From: starr@genie.slhs.udel.edu (Tim Starr)
Subject: Re: Repealing medical licensure laws
Organization: UDel, School of Life & Health Sciences
Distribution: usa
Date: Sun, 22 Nov 1992 07:58:51 GMT

In article <1992Nov21.193425.9501@netcom.com> rkaplan@netcom.com (Richard Kaplan) writes:
}In article <1992Nov21.123250.29506@genie.slhs.udel.edu>
} starr@genie.slhs.udel.edu (Tim Starr) writes:
}
}>This is also true for bonds.  Yet we have the private sector providing the
}>service of bond ratings through agencies which supply the demand for this
}>information.  This could also be done for rating doctors.
}
}Yes, but who regulates the bond rating agencies?  No one does.

Precisely my point.  It's unnecessary.

}You can figure
}out which one is good over the long run by seeing which
}one recommends the best bonds, i.e. which one would have
}made you the most money.  But evaluating a doctor-rating
}agency is very different; there is no clear-cut bottom
}line which shows which agency is better (or even
}competent) at rating doctors.

Good point, but there must be some way this can be done.  Competition would
certainly provide the incentive for standards of evaluation to be discovered
if truly none exist.  How are licensing agencies evaluated?  I can't see
a private medical ratings agency letting a competitor go by giving a quack
an A rating without trying to woo away its customers, can you?

}Furthermore, while you have lots of time to evaluate bonds
}and bond rating agencies before you buy one, such is
}not the case for medical emergencies.

There are financial emergencies, too.  Decisions about what was to be done
about the 1987 crash, the crash of 1929, etc., are both analogous.  How
would a coercive monopoly of investment bond rating agencies be an improvement
for dealing with financial emergencies?

}If you are in a motor
}vehicle accident and are brought to an emergency room
}unconscious, you deserve to know that the doctor treating
}you is competent; your free market system does not address this.   

I do deserve this?  It's not clear to me why.  We've had claims that we deserve
all sorts of things used to justify tyranny this century, so it's important
not to take them for granted.

Who has the obligation to inform me of this?  Suppose the doctor says: "I
just started this, and you're my first patient ever," and I say "Well, since
I don't want to risk trying to get another.  Go ahead and good luck!"  Then
it turns out that he got his degree and passed the tests fraudulently by
bribery, as many Soviet doctors did, or that he still wasn't able to treat
my condition.

}Rating doctors is not like rating stocks or bonds.  You
}can't just publish how many lives a doctor saves or how
}many of his patients die during surgery because often
}the best doctors at the best hopsitals treat the sickest,
}highest risk patients.  

Why can't this be taken into account?

}As I mentioned above, (1) we have no way of knowing the quality
}of the private rating agency;

What way do we have of knowing the quality of public agencies?

(2) in an emergency situation
}there is no time to check a rating agency.

Wouldn't that depend on the particular emergency situation?  How can any
government system do any better at guaranteeing the quality of doctors for
emergency care?

If you wish to 
}argue that our current medical licensing authorities are
}not regulating doctors sufficiently, that's another 
}issue I will be glad to discuss in a separate thread.  But
}we clearly must have a publicly accepted method for
}determining a physician's competency; complete free
}market economics do not apply to seriously ill or unconscious
}patients.
    
I won't contest your claim for abnormal patients for now.  But how does this
lead to the conclusion that all patients must get the same form of medical
regulation as them?  What about those who might want to patronize unlicensed
doctors without their being barred from entering into competition with
licensed ones?  Why shouldn't they be permitted to opt out of licensure?

}>}3.  If we repeal medical licensing laws, who will regulate
}>}narcotics and other controlled substances?  Or should
}>}all medications be legal for over the counter sale?
}>
}>The latter.
}
}See my posting earlier today.  Very few, if any, non-physicians
}can properly diagnose their illnesses and thus most people
}do not know what medications to take.  Many illnesses and
}medications will impair one's thought process and thus
}will require an impartial person to assess the drug's
}effect.  

Very few non-mechanics can properly diagnose what's wrong with their cars,
but we don't have prescription laws for auto parts and tools.  Use of these
can impair the safety of a car.

