MS Patients demand access to unproven procedure

You may have heard a few months ago that an Italian scientist discovered a promising new method of treating Multiple Sclerosis (MS). It involves inflating a balloon in veins in the neck to alleviate blockages that he (Dr. Zamboni – true story) alleges contribute to the progression of MS. Anyone who has had a family member suffer from this disease knows how horrible the symptoms can be – loss of motor control, paralysis, loss of speech, dysphagia, and others. I first became aware of MS when a close family friend was diagnosed back in the early 1990s. She became wheelchair-bound, could no longer work, and her family life began to fall apart at least partially as a result of her own frustration and anger at the loss of her mobility. It was further dramatized later in one of my favourite TV shows, The West Wing.

Needless to say, MS is a terrifying disease. What makes matters worse is that both the etiology (what causes it) and a viable treatment method have yet to be found. Dr. Zamboni’s work potentially provides answers to both of these questions. It is for this reason that several patients are demanding that the federal government provide access (funding) for afflicted people to seek this treatment:

“While studies in Canada get underway, some patients are travelling overseas, paying for tests and surgery out of their own pocket. Others are lobbying for the Canadian health-care system to cover the diagnostic tests to look for blocked veins in people with MS.

I’m not even going to pretend that I know what it’s like to have a debilitating illness, or that I can do anything besides blandly sympathize with people who are suffering from MS. However, this story highlights an important and seldom-talked-about fact of health care and health policy. Patients should not be the ones calling the shots. We have grown to feel entitled to be in the driver’s seat when it comes to health. Respect for the autonomy and wishes of the patient is paramount in medical ethics, and I have no beef with that. An individual patient’s needs and wishes need to be respected. However, this does not mean that health policy should be decided by sick people.

When you’re sick, you have only one goal: getting better. Millions of years of evolution have hard-wired a strong survival instinct into all living species, and human beings are no exception. People suffering from disease and their families are willing to do just about anything for a chance at recovery, and logic plays nearly no role in the decision-making process. The problem with this is that people suspend their disbelief and are willing to jump at any chance, no matter how remote, unlikely, or unproven. This says nothing of the fact that patients are not nearly as well-informed as they think they are.

Health policy should be guided by evidence, not sentiment. The fact is that this MS procedure has not been tested for efficacy. We don’t know whether or not it actually works, we have only the case reports of one surgeon to rely on. Far be it from me to suggest that Dr. Zamboni is being dishonest, but there is a mechanism for determining “truth” in science, and it comes from systematic appraisal of facts while controlling for alternate explanations, not simply believing what somebody says. The claims about how well this surgery works need to be tested before we give it the green light. This is another reason why patients should not be making these decsions – they can’t dispassionately appraise the evidence and weigh the pros and cons. It’s all ‘pro’ – there’s a chance at life.

“So what?” you might say “anything that gives people hope is better than having no hope at all.” That sounds nice, but it’s frankly untrue. False hope is not superior to honestly confronting reality. False hope carries a double-edged sword: not only will they be devastated when the object of hope doesn’t work, but they will also be out money and time that they could have otherwise used either on efficacious treatment or something else that would enhance their quality of life (travel, time with family, etc.). While it seems draconian and heartless to make decisions without putting patient suffering first and foremost in mind, the results of this process is that the greatest good will be consistently enjoyed by the largest number of people, rather than a scattershot approach that will be wrong as often as it is right.

Not only is it wrong to give false hope, there is a significant risk associated with surgeries, especially new surgeries for which many surgeons are not well-trained. All medicine is performed with a risk/benefit calculation in mind – basically, so long as the incremental benefit justifies the increased risk then the procedure is warranted. Surgery is particularly risky because of the risks of dying on the table, complications following closing, risk of hospital-borne infection, allergies to anesthesia, and others. What makes this particular surgery even more risky is that surgeons don’t have a lot of experience performing it, so the risks of complications and fatality is even higher. Without consistently establishing the size of the procedure’s benefit, it’s completely irresponsible to give patients access to the risk.

