The War on Pain Medication

Warning for those of sensitive sensibility.  There will be foul language.

So, the junior Senator from New York, Kristine Gillibrand had this to say (and let me just cheer Dr. Gorski’s response):

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“Nobody needs a month’s supply for a wisdom tooth extraction.”

Thank you, Dr. Gillibrand.  May I ask where you studied medicine?  Where you served your internship and residency?  Or is it from a position of dentistry where you make this ex cathedra pronouncement?  Please, tell me by what authority you make pronouncements on appropriate care for pain management?

Oh, wait a minute.  According to your Wikipedia page, you studied law, not medicine.  Nowhere in there is a medical or dental school even mentioned.  You’re not even a medical school dropout.  You’re a “never were.” And yet, you speak with such confidence on a medical (or dental in this case) matter.

Nobody needs a month’s supply for a wisdom tooth extraction?  Well, maybe, provided there are no complications.  Are you familiar with all the possible complications that might occur in the aftermath of oral surgery such as extracting impacted wisdom teeth?  I’m not.  And I seriously doubt you are either.  And extracting wisdom teeth is not the only, and certainly not the worst, pain issue that patients and their doctors might have to deal with.  But you still feel justified in mocking them with your flippant little comment?

There are other things than wisdom teeth that require serious pain management you addlepated twatwaffle. (Readers:  I did warn you).  What in the coldest reaches of Niflehel makes you think you know what’s best for those patients, you disgusting collection of rotting entrails?  How about letting the fucking doctors and their fucking patients make the fucking decisions, you vomitous mass of diseased filth?

I wouldn’t accept “just take a couple aspirin” from that vile scumsack that was the former US Attorney General, and I won’t accept it from you, you putrescent meatsuit.  Pain, hurts, in case you in your sheltered little life have never encountered it.  Chronic pain in particular can drive people to despair such that it kills. I’d say “get that through your head” except I’m pretty sure that your head is totally impervious to anything resembling facts or logic.

If we simply leave it up to the doctors and their patients will people use opioids when they should not leading to overdoses and death?  Yes.  However, your policy taking the decision out of doctors who have their patients’ interest at heart, and putting it in the hands of people who’ve never seen the inside of a medical school–people like you, you cowbrained lickspittle–will cause far more pain and suffering, far more death than addiction to and accidental overdoses of prescription medicines ever can.  If prescription drug abuse were a cold, you’d be the fucking plague–pneumonic form (have someone look that up for you and explain it in small words, you tinheaded snotrag).

You are a greater evil than all the prescription drug abuse from Hippocrates to the present day combined.

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Haul from the Indy 1500 Gun and Knife Show

I was helping a friend run his booth at the show today.  Among other things, it got me comped admission and parking. (Plus the fact that I got to hang with my friend and talk about cool stuff.)

And, well, my daughter and I did some shopping.

One of the things my daughter wanted was a revolver.  After some looking around she selected this one, a single-action six shot revolver in .22 LR.

SA 22 Revolver

While we were doing the paperwork on that one, I said to the vendor. “I’ve been looking for a High Power, would you by any chance have one?”

As luck would have it, he did.  A Hungarian made, surplus High Power, with three magazines:

High Power

Next thing my daughter wanted was another rifle (I think I’ve created a monster) to add to the AR pattern rifle and the Remington Model 12 she has.  We found this one, a bolt action “Glenfield Model 25” (made by Marlin).

Glenfield

And it’s a gun and knife show and we did not go empty handed when it came to blades.

First, we picked up a katana we had on layaway with my friend the vendor:

Katana 1.jpg

The blade had been “stained” in a way that really brings out the layers of the pattern-welded carbon steel:

Katana 2.jpg

In addition, my daughter picked up a replica of a Chinese sword from the warring states period:

And, finally, after first looking at a cute little folder, my daughter once again fell in love with this fixed blade knife:

knife.jpg

She particularly liked the “rough finish” of the blade.

