From: starr@genie.slhs.udel.edu (Tim Starr)
Subject: Re: health care industry woes
Organization: UDel, School of Life & Health Sciences
Date: Sun, 22 Nov 1992 08:17:09 GMT

In article <1992Nov21.141539.22360@netcom.com> rkaplan@netcom.com (Richard Kaplan) writes:
}>However, licenses are no guarantee against fraud.  It's possible to defraud
}>the agencies which grant the licenses, or to forge the licenses themselves.
}
}
}Don't cut off your head (eliminate licenses) for a headache (fraud).
}Your solution (delicensing) would create far more fraud.  You
}already mentioned above the better solution.... strengthen the 
}anti-fraud laws.

You're basically presuming medical practitioners fradulent until proven
otherwise.  Innocent until proven guilty?  Out the window and into the trash!
Does this mean that we may presume you guilty of theft until you prove that
you haven't stolen anything?  Of Murder until you prove you haven't even
killed anyone?

}>There isn't any such surety that prescribed drugs are safe and effective,
}>either.  AZT is fatal.  There are no long-term survivors of AIDS who are
}>on it.  Yet it's prescribed for AIDS patients, isn't it?  If it hadn't been
}>for bureaucratic delay, Thalidomide would have been marketed and damaged
}>babies despite this ostensible guarantee.
}
}AZT is not meant or promoted as curing AIDS..... In some patients,
}it prolongs the remaining length of one's life.  Just like
}many anti-cancer chemotherapy drugs.  

You claimed that a guarantee of safety and effectiveness justified your
position.  I pointed out that AZT is neither safe nor effective for all,
thus refuting the existence of your justification.  Sorry :-)!

}BTW, no drug (including over the counter medication) is completely
}safe or completely effective.  All drugs fail at some times and
}all drugs have risks.  This means we should manage the risks
}properly and with the proper knowledge.

Exactly the admission I wanted you to make.  Now the question is: "What's
the best way to manage risk and knowledge?"  I've cited some examples of
government failure, and can do more.  You now need to show how market failure
would be worse than the status quo.

}Your mention of Thalidomide shows PRECISELY why we should
}not allow universal self-medication. The "bureacractic" delay
}in the US when this medication was introduced came about 
}because of the concerns of an FDA scientist that the drug
}had not been proven safe enough.  England (which, like
}much of the world, has signficantly more liberal drug marketing
}laws) allowed the drug to be sold and we all know the
}tragic results.  This, to me, is an argument FOR government
}regulation of prescription drugs, not against it.  

Except that the FDA had no test that would have detected the problem of
thalidomide babies except to wait for it to be used and see.  How is this
better than a free market?

}>Furthermore, by what right are those who know what drug they need prohibited
}>from buying it the same way they buy cars - through mutual consent with
}>a seller to mutual benefit?  Why should any paternalistic authority have
}>to be consulted?
}
}
}How do you know which drug you need?  Often prescription drugs
}by themselves are not particularly dangerous but the danger
}comes in misdiagnosing yourself when you don't have access to
}the necessary knowledge and equipment.  Granted, the current
}system is not perfect and some prescription drugs could be made
}OTC (e.g. recent conversion of Monistat to OTC status).
}But the answer is absolutely not to blanketly make all drugs
}legal and OTC.

How do you know what car repair you need?  How do you know what food you
need?  How do you know what investment bonds you need?  You find out to
the best of your abilities, that's how.  You ask experts, friends, family,
acquaintances, etc.

This implicit presumption of ignorance is a tacit insult.  How do you know
what's wrong with the government?  How do you know which representative or
politician you need?  Shall we require literacy tests and prescriptions
for voting?

The assumption behind all this is that the people know nothing and that the
government knows best.  This is a simplistic prejudice.  There is a gradient
of how much people know.  Some people know a lot.  Others know a little.
But to presume incompetence is wrong, and to restrain the competent from
taking responsibility for managing the risks they face on the grounds that
some can't handle it is wrong, too.

}One problem with legalizing drugs is that many drugs will 
}alter one's thought process.  Therefore an objective (and
}qualified) person is necessary to evaluate the efficacy
}and appropriateness of the treatment.

I haven't argued against there being people competent to make this kind of
judgement, I've argued for ways to maximize their presence.

}Further, many patients who are ill cannot properly
}make decisions, though they may not recognize this
}themselves. So to allow a patient to self-diagnose and
}self-medicate in an impaired state is dangerous.  

It's their life, not yours or anyone else's.

}If you want, we can discuss SPECIFIC medications  which
}should be converted to OTC.... there are lots of them.  But
}certainly not ALL of them.

What, now we can't discuss repealing prescription laws?  Have you done away
with freedom of speech as well as the presumption of innocence and competence
as well :-)?

Tim Starr - Renaissance Now! - Think Universally, Act Selfishly
starr@genie.slhs.udel.edu

"True greatness consists in the use of a powerful understanding to enlighten
oneself and others." - Voltaire
Newsgroups: talk.politics.medicine