It’s also fascinating to me that every time a health governing body decides to push through a relatively new, somewhat untested treatment (like H1N1 or HPV vaccines, to cite a recent example), there is consumer backlash in the form of “we don’t know what the long-term consequences of this thing is, so we shouldn’t do it.” However, in this case, we’re getting backlash toward the health care governing bodies in the form of “you’re not moving fast enough.”

While I deeply sympathize with anyone who has to live with any catastrophic illness, I am firm in my stance that patients should not be the ones calling the shots when it comes to policy and decision-making, especially when it comes to untested interventions. Science takes time, and we will have an answer on this issue soon. In the meantime, it helps nobody to jump at every whiff of a cure, and could end up being far more harmful than we anticipate.

Dorothy Height, civil rights leader, dies at 93

Dorothy Height, a prominent civil rights leader for both racial and gender equality has died at the age of 93 of natural causes.

I thought it was appropriate to counterpoint this story with my post earlier today. There are a great many parallels between women’s struggle for civil rights and the black struggle. Both of the women mentioned here had feet in both camps. It seems inconceivable to us today that women and non-white racial groups should not be allowed to have a say in how their country is run, or even be considered full citizens of that country. It’s important to remember how recently it was inconceivable that they would be allowed these human rights.

Let us never lose our zeal for fighting injustice and prejudice in all its forms.

“Nova Scotia’s Rosa Parks” gets apology

This is a neat story.

Nova Scotia has apologized and granted a pardon to Viola Desmond, a black woman who was convicted for sitting in a whites-only section of a movie theatre in 1946. Premier Darrell Dexter apologized to Desmond’s family and to all black Nova Scotians for the institutional racism of the past.

I have to confess I’d never heard of Viola Desmond before this story. It’s an important part of my heritage, both as a black man and as a Canadian. I think sometimes we forget that racism was alive and well in Canada, and continues to this day. Obviously, the maritime provinces have been reminded of that fact recently. This apology is more than simply acknowledging the culpability of the government and people of Nova Scotia (although that’s an important and positive step); it is also bringing an important story to the surface. It serves to remind us that segregation and officially-sponsored racism isn’t a problem of hundreds of years ago, or something that only happened in the South. 1946 is in the living memory of many people.

Of course if you flip through the comments (which I do, because I am a goddamn addict) you’ll see the usual knee-jerk response of “why live in the past? We have to move on and let things go.” It’s a nice fantasy to think that we can just ‘get over it’, but denying history is not the path to progress. The apology should not serve (and I sincerely hope it doesn’t) to make white people feel guilty for being born white. As Canadians, we should all be aware of both our strengths as a country and, in this case, our weaknesses and mistakes.

CFI Debate: What’s Right and Wrong with Religion?

I had the distinct pleasure of attending an event co-sponsored by the Centre for Inquiry – a skeptical organization and Reasons to Believe – a group that promotes the harmonious co-existence of science and religion. The event took the form of two 30-minute presentations from a skeptic speaker and a believer:

  • Dr. Hugh Ross (the believer) is an astrophysicist from the California Information of Technology
  • Brian Lynchehaun (the skeptic) is completing a degree in philosophy at UBC

This was the first such event I’ve ever attended personally, but I’ve watched videos of several. The usual format is that the religionist makes a series of unfounded assertions, tortures logic and evidence to support those assertions, and spouts old and refuted theology as a conclusion. The skeptic/atheist speaker, thus completely drowned in nonsensical and illogical statements, must spend his/her valuable time refuting these statements and, as a result, has no time to present any reasonable argument of his/her own. The feckless wimp of a moderator then says something along the lines of “well we’ve heard a lot of good arguments on both sides” and opens the floor to questions. I assumed this CFI/RTB event would be much of the same.

Happily, I was only half-right, and the forces of stupid were not allowed to roll on unopposed.

I took the liberty of recording the presentations by Dr. Ross and Mr. Lynchehaun. As fair warning, Dr. Ross’ presentation is not for the faint of brain. If you are prone to headaches when exposed to assertions passed off as fact, theology substituted for logic, or self-contradiction, you should probably not watch this video. My father, who as a former priest in the Catholic church is fairly knowledgeable about church doctrine and theistic philosophy, joined me in recognizing that the theories propounded by Dr. Ross are both scientifically and theologically way off base. It might be worth watching for lulz. Also, the people sitting next to me were being jerks and laughing disruptively, so occasionally that happens.