You’ll notice there was a lot of “my daughter this” and “my daughter that” here.  The only thing there chosen what I specifically wanted was the High Power.  But you know what?  I’m happy with that.

Incentives

Whenever someone rolls out a new program, they always talk about the intentions, the goals, of the program.  This new program will make our streets safer.  That new program will reduce the cost of healthcare.  This other program will improve education.  Another will make college more affordable.  Reduce poverty.  Improve the economy.  And so on and so on and so on.

However, as the late economist Milton Friedman was wont to say, “One of the great mistakes is to judge policies and programs by their intentions rather than their results.”

Now, all too often, by the time we know what the results are, it’s far too late.  Thomas Sowell, however, gave us a key to helping predict what the actual results (as opposed to the intended results) a policy is likely to have.  That is, to look for the incentives that it creates.  What behaviors lead decision makers to benefit under a particular program vs. what behaviors lead to disadvantage.

I discussed a particular example of that before:  public education.  For a very long time now, the surest way for those involved in education to get more power, more funding, and more authority, was to produce excuses for failing to teach basic skills to our young people.  They were rewarded not for producing well educated, knowledgeable young adults.  They were rewarded for producing excuses for failure:  “We need more computers.” “We need bigger buildings with smaller classrooms.” We need to hire more teachers (and a lot more administrators).” “We need education to be a cabinet level post.” And on and on.  And we get what we pay for.  We get what we reward.  Given the incentives, the wonder, indeed, is that we produce children as well educated as we do.

It’s not rocket science.

In the private sector, this is something of a self-correcting situation.  In the ultimate extreme the incentive is to provide goods or services that people will part with some of their own resources (usually represented by money) in exchange.  If enough people are willing to part with enough of their own resources  for your product instead of for any of the other products they could purchase with those resources, your business prospers.  If they do not, you either have to find some way to make your product more appealing–either improving your product, offering it at lower cost, or some combination of the two–to more people or you’ll have to do something else.  If you attempt to press on without making those changes, bankruptcy awaits, forcing you to do something else.

Government, however, lacks such an automatic self-correction mechanism.  If a government program fails to accomplish its stated intentions, consider what usually happens.  How often has some government program failed and those in authority said “this isn’t working”, cancelled the program and tried something else?  You might find a few cases if you look hard enough but mostly, the response is “Oh, they just didn’t have enough money/resources/authority/power to do the job.” And, once again, we reward not success but excuses for failure.

Indeed, there is one perverse incentive that’s endemic to government programs of all types, and that is that by their very nature they reward those who seek power over others because that’s what government is–the license to forcibly exert power over others.  All government programs, by definition, involve force.  There’s no need to please the “consumer”.  Even elected officials don’t really need to please the consumer, to produce results in line with their stated intentions.  Entirely too many people are willing to vote based on the stated intentions and except endless excuses (there’s always someone at whom the politician can point the finger of blame).  Often times, the politician who implements a policy is long gone by the time the results roll around and it’s the new crop, who might even be trying to fix the problem, who then shoulder the blame. (City council imposes higher taxes on local industry in order to finance some “civic improvements.” A lot of businesses have rather immobile assets and can’t just pull up and leave but over time in the normal ebb and flow of business, fewer new businesses open to replace those that close.  Eventually, the drop in business starts pinching.  But by that time it’s a whole new city council who had nothing to do with the tax hike who are called on to “do something” about the struggling city.)

This kind of political “kick the can” is entirely rational for those engaging in it.  The immediate behavior is rewarded.  The longer term consequences are left for someone else.  It’s an inherent incentive of the political system and may well be insolvable.  There may well be no way to eliminate this kind of drain in any government structure.  Putting in new government programs to attempt to deal with it simply moves the perverse incentives to different locations.

Thus, we may have to accept that government, any government, is going to have perverse incentives that produce results far short of what we might wish.  Since it cannot be removed, the question is how to keep it as small as possible.  And, when stated that way, the answer also becomes clear.

