Wednesday, March 01, 2006

The comment section from a previous post

This is the comment section from the post about South Dakota banning abortion. I wrote a long winded response to Trib that should have been a post in and of itself, but who looks back that far? So I thought I'd copy the whole comment section up here and keep the damned thing going till it's dead.

Jennifer said...
And so it begins...

12:08 PM

yrautca said...
Nobody lives in SD, if thats any consolation.

1:11 PM

yrautca said...
I admit that this scares me, not because I believe whole-heartedly in abortion, but because now 'they' have enough people in place to materially affect other civil liberties as well.

I know you guys have it good in Canada. You guys are lucky. Its a much more enlightened society than US.

1:31 PM

Princess Pessimism said...
this is appauling. You know how I feel about back alley abortions, and coat hanger abortions...even to say those words makes me shudder. SD may not have the population that LA has, or NYC has, but they should still have the right to choice.

12:43 AM

Jennifer said...
Well Yrautca, it does seem that we are lucky to have our more enlightened society, but as the wonderful Canadian Prime Minister Pierre Trudeau once said, sharing the continent with the US is like sleeping in a bed with an elephant. As it is, we've just elected a Conservative (like Repulican) government with a party leader whose stance on abortion is that he'll 'try to keep it off the table' -read 'I'm reasonable, but my party are a bunch of scary Christian right fuckers from Alberta' so, our civil liberties in Canada are on thin ice too, and it's not as thin as the ice the US is on, but you guys are jumping up and down on the ice and sooner or later we're all going down.
The thing about it only being in South Dakota is that there's most definitely going to be a court case that will go all the way to the supreme court and without Sandra Day O'Connor who just retired the pro-choice on the supreme court is one short, she's been replaced by Alito and his vote is still up in the air.
PP, the thing about SD not having too many people is that only folks with money already are the only ones who can make it to the Planned Parenthood office, and now they have even farther to travel and more time to take off work in order to get an abortion. And, it may end up that no one in the US will have access to abortion in three years time when this gets to the supreme court. Should that happen, I wonder what would happen to abortion in Canada, or Canadian-American relations, considering how apoplectic all those right-wingers are over reasonably priced Canadian drugs going over the border. Would you have to get a pregnancy test before you were allowed to leave the US, or would the anti-choicers just trust that most women who need abortions couldn't afford to take the time off work and travel to Canada anyway.

9:46 AM

Princess Pessimism said...
I was thinking of that...having to travel to obtain an abortion....It might not be that bad. Yes, it's true, the added travel expense, and time and inconvenience.

However, if SD notices a decline in their monetary intake at hospitals, maybe they'll rethink it. I dont know much about the abortion rate in comparison to the medical bills in SD, but if one correlates to one another, then maybe they'll smarten up and bring the right to choose closer to home.

12:31 PM

Jennifer said...
The travelling thing is key, from your point of view or mine, it doesn't seem so bad, I could hop in a borrowed car and drive 3 or 5 hours, make up some story about needing the day off for an appointment, but imagine being a single mother with some fastfood type job, maybe two and kids, and no car, how are you possibly going to make that happen, then what if you want to keep it quiet, because obviously people in SD aren't very tolerant of these things.
I read somewhere that the majority of women who died of clothes hanger abortions before it was legalized were visible minorities ie black and hispanic (something like 85 or 90%), because they didn't have the money to travel out of the US to get their abortion.
The economic implications will likely have no effect in SD, the only abortion clinic is Planned Parenthood which has already said they'd sue, no hospitals offer it. Besides, I'm sure that the security costs of bombings and protesters, and the amount you'd have to pay a doctor to risk their lives at the job, has taken any profitability out of providing abortions that there may have been in the first place. I think Planned Parenthood is a non-profit anyway.

12:52 PM

Trib said...
I wouldn't be too concerned about this. Both of the new justices are very against legislating from the bench and are precident oriented. They are very sharp jurists and believe that their job is to interpret the constitution, which it is. Actually, I think the 9th Appelate could learn something from them. The only people who think abortion will be outlawed in this day and age are christian fundamentalists. Now that they're in Alito and Roberts have nothing to fear from those folks.
Also I'd just like to comment that Canadian drugs are cheap because of a free rider phenomenon. If Americans weren't paying so much for the R&D the drugs (especially for rare diseases) wouldn't even be around. That we pay out of the nose for them is a fact that we as a society have deemed acceptable for pharm to keep making drugs at the rate they are.

5:25 PM

yrautca said...
I think if Canada can improve on its economy and become a major world market, people around the world will look up to the Canadian model.

Yes Canada is socially conscious, but does that feed the hungry? I am surprised that they elected a conservative govt.