Here’s part 1:

Part 2:

and part 3:

Like I said, it’s some pretty heady stuff. Apparently, aside from the outright lies like the proof of the existence of Adam, we are to believe that there is scientific evidence that there is a being outside of space/time (note: evidence not shown). Also, God likes to tinker with species from time to time because He apparently can’t get it quite right the first time. Additionally, the biblical writers believed simultaneously in a geocentric universe and the Big Bang – two perspectives which are directly contradictory. Ross’ explanation of the problem of evil is about the least artful I’ve ever heard – God invented evil so he could test us to make sure we can get into Heaven; why He didn’t just start humanity in Heaven is a problem best left unmentioned. This is all to say nothing of the fact that Dr. Ross has studied all the world religions, and only Christianity is the true one (again: evidence not shown).

At this point, I was dreading listening to Mr. Lynchehaun’s response – not because I was worried that his argument would be as brainless as that of Dr. Ross, but because I was worried Mr. Lynchehaun would try and address the glaring contradictions and illogic present in his counterpart’s reasoning. I was pleasantly shocked when Mr. Lynchehaun started his talk by saying ‘I’m not going to address the science – I can tell that this crowd is not amenable to another science talk.’ From there, Mr. Lynchehaun presented a coherent argument for why Christianity is not a good moral system, which was supposed to be the topic of both presentations (to Dr. Ross’ credit, astrophysics can say very little about ethics, so it wasn’t really a good idea for him to try).

Here’s part 1:

and part 2:

I disagree with Lynchehaun on a couple of points, the largest of which being that science cannot inform ethics (note: he may not have actually said this… sorry Brian :P). I guess the material sciences can’t really say anything about ethics, which may have been what he meant. However, the scientific process of testing hypotheses from reasoned first principles can be adapted to issues of morals. The point that you can’t measure good and evil with scientific scales is well taken. However, on the whole I think Lynchehaun did an admirable job of presenting a non-judgmental and inoffensive argument for why secular value judgments are not only superior to those from scripture, but are actually what’s done already even by believers. It’s crucial to note something here, and that’s the fact that Lynchehaun started his presentation by providing a definition of his first principles. He didn’t just launch in and then try to shift goalposts when confronted; he defined his terms a priori and even allowed his opposition a chance to object or refine them. That’s real debate.

After the two presentations, the participants were invited to engage in a moderated debate, in which they were allowed to address each other. I didn’t record this part (I had poor sight-lines – if CFI puts the video online I’ll link you to it later). Suffice it to say that it was essentially more of the same – Dr. Ross made assertions and wove cherry-picked sciency-sounding things in order to support his claims, while Mr. Lynchehaun sat quietly and waited until Dr. Ross stopped speaking.

The floor was then opened to questions from the audience, which is, in my mind, a complete waste of time. Dr. Ross has shown himself to be logic-proof and absolutely will not accede any points that refute his narrative of the universe. The skeptic audience members who asked their questions were not going to unseat his arguments because they are relying on logic and reason while Dr. Ross is starting from a “God is true, therefore anything else can be explained in terms of God” position. There was only one believer who got up to say something to Lynchehaun, but his “question” was just a series of faith-based platitudes about the infinite mercy of God. Lynchehaun, without missing a beat, said to the guy “this will likely come as no surprise to you, but I disagree” which got thunderous applause from the audience.

The other high point occurred when Dr. Ross explained the reason why God has not directly intervened to make the world a paradise yet – yes, in direct contradiction of both scripture and his own previous statements. See, since we know that the world is 5 billion years old, and God created the world in 6 “days” and rested on the 7th “day”, we can assume that we are still in that 7th day of rest. God isn’t dead, ‘Es just restin’.

UPDATE: I can’t believe I forgot to mention this part. Lynchehaun did take a moment to expose Dr. Ross’ weird argument about the disappearing body of Jesus. He (Lynchehaun) mentioned casually that growing up in Ireland, he was aware (although he was not personally associated with, again my apologies for not making this 100% clear, Brian) that there were great many people who were experts at making bodies disappear, and that it’s probably not as hard as Dr. Ross was making it out to be. Dr. Ross countered by saying that it’s impossible to perpetuate such a large fraud only 30 years after the event. I felt like asking him if he wanted to buy a bridge from me.