The way to keep the perverse incentives endemic to government as small and innocuous as possible, is to keep government itself as small and endemic as possible.  National defense.  Minimal police and courts.  And, really, not that much else.  Only there do the benefits possibly counterbalance the very large millstone around ones neck that government has always proven, must always prove, to be.

Benefitting from Prosperity. (Originally “The Poor get Poorer”): A Blast from the Past

So Freshman Congresswoman has apparently claimed that the majority of people in the US don’t benefit in our national prosperity.

What, is she smoking?  Seriously.  The stupidity of that statement stands out among a litany of stupid statements.

As it happens, I answered that ridiculous claim January a year ago when someone else was making equally ridiculous claims:


People of a certain political persuasion say that the rich get richer while the poor get poorer.  Let’s take a look at that.

Imagine if you could go back 100 years.  You’d have to live life 100 years ago but you would have the wealth of the richest American of the day.  As it happened, Forbes created its first “Rich List” in 1918, 100 years ago, and listed John D. Rockefeller as far and away the richest American with a net worth of $1.2 billion then (roughly equivalent to $21 billion today).  Number two on the list was Henry Frick at $221 million.

So, Rockefeller’s $1.2 billion but in 1918 instead of today.  Would this be a trade you would make?

For the vast majority of us you’d be a fool to take that deal.

Consider:  I’m diabetic not insulin dependent (thankfully) but still diabetic as are a lot of Americans.  Insulin to treat diabetes was not invented yet.  So diabetes meant an agonizing death.

I have cholesterol issues–diet doesn’t touch it.  Believe me, I’ve tried.  If not treated, that’s a quick route to high blood pressure, heart attack, stroke, and an early death.  Medication to control cholesterol was still decades away.

Well, if we can’t control cholesterol perhaps we could control the high blood pressure resulting from the failure?  Nope.  Sorry.  It was an “essential malady” and not a treatable condiction.

Now, maybe you’re one of the lucky ones and diet and exercise can prevent these issues, or push them back as far as they can be for me with modern medicine, but are you really willing to gamble your life on that?

Wealth doesn’t do you a lot of good if you are left immobile from a stroke, or dead from a heart attack.

But, hey, with the wealth of Rockefeller  you could spend money on fancy, and fast, cars, right?

The Indy 500 was not held in 1918 (or in 1917 for that matter) because of World War I.  But if we peek ahead at 1919 we can get a look at what some of the fastest cars in the world could do and…

The winning car averaged just a hair over 88 miles per hour.  The cheapest beater I have ever owned (and I’ve owned some dogs) would have blown that car away, and do so with more comfort, more luxury than the fanciest Touring Car (air conditioning!).

And speaking of automobiles and medicine, a modern ambulance had more ability to keep you alive–saving only actual surgery–than even the hospitals of 1918.  And the only thing the ambulance would actually need to compete with those hospitals on surgery would be a surgeon and anesthesiologist–both of whom would be far, far more capable than the surgeons and anesthesiologists of 1918.

But…you could travel to exotic places with Rockefeller’s wealth in 1918.  Well, I’ll give you that one if you don’t mind taking forever.  You couldn’t hop in your car for a road trip down to Disney World (leaving aside that Disney World didn’t exist).  The modern network of highways with fuel stations every few miles did not yet exist.  Okay, there were a few airlines in operation but they were small and limited in operation.  Perhaps their expense wouldn’t matter with the wealth of Rockefeller at your beck and call, but there just aren’t that many places you can go by air.  Transoceanic flights don’t exist (Lindbergh is still years in the future) and neither do transcontinental.  The big thing in aviation at this time is “air mail”.  And that’s still chancy with things getting lost when the planes crash. (Look at that again and maybe think twice about that air travel.)

Train or ship, that’s pretty much your only option for long distance travel at any kind of speed at all, and those take days where in the modern day we travel in hours.