11:52 PM

Jennifer said...
Actually, social programs do feed the hungry. Also our socialized medicine heals the sick.... need I continue?
As for the Conservative government being elected, I don't know either, if people were voting that way to get back at the Liberals for corruption, sure they punished the Liberals, but they punished themselves and the rest of us too!

12:46 PM

Jennifer said...
Trib, I know you get a lot of propaganda from the drug companies when you are in med school, but most of them spend more on marketing than research and development and of their R&D money they spend more on developing 'lifestyle' drugs than drugs for actual illnesses, the largest growing sector of the pharma business today is pet anti-depressants - puhleeeease!
I know about this, I work for a company that markets on of the major 'lifestyle' drugs.
They haven't come up with a new treatment for malaria in 20 some odd years, because people who suffer from malaria don't have money. In fact one of the big pharmas did develop a new anti-malarial - and when I say they developed it, I mean they were given the patent for it by a university which developed it with public funds - anyway, they have this drug which works and will turn a profit, but they won't release it because they won't turn a big enough profit.
This brings me to another point, gifts of R&D from public institutions to big pharma, your tax dollars pay for the development of these drugs, then they pass them on - for free - to private corporations, then those corporations insist on having a patent so they can charge whatever they like for the new drug for 20 years.
So the companies develop drugs for diseases that only effect rich people like ADD, depression and erectile disfunction with research that was donated by public institutions and spend a fortune to market them, then charge an arm and a leg for them and we are supposed to thank them? Worthwhile drugs market themselves because they fill an niche, because there was a demand for them before they were developed.
So the government of Canada negotiates collectively to bring down the inflated costs of drugs. That's why we pay their salaries, to protect us from big corporations, the government is there to work for the people not to work for the corporations. If the big pharmaceutical corporations all went under, other ones would crop up and be able to use public research just as effectively to produce our drugs as the old fat cats do now. Because after all they aren't charities, they are corporations and the point of corporations is to produce profit for shareholders and not to provide services to the public. Government is the body whose job is it to provide service to the public.

1:08 PM


Trib said...

Actually, I didn't learn that from pharmaceutical company propaganda, but from my MBA in Health Care classes and specifically from a fairly well respected economist. Now, obviously, I'm committing the philosophic no no of ad hominem, but I thought you'd like to know that I'm not just making it up.
About malaria - Malarone was just approved in 2000. Which is probably not the drug you were talking about because I've taken it.
And as bad as the situation is with them trying to make the next viagra, it would be much worse if we cut their profits. Taking their patent protections would reduce barriers to entry in the market and make everything operate on a shoes string budget. Low profits = low investment = less money to buy the drugs from the people who actually develop them (not Pfizer). In a situation like that there would be NO money to spend on anything but the drugs with the highest profit margins.
Do I thank the big pharm? Do I thank Walmart? Of course not, but I realize that they fulfill a function. If everyone negotiated for drugs like Canada do you think they could practically give away AIDS drugs in Africa? Those same drugs cost an arm and a leg here. We put up with all the big pharm antics because the alternative is worse.

Jennifer said...

I've taken Malarone too, lovely drug, no pesky hallucinatory dreams or depressions like Lariam. I'd take it again if the need arose, but here's the thing, even with our cheapskate negotiations with the wonderful pharmaceuticals, it cost me something in the neighbourhood of 400$ Canadian for 2 or 3 weeks worth, and that wasn't covered by any drug plan, that was out of pocket. That's a lot of moolah even for someone taking a fabulous third world vacation, never mind someone who lives in the third world where the currency is weaker and the salaries are lower. Imagine a day labourer in Bangladesh shelling out for that.
I'd have to look up the article I read that info from at home, although I don't think they ever mentioned the specific name of the drug.

As for the rest of your argument, I don't see the difference between the situation we have now where they only put out the most profitable drugs and don't invest much and the worst-case scenario where they only put out the most profitable drugs and don't invest much. It just seems like scare tactics to me.
God forbid I seem like too much of a socialist or (gak!) naive, but if the government can pay for the development of the drug, why not just put together what we in Canada would call a crown corporation to manufacture them? Canada has a long history of great crown corporations. Petro Canada and Air Canada are some examples that have since been privatized into profitable private companies. We also sell liquor through a government agency called the Liquor Control Board of Ontario that is the largest buyer of spirits in the world; it generates a large amount of revenue for the government, which in turn allows them to provide services.
I know it's dangerous territory in a debate to actually suggest something instead of criticizing the ideas of others, but in the paraphrased words of cutie member of parliament Peter Cormos, some things are just too important to leave in the hands of the private sector. At the time he was talking about socialized prescription insurance, a fabulous idea, and I can't understand for the life of me why it hasn't been implemented because I'm paying 500$ a year to as a matching contribution to my BF's employer to get my prescription coverage and I feel like it could be a lot cheaper and better done by the government like our health insurance.