If there’s any lessons to be learned from this talk, it’s how startlingly bankrupt the argument “well some scientists believe in God” is. When you have to rape and pervert the scientific method to accommodate your belief in a supreme being, you’re betraying science. During questioning, Dr. Ross said that the way to establish the truth of scripture is to give consider the “truth” therein to always have the best possible benefit of the doubt – a complete inversion of the scientific process. If you’re willing to abandon the ideals of establishing truth through observation and reason, then you abdicate the title of ‘scientist’. Of course, this smacks of the “no true Scotsman” fallacy that Lynchehaun talked about, but it’s different in an important way. Science and belief are incompatible because the former demands a default position of skepticism, while the latter begins by assuming the truth of unprovable claims and then fits evidence to support those claims. They are polar opposites. Can scientific findings be twisted to fit religion? Absolutely. Can blind belief and faith advance the philosophy of science? God Almighty, I hope not.


UPDATE: PZ Myers has cross-posted this entry over at his blog, Phayngula! Hits! Oooh, sniny!

How inaccurate Nazi comparisons fuel anti-Semitism

It will definitely not be among my most controversial statements to say that Adolf Hitler was a bad person. It will similarly be unobjectionable to say that Nazi-ism is and was a deplorable and horrifying philosophy and practice. No-one aside from the handful of anti-Semitic nutjobs who deny the Holocaust believe that Hitler or Nazis are a positive force in the world.

However, in colloquial parlance, Nazis and Hitler are bandied about so wildly inaccurately that we’ve lost sight of why they are bad. Let’s take a look at the philosophy of Nazi Germany under Hitler:

  • Totalitarian regime
  • Advocated the mass slaughter of Jews, Roma, homosexuals, Catholics, mentally and physically disabled
  • Practiced ghettoization of ‘undesirable’ members of society
  • Preached a doctrine of race chauvinism, with the intent of the destruction of all but the racially “pure”
  • Attempted to spread this doctrine by force across the entire world

This is not good stuff. Nothing on this list can be counted as a positive trait. Any movement that seeks the mass slaughter of people based on a doctrine of chauvinism and is spread by force of arms should rightly be compared to Hitler and the Nazis. It is absolutely right to draw comparisons between such practices and the horrors of the Holocaust.

You know where it’s not right? When talking about health care.

President Hitler signed a shockingly similar bill with similar tactics used to get it signed….threats,  harassment,  false promises,  intimidation, invented crises.  Gee….did Obama take lessons from Hitler?

Excuse me, WHAT? Dr. Laurie Roth seems to think that using unethical political tactics (and I’m not saying I agree even with this characterization) to sign policies into law is tantamount to being in league with Hitler.

First of all, understand Hitler was a brilliant, charismatic speaker who said things in style, lied through his teeth and manipulated whatever he had to, to get a vote and power…

Obama also seduced 60% of the nation, congress and most the media into not asking real questions and just believing his countless lies.

Hitler wore black socks. Obama has been photographed WEARING BLACK SOCKS! The similarities abound.

The question here that must be asked is as follows: is Obama similar to Hitler in any of the characteristics that are important? Namely, is he (openly or covertly) advocating the mass murder of a group of people based on ethnic or political affiliation? Is he declaring an expansionist war agenda in order to accomplish said mass murder? Is he jailing and shipping off political dissident groups to internment camps? If you answered ‘yes’ to any of these questions, then I think your trial separation with reality has gone on long enough and you should just file the divorce papers already. If you answered ‘no’, then the question becomes whether or not the comparison to Obama is a fair one, or if you’re just using the spectre of Hitler and the Holocaust as a cheap and frankly tactless way of manipulating the emotions of your audience.

And before we get too smug here on the left side of the aisle, shall I remind you of the anti-Iraq-war protests of only a few years ago? Ringo remembers.

