Many moral questions are tricky, requiring complex theories and difficult judgements… but many more moral issues are really very simple when you look at them clearly. Manditory mass medication is one of those simple issues. I am as keen as anyone else to not see epidemics of infectious disease and in the case of such, I take the view that it is rather like why you have states to fight against foreign armies: a collective threat to everyone can sometimes only be faced by a government acting collectively. However very few things fall into this category, but infectious disease is one which indeed does – a collective threat that can only be defeated collectively. So yes, I am all for property rights but that does not include having a malarial breeding swamp on your property next to mine or infecting everyone’s water supply with some nasty bug.
Birth defects on the other hand, are not a ‘collective threat’ and so taking folic acid to avoid certain birth defects is the responsibility of anyone who does things likely to get them pregnant. So when Max Pemperton writes an article in the Telegraph opposing government plans to force bakers to add folic acid to bread, you would think I would be supportive of him, right? Well no.
In his article Folic acid is not the best thing since sliced bread he goes into a great song and dance about the pros and cons to various groups in the population of adding folic acid and whilst he does talk about civil liberties, he is mostly just making a utilitarian argument of net-benefit. He ends with saying “It’s certainly a complex moral dilemma”… and that completely fogs the issue.
No, it is actually a very simply moral dilemma: does anyone have the right to alter my body chemistry to benefit other people when my body chemistry poses no threat to anyone else (unlike if I have smallpox, for example). The question (does the state have this right?) and the answer (no) are not complex at all. If women want to avoid neural tube defects in their children, they should take folic acid. Making me take it as well will not help and is none of anyone elses damn business.
Few things are as impermanent as medical theories of ‘what is best’, so the utilitarian argument is utterly irrelevant. As it happens I take folic acid pills for a medical condition so I have nothing against the stuff myself but that does not change the fact the state has NO moral right to medicate me in such a way and anyone who trusts the state to pick ‘what is best’ for your health and make it a force backed law really needs to take a look at the state’s history of screw-ups and ask themselves is this is an institution which should have the right to mess with your personal body chemistry.
The most striking recent example of the state’s – in this case numerous states’ – medical expertise is the exaggeration of the threat of AIDS in Africa. A report in the Washington Post – hardly a hotbed of racist redneckery – makes it clear that the governments’ lies and utter incompetence have been responsible for the misuse of billions of dollars in resources and the mistreatment of thousands if not millions of patients. It’s simply murder.
Hold on. I am not sure you can make quite such a sharp distinction between risks of infectious diseases and non-infectious things. Both are weak to the “medical science changes” argument although the benefits of immunisation in nearly all individual cases outweighs the risks. Surely, it remains up to the individual to decide whether to accept a vaccine, whatever the government wants or desires. If people are allowed to take those decisions for themselves then for the most part, they will make decisions that are sensible and the collective action problem will be solved without resorting to strong arm tactics.
As for the malerial marsh problem, surely it isn’t really a problem of the existence of a marsh on private property but on infectious creatures wandering away from the marsh and infecting people? So it would be the equivalent of being responsible for a wild dog on the loose outside of one’s land and therefore it would be reasonable for people to intervene.
Libertarian rights has an answer for everything, even hard cases such as these.
Nic
This isn’t the case. Even if only a small proportion make the “wrong” decision and fail or forget to immunise their children, then the risks to the whole population increase dramatically.
The state should be able to force people to be vaccinated against dangerous infectious diseases. Remember the debacle of MMR?
Non life-threatening diseases such as tooth decay are harder to call. On the one hand, it is of no concern to me if my neighbour chooses not to put fluoride in his water, but it does become my concern if i have to pick up the resultant dental bill.
Non life-threatening diseases such as tooth decay are harder to call. On the one hand, it is of no concern to me if my neighbour chooses not to put fluoride in his water, but it does become my concern if i have to pick up the resultant dental bill.
No, pommy granate, you should not have to pick up his dental bill so his decisions should be of no concern of yours. No national health systems. Private. Capitalism will sort it out. Your neighbour is responsible for himself and his family, not me and mine.
The state has also prevented private sellers from adding nutritional supplements to foods in a apparently vain attempt to force people to eat “correctly.” In the past, manufactures have tried to fortify everything from bread to snack foods only to be shot down by regulators.
Perry is right. The state should only be able to use compulsion in a case where everybody’s health is at stake.
The problem is that if you have taxpayer funded medical care then an individual’s health becomes everybody’s financial concern and creates a justification for putting folic acid in bread or fluoride in water. Verity is right, there should be no national health systems and therefore no justification for this sort of interference.
