am not one to point out typos, as I am a horrid typist myself, but there seem to be quite a few here. This brings up an off-topic point…do typos really matter in these threads? They are, after all, a sort of written speech, and our speaking English is pretty poor compared to written English. People change the structure of spoken sentences in mid-sentence.

  2. A slightly easier to read version of this graph is available here:
    http://gothamist.com/images/2004_01_healthstat1.php

    Thank you for passing this one on. It will be very useful in some discussions I am about to have at work.

  3. Kevin,
    They don’t matter a jot to me. However if there’s code to be cracked then one needs to know that the text is exactly as intended. The text then becomes more like maths. We all know how typos aren’t tollerated in maths, they count as mistakes. That was the point that I was making, badly, on the previous post. Having reread my comment it sounded sharper than intended.

  4. I wonder if the push for complete government involvement in health issues and a 50% rate of free riders are related. When we were children, our parents took care of our health and bills and whatnot. Now the government is trying to. We seem to have a large popluation yearning for the Good Ole Days of Total Care. Growing up sucks.

    OTOH, there have always been those dour souls who are personally affronted by anyone not eating right or having a good time or otherwise just plain not toeing the line. It’s no coincidence that “being good” is equivalent to “doing penance”.

    Sack cloth could come to be the new fashion. Wearers of coats, ties and Panama hats should beware. Those things are rapidly going the way of after dinner cognac and cigars.

  5. The Mark Twain quote, and your related thought, “It should be the quality of life that counts, not its quantity.” are the weakest arguments I’ve seen on this site.

    Your use of the word “should” is the biggest red flag, of course. Where did the prescriptivist attitude come from? The list of ten items you read at the end of the podcast was, essentially, a list of prescriptivist foolishness: who are they to say what I should eat or drink? And yet you (and Mr. Twain) seem quite comfortable insisting that I am wrong to abstain from beer and cigarettes.

    But even if I agree that you or I can determine for everyone whether quality or quantity should be the priority, I think you have determined wrong. An item which provides temporary pleasure at the cost of lifespan provides a questionable benefit to quality of life. Lifespan reduction is rarely an immediate thing. Consider someone who eats unhealthy foods, and is obese as a result (someone like me, in fact). In return for tasty foods, I lose much more than some retirement years. I also suffer from shortness of breathe, sleep apnea, acid reflux, excessive sweating, increased clothes cost, poorer appearance, poorer social life (both unfortunate, but true: overweight people just aren’t as attractive), etc, etc. There’s a reason for why diet books are a huge industry, and it’s not because millions of people are worried about dying when they’re 70 instead of 80. It’s because being fat sucks.

    That’s the area where I have the greatest experience, but I’m sure similar results could be found with other indulgences such as smoking. Still, for some people the benefits will still outweigh the detriments. But the quality over quantity argument still doesn’t hold up. In the extra years that an abstainer lives, their quality of life will greatly exceed that of the indulger, since the indulger is dead. A slice of pizza may beat a salad, but a salad beats being dead any day of the week.

    There’s a reason that life expectancy is used as an indicator for quality of life. Look up the life expectancies of a few countries and ask yourself where you would rather live.

    This is not an idea limited to health. I don’t have any research to back this up, but consider pretty much any consumer product, whether a car, tv, microwave, whatever. (Maybe ask a few friends or relations) What constitutes a better value in a product? Extra features, or better reliability? Assuming the features are incremental improvements (as indulgences are to life), I think the answer will be the reliability every time.

    Prescriptivism is bad whether you prescribe abstinence or indulgence. I’m surprised to see it advanced as an argument on your site.

  6. Kevin,

    Look at the countries with the shortest life extancy and ask yourself what’s different. The general answer is: wealth. The average life expectancy has risen only because the diseases that tend to reduce it have been reduced as well. Ideas correlating various things to life expectancy aren’t nearly as modern as you think. Think about it. Twain died 100 years ago (at age 76). Kellogg is the guy famous for pushing the benefits of bran to the bowels. That, too, was 100 years ago. Believe it or not, the Romans had similar ideas. Still, it was mostly the rich who made it into their 80s.

    You should examine the demographics of consumers of diet books. Who do you think make up the largest group and why?

    Truth be told, it’s ill-moderation that is the problem. I agree with Twain. Total abstinence is just plain silly. No matter what you do, something’s gonna getchya. There’s little point in cowering in the face of it.

  7. Hi, I’m really enjoying your podcasts. They’ve filled a wit-free gap in my mid-week listening. Much obliged!

  8. Noblesse Oblige

    October 8, 2009 at 9:53 am

    The mortality rate for the 1918 flu was probably only 3 per 1,000, if you reckon it by the departure from the trend line. Whatever.