It seems as though we’ve taken the above description of Hitler and the Nazis and boiled it down to the first bullet point: Nazi = totalitarian regime. While nobody would suggest that totalitarian regimes are good, that’s not the only reason why Nazi-ism was so horrible; it’s not even the primary reason why Nazi-ism was so horrible. Look down the list – forced imprisonment, genocide, unjust war-making, all fueled by an underlying racist doctrine. The atrocities committed by the Nazis under Hitler were the worst that the developed world had ever seen, and possibly the worst in all of history.

It does disservice to the memory of the millions of people who have died at the hands of the Nazi philosophy to trivialize its inherent ugliness as mere totalitarianism. Most feudal monarchies were totalitarian, but many positive things came out of them. There are admittedly few examples of totalitarian regimes that were good for the world, but much fewer are the examples that can be aptly compared to Nazi-ism – perhaps Russia under Stalin, Cambodia under the Khmer Rouge, the genocides in Rwanda and Sudan, and even these last few are not at the hands of totalitarian rule but of brutal military rule.

Taking a handful of characteristics, out of context, from the Nazis or Hitler, finding similarities to modern events and then forging specious equivalence between those events and the Nazi philosophy is belligerent intellectual dishonesty. Worse than that, however, is the fact that as the word “Nazi” gets applied to everything under the sun that one person or another doesn’t particularly like, the real meaning and context becomes diluted. The consequence of this is that we begin to forget the dark scourge of anti-Semitism that allowed such a philosophy to propagate on a global scale. As I showcased recently, anti-Semitism is still alive and well both internationally and here in Canada. It doesn’t need to be helped by down-playing the horror of its history.

It seems appropriate at this point to say something about anti-Semitism. I have no particular allegiance to any religious group; I find them all distasteful at best, and destructive at worst. I fully recognize that Jewish people, and the Jewish faith is no better or worse than any other, except insofar as its adherents tend to be less militantly violent and intolerant than Christians, Muslims, or Indian Hindus. I highlight this particular race chauvinism (anti-Semitism) not only because it’s topical but because it’s pervasive. I am not claiming that anti-Semitism is philosophically better or worse than any kind of racist philosophy (although it has the longest history and is perhaps the most widespread). I am opposed to the idea of group identification based on religion, since religious expression is highly varied and is almost entirely based on superstition and nonsense. However, I am more opposed to the idea of violently exterminating a group of people based on group identification or shared belief. I am also opposed to intellectual dishonesty and the degradation of history to serve the agenda of the forces of stupid.

So the next time you hear someone compare Obama or Bush to Hitler, or call someone else a ‘grammar Nazi’ or, in the case of one friend of mine, receive the fascist salute from a student because they don’t like your teaching style, I’d invite you to remind them that totalitarian as Nazi Germany was, that’s not the biggest criticism to be levied at them. I’d also invite you to offer to slaughter their families if they want their characterization to be more apt.

Movie Friday! – Dara O’Briain

It’s Friday. I like Fridays. Do you like Fridays?

In honour of this auspicious day, I’m going to do something different. Instead of my usual old-cranky-man ranting about this and that, I’m going to post movies that I find interesting or funny.

Today’s movie is making the rounds as a skeptic’s classic. The comedian is Dana O’Briain, who is one of the best standups I’ve heard in a while. He’s talking about a lot of the same issues I’ve been bringing up, but he’s a lot funnier than I am.

Happy Friday!

Why I’m glad I live in Canada

I’ve mentioned this before, but I’m a big fan of free speech. Free speech means free societies. It also means it’s almost impossible to completely crush a minority group for being dissident to the majority rule. As a black man, I know why ‘majority rules’ isn’t always a positive thing.

Which is why these news items make me glad I live here in Canada (even with its tainted speech laws) and not in Somalia.

Most radio stations in Somalia have stopped playing music, on the orders of Islamist Hizbul-Islam insurgents who say that songs are un-Islamic.

Ignore for the moment the backwards stone-age attitudes of people who appear to be former residents of the town from Footloose. One of Somalia’s most well-known exports, besides pirates, is expatriate singer/songwriter K’Naan. He’s been featured on official soundtracks for the charity War Child, FIFA Soccer video games, and most recently his anthem “Wavin’ Flag” has been appointed as the official theme song for the 2010 World Cup. Counterpoint this – an internationally prolific symbol of freedom, human rights and awareness spreading his message through music – to a repressive, backwards country that won’t even let the BBC report from there. How can such a contradictory juxtaposition occur?