And if you want to just relax at home and maybe listen to music?  No Radio stations.  First commercial broadcast is still years away.  You can go out to listen to a live performance–in a public venue with neither adequate heat nor air conditioning (I’ll get to that shortly).  Or perhaps you can listen to a device like this:

If you’re lucky, you might actually have a couple dozen records.

I’ll take MP3’s [Ed:  and into several hundred and growing now] on my cell phone, thank you very much.

Individual rooms in your house are probably heated with wood or coal burning stoves.  The first patent for central heating isn’t for another year and forced air central heating isn’t for another 17.

Air conditioning?  Yes, it’s been invented.  You, having the wealth of Rockefeller might have one of the early gigantic “air conditioners” that were just appearing but they really didn’t start getting into homes for another decade.

Well, I could go on and on and on, there’s so much available to the poor today that all Rockefeller’s wealth could not have bought him 100 years ago.

This is without going into the computer technology revolution, portable computers, and cell phones that contain within them more computing power than existed in the world as recently as a few decades ago.

Even many if not most of today’s poor in American know wealth that the John D. Rockefeller of 100 years ago could not even have dreamed that, if you were to describe it to him, would just be so much noise because the concepts were just too alien to the time.

The poor of today, far from getting “poorer” compared to the poor of times past, know wealth beyond the dreams of Midas.

Feeding the Active Writer: No Cook Chili

I was really in a hurry when I knocked this one out.  I was running late and needed something to take to work for my lunch entree.

“No Cook” is, perhaps a bit of a misnomer since I used pre-cooked canned meat in the recipe.  Still, the results were surprisingly tasty.

Ingredients:

  • 1 28 oz can “Keystone” beef
  • 1 16 Oz jar Chi-Chi’s “thick and chunky” medium salsa
  • 1 Tbsp garlic powder
  • 1 Tbsp chili powder
  • 1 Tbsp dried cilantro
  • 1/2 Tbsp ground cumin

Mix it all in a bowl.

Really.  That’s it.

Heat it up (microwave is fine) when you’re ready to eat it.  Serve topped with a bit of cheese and with whatever side dishes you prefer (I usually use non-starchy vegetables–it’s a diet thing).

 

Entertainment and Politics

Why is it, that people who play pretend for a living, mouthing words that other people wrote for them, think that anyone should pay attention to anything they have to say on society, economics, or politics simply because they’re famous?

Yeah, I get it, you get lots and lots of money to dress up and play pretend on the screen.  That does not make you an expert in economics or geopolitics.  It just doesn’t.

But, they will prattle on.  Now, there are a few that are worth listening to but they’re not the ones whose arguments boil down to “do this because I’m famous and I say so” who generally promptly descend into name-calling in the face of disagreement. The ones worth listening to are the ones who can articulate the case well, make that case with fact and logic, and respond to disagreement by challenging the disagreement with fact and logic.

A rare breed indeed.

Now, some friends of mine just tend to roll their eyes and say that we should just ignore their spouting and “enjoy the movie” (or the show, or song, or whatever).  Well, maybe.  And sometimes, yeah.

But here’s the thing.  I have limited funds and time to spend on entertainment. I’d much rather spend those funds on things, and people, who don’t insult me and denigrate everything I love. And even given the massive bias in Hollywood, that still leaves more out there than I could ever afford to pay for either in money or time–particularly since Hollywood is not the only game in town.  It’s not the only way I can get entertainment. (I don’t have to just watch movies or TV shows.  I can, for instance, read books.)

So if they want my money, and my time, they’d better be damn good if they want me to ignore the insult to me and mine. “A good popcorn flick” isn’t, by itself, enough to do that. I’ll pick up one of Larry’s, or Sarah’s, or Amanda’s, or Dave’s, or…well, you get the idea…books first.  Or I might hit up a Bollywood flick (great over-the-top fun).  There are indie film makers.  There are streaming programs.  There are all sorts of places I can go and I shall not lack for entertainment.

I don’t need to support people who hate me.