Trib said...

One more fun thing I remembered about malaria is that if we were really concerned about getting rid of it, we'd spray everything down with DDT. We used to have endemic malaria in florida before we crop dusted everything and everybody. Political correctness and concerns for thinning eagle eggs are essentially to blame for 300million infections and 1million deaths/year, not to mention that it would seriously curb things like trypanosoma.
I paid $300 for my malarone, but Glaxo-Wellcome is planning on giving away 1million treatments worth to Africa/year. When there's a natural disaster drug companies are willing to ship pallets of drugs like imipenum to the effected areas and even here in the US if you have a patient you really think will benefit from a certain drug who can't afford it the companies have programs to donate those drugs. They're not JUST evil corporations.

Drugs cost different amounts in different countries based on how much the people who live there can afford to pay. If everyone in the first world paid Canadian prices, they would raise the prices in poorer countries. I would rather pay more than see that happen.

It seems that your gov't is a little better at managing things than ours is. Around 13% of our GDP goes to health care and our outcomes are worse. In the US a gov't run drug company would not work. I certainly don't believe in lassez faire free market, but companies are efficient. I like the idea of the crown corporations, but it seems like they're run like businesses and for them to have privatized they had to have turned a profit. What kind of profit can be realized by developing and manufacturing a drug for a disease that only 1000 people in the country have? And what about those hugely expensive clinical trials? And what about the drugs that fail the trials?I guess you'd have to spend some of the money you made off of those really profitable drugs. Sounds familiar.

I'm drawing a blank right now on what drugs the pharm companies should be working on right now.

I think it's great that you get cheap drugs, but I think it's important to realize that not everyone can be in that position. The way the drug market works, someone has to pay.

There aren't simple solutions to this problem and yes I do think that it's a problem, but I can't come up with a better way to do it and I think saying that the gov't should do it is not a real solution. So it is a cop out that I'm not suggesting anything and just saying that the things you've suggested won't work, but I've thought long and hard about this since this summer and all I've got to show for it is that I 'get' why things are the way they are. It's not satisfying and it doesn't have fun idealism, but it's my reasoned conclusion. It's a different kind of business than any other and so they get to play by different rules.

Trib said...

I just wanted to add that I know how you feel that it doesn't seem right that they should have such huge profits in a world in such need of drugs. I happen to agree. I just think that our feelings are beside the point.

Jennifer said...

I think that you and I aren't disagreeing about the facts so much as motivations, I think the executives at drug companies are evil and eat babies and you think that they are saint/gods who walk on clouds and heal the sick with their touch. Either way the system is flawed and there's no easy solution.
But surely you are joking about DDT. I can't imagine a worse idea than bringing that back. Pest control at the expense of all top predators is not an improvement, especially since we are a top predator too. My mother tells tales of shaking DDT powder on the backs of pigs on the farm growing up to keep the bugs off them, with no face mask. But on the other hand the government used agent orange on the edges of my mother's farm when she was a kid as a defoliant, so it's a miracle I'm not writing this to you from the cancer ward.

Trib said...

I agree absolutely with you there.

Actually I am serious about DDT. The case against it is actually not very strong. The case for it is. Silent Spring was, for lack of a better word, not very scientific. There were actually increases in most species of birds in the years when the spraying was going on. There's a bunch of stuff in this article:

Agent orange is much worse, but you know that. What it's really good at causing is chloracne. You can ask Yuchenko about that.

Jennifer said...

Funny story about chloracne, I took a class with the famous (and awesome) anthropologist Richard Lee last year. He's married to Harriet Rosenburg, who you might have heard of in relation to these sorts of things.
So anyway, he and Harriet are sitting there watching the news and a story comes up about how Yuchenko is ill with some mysterious disease, he's been poisonned, no one knows what he's been poisoned with and he's being sent to some super high tech European clinic for diagnosis. Anyway, Harriet takes one look at the picture of him on the news and says, obviously that guy has chloracne. Sure enough after a month of super high tech expensive testing the release that he had been poisoned with dioxin. Harriet could have told them for free.

I don't disagree that Silent Spring wasn't exactly scientific, I haven't read it myself, so I'm not going to really defend it here other than to say that it raised awareness in the general public as to the dangers of some chemicals. Take Love Canal for example, in the 40s and 50s they thought it was acceptable to build a school and a neighbourhood on top of a toxic waste dump. It wasn't until Canada started complaining that this stuff was leaking into the Niagara river and ultimately into Toronto's tap water that the state of New York was prepared to do a damn thing about it.