It’s easy – K’Naan grew up in Canada. Canada has free speech and actively supports artistic expression, even when it’s decidedly anti-government (think of the Air Farce, which happened on government-funded radio and television for the better part of 4 decades). Canada, even with its exception for hate speech (which I disagree with), allows people to express ideas freely. Contrast that to Lybia where if you complain because you’re getting tortured, they lock you up.

Free speech makes the world a better place. It’s of primary importance to the survival of any enlightened, progressive society. Erosion of free speech means the erosion of progress and liberty, both of which improve quality of life for people. Muslim apologists often say that “Islam means peace” and that devout Muslim belief is a path towards beauty. Somalia puts this claim to the lie.

Using economic levers to change behaviour: the case of Thailand’s universal coverage health care reforms.

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Agency problems in hospitals participating in self-management project under global budget system in Taiwan.

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Can regional resource shares be based only on prevalence data? An empirical investigation of the proportionality assumption.

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Delivering value for money.

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AIDS drug assistance plans feel fiscal pinch.

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Where are we in the rationing debate?

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Optimizing resource allocation for HIV/AIDS prevention programmes: an analytical framework.

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Decentralization and health resource allocation: a case study at the district level in Indonesia.

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Budget India 2008: what is new for health sector.

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Ramsey waits: allocating public health service resources when there is rationing by waiting.

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Cost-effectiveness and healthcare budget impact in Italy of inhaled corticosteroids and bronchodilators for severe and very severe COPD patients.

Dal NR, Eandi M, Pradelli L, Iannazzo S.

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The state-of-the-science: challenges in designing postacute care payment policy.

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Getting by on credit: how district health managers in Ghana cope with the untimely release of funds.

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Performance-based budgeting in the public sector: an illustration from the VA health care system.

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Is Utah the new Oregon?

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[The nurse facing economic control]

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Optimising health care within given budgets: primary prevention of cardiovascular disease in different regions of Sweden.

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Optimal allocation of resources over health care programmes: dealing with decreasing marginal utility and uncertainty.

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Medicine as a business.

Matthews M Jr.

Mt Sinai J Med. 2004 Sep;71(4):225-30. Review.PMID: 15365587 [PubMed – indexed for MEDLINE]Related citations


Decision makers’ views on health care objectives and budget constraints: results from a pilot study.

Al MJ, Feenstra T, Brouwer WB.

Health Policy. 2004 Oct;70(1):33-48. Erratum in: Health Policy. 2005 Sep 28;74(1):111. PMID: 15312708 [PubMed – indexed for MEDLINE]Related citations


Using PBMA in health care priority setting: description, challenges and experience.

Mitton C, Peacock S, Donaldson C, Bate A.

Appl Health Econ Health Policy. 2003;2(3):121-7. No abstract available. PMID: 14984275 [PubMed – indexed for MEDLINE]Related citations


The evolution of PBMA: towards a macro-level priority setting framework for health regions.

Mitton CR, Donaldson C, Waldner H, Eagle C.

Health Care Manag Sci. 2003 Nov;6(4):263-9.PMID: 14686632 [PubMed – indexed for MEDLINE]Related citations


Decentralization in Zambia: resource allocation and district performance.

Bossert T, Chitah MB, Bowser D.

Health Policy Plan. 2003 Dec;18(4):357-69.PMID: 14654512 [PubMed – indexed for MEDLINE]Free ArticleRelated citations


[The 2004 budget in the county of Stockholm hits against private practitioners]

Sjödin C.

Lakartidningen. 2003 Nov 6;100(45):3694-5. Swedish. No abstract available. PMID: 14650042 [PubMed – indexed for MEDLINE]Related citations


The economics of public health: financing drug abuse treatment services.

Cartwright WS, Solano PL.

Health Policy. 2003 Dec;66(3):247-60.PMID: 14637010 [PubMed – indexed for MEDLINE]Related citations


Optimizing a portfolio of health care programs in the presence of uncertainty and constrained resources.