    DAV has it right. Government run healthcare will make us poorer as a nation, and when that loss of wealth is combined with the economic contraction that will result from the monstrous spending by our elected representatives, we will be less helathy as well.

    Our slide down the slippery slope speeds up.

  9. Simply signed on to leave a comment regarding the prototypic Twain. Then was hit with public school grammar lessons. Whew! You’ve a tough audience.

    What is it that drives those schooled in public schools to over elaborate their writing? Redundancy is the curse of authors and is exhibited in criticism above. Is the reflexive simply no longer taught?

    Finally, what is it about utility that isn’t understood? Can we define utility in macro terms? And if we do, what do we gain from the attempt?

    On your next trip to Budapest, I recommend the fried liver pate, a good cigar and a bottle of champagne. At least in civilized Europe one can find these treasures without the guilt, or the limits.

  10. N-O
    the mortality rate for 1918 flu in NYC at that time is somewhat masked by the overall high death rate in the city. The mortality rate of that virus is well documented.

    Regardless, the new flu is not expected (by scientists) to have a higher general pathology than last year’s seasonal flu, but total numbers of people infected should be higher due to lack of pre-existing immunity. This appears to hold true, since the total reported cases of flu this year are already at levels we didn’t see until mid-late December in 2007,2008.

    The 2006-2007 flu season resulted in peak of 6% of all hospitalizations resulting from influenza infection, because there was a mismatch in 2 out of 3 components in the vaccine. That or a little higher (maybe 10% max) is what you can expect this year since the vaccine is coming out later than normal, and because so many people are not going to take it because they are more ignorant and are more afraid of the vaccine than they are of the virus.

    You can be thankful things like Cholera are not global events, but rather local to cities with crappy water supplies. But still you are more likely to die of flu any year than you are from Cholera. 0.1% global death rate applies to you, the 5% local mortality from an event like Cholera doesn’t unless you live in the city where it happens.

  11. On uniform: I gave up that charade years ago. Patients treat you better, also, it stops laziness in that you can’t hide behind the uniform. If you’re not dealing with open wounds or body fluid, there’s no need. If the need arises, there’s always a plastic apron and gloves available.

    A nurse wears her uniform, uncovered, and gets on as I get off the train most days.
    In the good old Whitley contract, this was an offence for infection control and other litigious reasons we weren’t even allowed to wear our fetching navy cardigans on the ward either.

    On swine flu:
    I had it three weeks ago, It’s not that bad, but it took a while to go. Our government wants to be seen to avert a disaster and gain votes. All flu viruses are potentially fatal for the elderly, very young, imunocompromised or if there are other health problems that may be impacted.

    It’s concerning how our own government is dealing with this. Patients are not being tested for the virus, they are treating with tamiflu on spec over the phone. This means some will not receive antibiotics for a chest infection or pneumonia when they need it this winter. this delay could be dangerous. Two of the questions asked over the phone by the swine flu hotline are:
    “Are you conscious?”
    “Are you breathing?”
    I bet some of the patients in good faith answer no to one of those. How ridiculous. These people have been specially trained! Wonder how much the software cost the NHS. Talk about panic, it’s hardly the black death.

    Sorry to sound so cynical and cheesed off, it’s not funny at all. We spend a lot of time undoing the panic and anxiety thrust on people by politicians and media about issues of health and It gets to the point of exasperation. People don’t need any help finding things to fret over. Most people if you read out a list of symptoms will find they have some of them.

    There’s a family story that my Grandad once declared “yes! That’s it…that’s me… that’s what I’ve got!”
    “You’ve got distemper.” Said my Grandma. Symptoms included a dry nose!

    In college, I told one of my year,
    “Oh God, look at that! I think I’ve got motor neurone disease!”
    “You as well? Yep, I’ve had that too” said Dave an ordinarily sensible person. We both laughed about it but we’d both had the same fear.

    When the NHS started out, there were not the treatments available that there are today. They set up a system that is a bottomless pit for public money and a perpetual political pawn. Now I’m going to lie down in a darkened room.

    Kevin,
    Life is about having choices. I sympathise with people who struggle with their weight and I mean that sincerely, but they still have a choice. This is not to say that people don’t need input to help with affects of obesity but just as some moan about motorcyclists that drain resources when they know there’s a high chance they’ll end up in hospital due to some injury, or a sportsman, or a smoker or a druggy or all of the above, we all have a choice. Why, and it’s a good question should others pay for something that they don’t care about? But I care, and I don’t mean to sound mean. I just relate to the argument that the system (National Health) is inherently unfair. If one is prepared to accept this, then the system can be seen as morally justifiable: on grounds of compassion. However, I am a ‘healer idealist’ so the Myers-Briggs thing says, so don’t listen to me.