Trib said...

Our pathologist did the same thing. Actually, he expected us to have recognized it. Considering I'd only seen one picture before that, I missed it. Public awareness is a good thing, but they're so easily mislead. Stuff like science articles on are really difficult for me to read because they don't include any actual information. I read and reread and reread and end up guessing at a conclusion. That's the problem with "science books" is that they're cnn articles writ large. You'd have to go back and start reading the journal articles to find out if the author is using them correctly. And the studies might have design problems too and then you're at the library requesting them interlibrary loan and referencing books on statistics and when do we have time for this?! ARGGH! Stupid science. Back to novels!

Trib said...

Public outrage is the way to get things changed, though! I just hate to see when it gets misdirected like against vaccines.

Jennifer said...

Dude, I am 100% with you on the vaccine thing, I can't understand why you'd rather risk your kid getting diseases that were so bad that they put tonnes of money into finding a vaccine for them - rather than take the miniscule chance that your kid has a bad reaction or 'catches' autism from them. I think that the only way someone could think that it's better to be unvaccinated would be if they were raised in an environment where everyone is vaccinated and therefore those diseases are no longer in the forefront of their minds as a danger.
When I went to Bangladesh, I had all my vaccinations updated. The friend I was travelling with was born in Bangladesh and didn't do nearly as much prep for the trip, including not bothering getting her vaccinations up to date (or a visa, which turned into a pain in the ass). So we're in this village, I was the second white person ever to go there, which made me a minor celebrity, we visit the house of some acquaintances, and everyone in the village showed up for the occasion and then I notice that one of the sons in the family is looking kind of sick and he's kind of swollen around the face. I'm the curious type, so I have a good look at him and ask a bunch of questions. Sure enough, mumps. Well, I had this moment of thinking 'oh shit!' Then I remembered that my shots were up to date. I turned to my friend and asked her if she had been vaccinated, she hadn't, so we beat a hasty retreat. The house was packed, and not only did I not want my friend to have a run-in with the mumps, but I didn't want all the guests who showed up to turn one case of mumps into an epidemic.
The moral of the story, if anyone is still reading, is that public health measures, such as sanitation and vaccinations, have done more for the health of humans than medical science ever has, or probably ever will. But the big kicker is that you actually have to get vaccinated before you get the disease, you have to invest in sewers and public education.
Public health isn't sexy, there's no show about public health officials, while their are a zillion about doctors with names like Dr. McDreamy.
The only way affluent little north American kids can get away with avoiding the minor risks associated with vaccination and run around with no immunity to diseases that kill in the rest of the world is because everyone else is vaccinated. It's not only stupid but incredibly selfish.

Trib said...

They also don't realize that even though everyone else around them is vaccinated, they can still get it. Check it, the old polio vaccine was the ipv which prevented gi as well as paralytic polio, there was a very small chance that you could get paralytic polio from it though so we stopped using it here. Now we use the opv which will prevent paralytic polio, but NOT gi. Gi polio isn't all that big a deal, but it is contagious and so all the vaccinated people could be transmitting polio around and if an unvaccinated person got it they could be paralyzed. And to that I say SNAP!

Jennifer said...

I knew they had switched polio vaccines, but I wasn't aware that the new vaccine doesn't do the same things as the old one, I only knew that it was safer.
I saw people who had had polio when I was in Bangladesh, it was ... I don't know if I can think of a word to describe it.
I had also heard about a polio outbreak they had a few years back in Haiti, which they thought was a result of the vaccine and not a natural outbreak.

What's your opinion on the whole 'vaccinations give you autism' line of thinking. It seems like hogwash to me, even if it's true, it's a bullshit arguement for not getting vaccinated. But I guess I'm asking, is autism something you are born with like they originally thought? or is it possible to get it later?

Jennifer said...

PS if a patient came into your office and had a disease that they should have been vaccinated for but weren't because they were against vaccinations for yuppyish bs type reasons - would you actually say SNAP?
That would be pretty funny to have the doctor who tells it like it is. My dentist is like that, it's often amusing, visits are unpredicatable and occasionally hilarious.

Trib said...

I think autism is still a bit mysterious. The kid has to be a certain age before you really notice it. It is a neurological problem and there are familial patterns so a genetic component is likely.

ERF has this whole article on vaccines.

I would think SNAP, but I think the parent would feel terrible enough as it is that they wouldn't really need it rubbed in. I would use it as a cautionary tale, though. House MD is kinda my hero.