Sendi P, Al MJ, Gafni A, Birch S.

Soc Sci Med. 2003 Dec;57(11):2207-15.PMID: 14512250 [PubMed – indexed for MEDLINE]Related citations


Should general practitioners purchase health care for their patients? The total purchasing experiment in Britain.

Wyke S, Mays N, Street A, Bevan G, McLeod H, Goodwin N.

Health Policy. 2003 Sep;65(3):243-59.PMID: 12941492 [PubMed – indexed for MEDLINE]Related citations


Revisiting the decision rule of cost-effectiveness analysis under certainty and uncertainty.

Sendi P, Al MJ.

Soc Sci Med. 2003 Sep;57(6):969-74.PMID: 12878098 [PubMed – indexed for MEDLINE]Related citations


The drug budget silo mentality: the Dutch case.

Koopmanschap MA, Rutten FF.

Value Health. 2003 Jul-Aug;6 Suppl 1:S46-51.PMID: 12846925 [PubMed – indexed for MEDLINE]Related citations


Tools of the trade: a comparative analysis of approaches to priority setting in healthcare.

Mitton C, Donaldson C.

Health Serv Manage Res. 2003 May;16(2):96-105.PMID: 12803949 [PubMed – indexed for MEDLINE]Related citations


An army of patients. The VA struggles with a growing population of veterans using its healthcare system as it works to boost quality and capacity.

Fong T.

Mod Healthc. 2003 May 19;33(20):48-50, 62. No abstract available. PMID: 12800589 [PubMed – indexed for MEDLINE]Related citations


The budgetary crunch and how to rationally decide what to cut.

Kozma CM.

Manag Care Interface. 2003 May;16(5):43-4. No abstract available. PMID: 12789864 [PubMed – indexed for MEDLINE]Related citations


Setting priorities and allocating resources in health regions: lessons from a project evaluating program budgeting and marginal analysis (PBMA).

Mitton CR, Donaldson C.

Health Policy. 2003 Jun;64(3):335-48.PMID: 12745172 [PubMed – indexed for MEDLINE]Related citations


Managed Medicaid’s last stand.

Carroll J.

Manag Care. 2003 Mar;12(3):46A-46B, 46F, 46H. No abstract available. PMID: 12685376 [PubMed – indexed for MEDLINE]Related citations


The prisoner dilemma: should convicted felons have the same access to heart transplantation as ordinary citizens? Opposing views.

McKneally MF, Sade RM.

J Thorac Cardiovasc Surg. 2003 Mar;125(3):451-3. No abstract available. PMID: 12658181 [PubMed – indexed for MEDLINE]Related citations


Does it matter who you are or what you gain? An experimental study of preferences for resource allocation.

Schwappach DL.

Health Econ. 2003 Apr;12(4):255-67.PMID: 12652513 [PubMed – indexed for MEDLINE]Related citations


Fight for Ottawa’s money will be fierce.

Kondro W.

CMAJ. 2003 Feb 4;168(3):330. No abstract available. PMID: 12566350 [PubMed – indexed for MEDLINE]Free PMC ArticleFree textRelated citations

Measles outbreak in Vancouver

I’m sure some of you have been following this story:

The BC Centre for Disease Control asked health-care professionals and the public to be alert for measles on Tuesday after eight of the 14 cases were diagnosed in a single household with unvaccinated members. None of the cases identified to date had received two doses of the measles vaccine, which is needed for full protection, officials said in statement.

My stance on anti-vaccination groups has been stated quite unequivocally on a previous post. To put it briefly, they are prime examples of the Forces of Stupid, a group of people who seem to think that ignorance is a virtue and anyone with access to the internet is equally equipped to give an informed opinion, regardless of the process by which they arrived at their knowledge. Part of the reason I started writing this blog is to challenge the idea that everyone is entitled to an opinion. Some opinions, when left unchallenged, result in calamity. This measles outbreak is a prime example of what happens when we “leave well enough alone” and allow stupidity to take root.

Obviously, there should be robust debate about important issues. However, there is no room to debate facts. Facts are not subject to democratic approval. Something either is or it isn’t, regardless of whether or not we agree with it. If you disagree, find evidence to support your belief. The evidence needs to be stronger than the evidence that supports your opposition. That is how progress gets made.