But my mother's a medical technologist, and has picked up some knowledge of
medications in her decades of experience.  Why should she or anyone who does
know what's wrong with them be deprived of their right to self-medication?
Why should they have to get anyone's permission to put whatever they want
into their bodies?  Why should they have to pay a doctor a cent for this
"privilege"?

Besides, much of the reason why many are ignorant of medication is because
of the fact that they aren't permitted to act on it by getting the medication
they need on their own judgement.  The value of this knowledge to many will
increase if prescription laws are abolished.

I simply don't buy the argument that prescription laws are justified because
impartiality is necessary to evaluate the effect of drugs.  If you weren't
licensed to prescribe drugs and you took some codeine to anesthetize yourself
against some pain you were experiencing, why should you be punished?  Why
should the law PRESUME that non-doctors are incompetent or not impartial
enough to decide these things for themselves?  This is highly elitist.

}>This goes on now, only on the black market.  Laetril ring a bell?  How does
}>relegating this to the black market improve things over having such phonies
}>operating where they'd be subject to fraud liability and the rating of
}>health services consumers' agencies?
}
}Yes, Laetril is a perfect example of what would happen if we
}deregulated medicine.  How does relegating this to the black
}market improve things?  Because if this were legal then 
}many more people would consider this to be a valid treatment and
}thus would either waste their money or defer more valid treatment.

Perhaps you don't understand the economics of prohibiting chemical substances
like alcohol, opiates, etc.  By relegating them to the black market, it tends
to do three things to the products: raise their price and their potency, and
decrease their quality.  The magnitude of these effects can be quite big.
Powdered cocaine costs about $15,000/kilo on the black market, yet about
$7/oz by prescription.  And black market marijuana is now about 6 times
more potent than it was prior to its prohibition.

Prescription laws are an intermediate step between a free market and a
black one.  If you want to minimize the incentive for marketing Laetril
or any other drug, you want to keep its price low - which happens on free
markets, not black.  If you want to make sure that consumers won't be hurt
by bad quality drugs or ones with potencies that are too high, then you
can't get these things on the black market, either, but only on the free
market.  See the book "The Economics of Prohibition" by Mark Thornton for
more information about this.

}I am NOT saying that MDs know all the answers and that homeopathy
}and other non-traditional techniques do not have something to
}offer.  But those who wish to introduce newer techniques must
}back them up with some data to show their efficacy and all
}medical treatment should be subject to licensure of some sort. 

Why must they show their efficacy to a coercive monopoly and not to a free,
competitive market of agencies?  We have something like this now: global
competition between coercive monopolies.  Piracetam is approved by the
equivalent of the FDA in other countries; why shouldn't we be able to buy
it here?

}>Competency isn't the issue I raised, competition is.  MDs are a legally
}>privileged labor cartel or oligopoly because of licensure.  This raises
}>prices, decreases quality, and stratifies practices against demand-driven
}>changes.
}
}
}Raise Prices?  Unfortunately yes, I agree
}
}Stratify against demand-driven changes?  In the short run, yes.
}In the long run, no.  This is the way it must be.  Medicine
}cannot react to fads as the music and fashion industries do;
}too many times this was attempted in medicine with tragic
}consequences, e.g. thalidomide.  

Except that it now turns out that thalidomide has been approved in other
Countries besides the USA for some uses.  Why hasn't the FDA done this too?
Because it's a monoculture that's unaccountable to those who might need it
to treat what ails them.

Marijuana has medicinal benefits, yet it's effectively prohibited even for
medical use.  Why?  Same reasons.  The FDA has banned companies from even
telling consumers that taking some aspirin daily will reduce their risk of
heart attack by about half.  They've restricted the importation of "smart"
drugs and nutrients, prohibited their commercial sale and advertisement,
and broken down the doors of a clinic in Tahoma, Washington, with guns
and bullet-proof vests because they were field-testing a new bureaucratic
tool to use.

The ban on the aspirin information alone is probably accounting for the
death of 100,000 Americans per year.

}Decrease quality?  Absolutely not.  We are dealing with people's
}lives here, not the latest in automobiles or food.  A 
}conservative approach is in order to be sure we do not 
}harm people with fads.

This conservative approach is leading to untold thousands of deaths.  It's
precisely because human life is so important that we must let people take
responsibility for their own without prescription laws.

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