    And Briggs,
    For smokers there is a way you could lengthen your life expectancy. Talk about quality of life!

    http://www.youtube.com/watch?v=nbvfunrPfko&feature=related

  12. Oregon Guy,

    My doctor offers a lesson in reflexive with a little hammer to the knee and one of my lawyer friends got his irregular reflexive lessons from Latin class (sue I; sue you; sue us) or so it seems. It is my most fervent hope that reflexive arguments will not terminate in suicide.

  13. Joy, I got to thinking about your comments on the previous post, and began to wonder if Briggs is sending in code, or just rushed to be on his way. I don’t view these threads as more than speaking English. If I had to put a polish to my grammar, I’d soon stop posting. On the other hand, your comment about code has me concerned. If someone like me, who has a tendency toward typos and misspeaking is trying to send code, then the code better have redundancy. Then the occasional typo won’t matter.

  14. It would be the ultimate reflexif?
    .

  15. Oregano guy,
    ,Typos was the subject, did you read the story? The talk was about hidden codes, and the possibility that typos mark something therein. So indignation is Redundant.
    Many from public schools, however, will never be redundant.
    Redundancy in a mathematical argument, or hidden code is poetry in English, or may be deliberat poetic licence. Or just bad typing.

    To illustrate the point, literally,
    Did Monet intend to paint La Pie Effen De Neige with his cute shadow the wrong way round? I think he did, to emphasise or be humorous, others think he just made an error.
    “I am The Walrus” was written deliberately by John Lenin to confound his English teacher who had been using his lyrics in class and reading deeply into them. So he wrote that to give him something to think about.

    A bit of mischief to brighten the day, “that’s Briggs ‘ blog that is”

  16. There is plenty of evidence here that spelling or grammatical errors have nothing to do with the validity of an argument and the commenter’s intelligence and social skills. Some people can afford to spend an unhealthy amount of time on this site, but most of us have families and hold regular jobs. Decoration and perfection take time.

    BTW, whose blog is this anyway?

    Kevin Jackson,
    Indeed, quality and quantity of life could come hand in hand.

  17. Briggs

    October 12, 2009 at 10:48 am

    All,

    Sorry for being slow to respond. Been out and away. I’m back now, but I’m sure to miss somebody’s question, or, worse, answer it incompletely or inattentively. Please feel free to re-ask or email.

    Kevin,

    Hmmm.

    Bruce,

    That’s fantastic, thank much.

    Kevin!

    Surely you don’t think that I am prescribing smoking to anybody, are you? I merely say, that it should not be banned outdoors. I have another quote from Twain for you on this. I’ll dig it up when I’m near the book.

    The quality over quantity argument surely works for many. What did the pirates say? A short life but a merry one! The old French saying: Whoever does not die young will regret it sooner or later. Another Frenchman (Cioran): A man who survives spoils his biography.

    If your idea of a large time is eating small portions of lightly steamed bean sprouts washed down with ice water, then amen. But what did Rumpole say? “No pleasure on earth is worth forgoing for an extra five years in the Wayside nursing home” (or similar).

    Rafe,

    Thanks!

    OregonGuy,

    Man, does that sound good.

    John,

    Quite right. The sewers do a good job vaccinating us from cholera. The media does a fine job ensuring that we’re still scared of it (or, it would, if the newsreaders could be reminded of that disease).

    Not, by any means, am I suggesting that anybody not get vaccinated. I did.

  18. Health insurance does not exist. Health is a personal condition, not a commodity or service you can buy, so you can’t insure for it. You can buy medicine or medical care so you can insure for those.

  19. William,

    I’m working through your back catalogue as a result of links related to ClimateGate.

    One of the other posters beat me to the link to a clearer version of the chart at:

    http://gothamist.com/images/2004_01_healthstat1.php

    for the purposes of following the podcast.

    Although your photograph has a definite naive charm, would it be worth flagging this link right at the top of the article?

    I suggest this as, although the podcast is relatively elderly, recent events might see you getting renewed interest.

    Cheers

    Sean

  20. With respect to living forever at any cost, The Onion says it best (as usual):

    http://www.theonion.com/content/news_briefs/amazing_medical_discovery

    Particularly taken with the final paragraph.

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