Which is why it’s so painful to see articles like this one:

Unvaccinated students are being sent home from school because of the growing measles outbreak in Vancouver, and that has at least one parent concerned that the policy is unfair.

A student’s mother chose to refuse the measles vaccination for her daughter, citing fear of a reaction to egg albumin in the vaccine. That’s a completely reasonable stance to take if there’s legitimate concern over an allergic reaction. What isn’t reasonable though, is expecting everyone else to bend over backwards to accommodate her decision.

“I think every parent, whatever decision they make, it’s always because they love their kids, and they want to do what’s best. It’s not a right or wrong issue,” said Conley [the mother]. But Conley said the length of the quarantine is too long because she believes measles is only infectious for up to 14 days.

Good for her. What do people who know something believe? I couldn’t care less what some random lady thinks about a disease. Luckily, she’s not in any position to set policy and has been overruled by the school board, who cite the science dictating a 20-day possible incubation period. They are, reasonably, erring on the side of caution. Not only that, but in this case it is a “right or wrong issue”! You might be right to safeguard your kid, but the school board is more right to refuse to allow your decision to potentially infect hundreds or thousands of kids in BC and Quebec.

So why does this grind my gears? Because they put the mother’s testimony first. The opinion of a parent is not news. It’s certainly not a balance for scientific fact, and given that people tend to think of the top of the article as being more authoritative and informative, CBC seems to be suggesting that this random mom’s wacky opinion is superior to the science. It makes for a nice headline to the story: Brave Mom Fights for Child’s Rights. Here’s a better (or at least more accurate) headline: Mom Told to Live with the Consequences of Her Decision. You don’t vaccinate, you don’t get to participate.

Another thing I found interesting is that as soon as she was told there was a field trip at stake, she got her kid vaccinated right away. Where did the allergy concerns go?

Far be it from me to suggest that ideas are stupid a priori. The vaccination/autism link was certainly plausible when it first appeared on the scene. So what did we do? We tested the idea. Upon testing, we found no evidence to support it. We kept testing, trying to replicate the studies that trended positive. Again, we found no link. Once an idea has been shown to have no evidence supporting it, it then becomes stupid. Sticking to belief in a stupid idea isn’t admirable, it’s dangerous. Luckily, at least in this particular case, better-informed heads prevailed. I feel bad for the kid, but there are consequences to these decisions that the kid, and her mom, have to live with.

Update: the niqab in Quebec

There’s another story in the news that is quite contentious that speaks to my post yesterday, so I thought I’d throw in some interesting reading. The issue concerns the niqab, which is to my eyes the same as a burqa. Recently the government of Quebec passed a law banning the wearing of burqas while accessing government services. There are a lot of stupid arguments for why this is a good law: security issues, enshrining women’s rights, assimilationism. I doubt there is much of a security risk posed by these women, and there is a good argument that women should be allowed to wear whatever they want.

This article takes a decidedly anti-ban stance. I disagree with their conclusions, but their reason for opposing the bill is sound – it’s not protecting a woman’s rights to take away her freedom of expression. Saying that banning the burqa is tantamount to supporting feminism is like saying that opposing Affirmative Action makes you a civil rights leader. It’s paternalism, plain and simple.

However, Canada seemingly isn’t the only country with this problem. France is currently experiencing major issues with the influx of Muslim immigrants. France, however, does have an aboriginal ethnic majority population so their issue is distinct from Canada’s. We are a nation of immigrants from the beginning of this land as a unified nation.

My stance remains the same. In a secular society, the government is not obligated to accommodate your superstition, no matter how many people believe in it. I am as offended by a woman wearing a burqa as I am by a member of Opus Dei flogging himself on the streets, or a Jehovah’s Witness coming to my home (although I live in an apartment now. Crommunist -1; Jehovah – 0). I have no patience for religion. However, as long as it’s not thrown in my face I can’t really have any objection to it. People should have the right to have their own private beliefs, but that right does not extend to public places and it certainly does not require the government to bend over backwards to facilitate your belief in mumbo jumbo.

There. Political career officially nipped in the bud.