What intrigues me is how societies should regulate the use of antibiotics viz. the problem of improper use increasing the chance of resistant strains of bacteria?
Robert Speirs says: Surely, it remains up to the individual to decide whether to accept a vaccine, whatever the government wants or desires.
That would be the case.
Resident Alien – that is indeed worrying. The improper use of antibiotics, to please the patient and get him out of the doctor’s office – is a hazard to everyone. This is why there should be no government involvement in medicine. Governments want to please voters.
Resident Alien,
With antibiotics, the owner of the patent should be trusted to manage his product in a way that will maximize its value. Some will flood the market and soon have a useless and worthless product. Some in the course of maximizing its value will choose to have it used cautiously.
The owners of the antibiotics would have to be permitted recourse against someone who violated the patent owners terms of use.
One way to modify incentives for either ‘burning up’ an antibiotics usefulness or sustaining it is through adjusting the length of a patent.
There are some minor technical issues unrelated to the economics of drug supply here.
Reckless prescription of antibiotics may or may not degrede the longevity and value of the patent, but it also tends to result in antibiotic resistant bacteria. This is a problem not just for the patent owner but also, and rather more pressingly, for medicine and the wider treatment of disease.
It should also be noted, pace Verity, that reckless prescription of antibiotics has been in the past a feature of both state and private medical systems. Politicians may want to please voters, but doctors also want to please patients, companies want to please shareholders, and so on. The issue is not one of capitalism.
EG
Not that i necessarily disagree with the content but perry’s post reminded me of the crazy general in Dr Strangelove.
However i too don’t want the state messing with the purity of my “essential bodily fluids”
“Non life-threatening diseases such as tooth decay are harder to call. On the one hand, it is of no concern to me if my neighbour chooses not to put fluoride in his water, but it does become my concern if i have to pick up the resultant dental bill.” – Pommygranate
Pommygranite what should concern you is if the state wishes to put fluoride, (a toxin), into both you and your neighbours water supply. Tooth decay would be th least of your worries. Hey you might be dead, but at least your teeth might look good …
“Few things are as impermanent as medical theories of ‘what is best'”: spot on. Does anyone know of cases of people suing governments for having been mass-medicated in a way that is now deemed to be harmful?
So Perry is upset because the commies are messing with his precious bodily fluids. Fortunate he’s a blogger and not a SAC general!
I think you’ve missed something in the argument here.
If, after a few years of reckless over-prescribing, the antibiotic is rendered ineffective due to new strains of resistant bacteria evolving, then nobody will want to buy the drug and the patent owner can’t make any more money out of it. Therefore, the patent owner has an incentive to ensure that he only licenses the drug to people who agree not to over-prescribe.
I’ve no idea how strong that incentive is, though. It would be limited by the fact that patents are not granted indefinitely.
All this massive, hideous, grotesque interference by the state in other people’s lives and bodies is directly attributable to nationalised health service. It’s all about people “not being a drain on the service”, so they have to be commanded how to run their own bodies.
Now the government is trying to interfere with supermarket packaging and graphics by forcing them to colour code, on the pack, for levels of fat, sugar and god knows what else in the product.
The NHS has been the road to tyranny in the UK and it may be the most dangerous establishment in the country.
And also, more importantly, you get a strain of bacteria resistant to antibiotic treatment. The medical implications of overprescription far outweigh the commercial considerations.
Why do you think methicillin-resistant staphylococcus aureus is a problem? Is it more or less important than the ability of durg manufacturers to make a longer term profit on their product?
EG
That is presumably why America has had folic acid fortification of a range of foodstuffs for the past decade, I suppose?
EG
Andy Wood understands. To add to that, no antibiotic is effective indefinitely unless the disease is erradicated totally. In which there is no more need for antibiotic against that disease. And if there was, it’s still available.
No antibiotic can remain effective indefinitely. The pace of resistance selection can be effected by the way it is prescribed, but sooner or later resistant strains will be selected for.
The patent owner will have every incentive to preserve the value of his product while still selling it.
Again, you seem to have missed the argument.
The possibility that over-prescribing will bring such strains of bacteria into existence and so reduces the patent owner’s profits is what gives the patent owner an incentive to limit over-prescription.
In other words, to maximise his profits, the patent owner has to limit over-prescription, which is what you want him to do.
Or are you claiming that some of those bacteria will be resistant to other antibiotics in addition to the one which was over-prescribed? In which case, I agree, there is an additional externality there that a patent wouldn’t correct.
The issue in relation to infectious diseases is one of so-called ‘herd immunity’. If the proportion of the general population not vaccinated/immunised falls below a certain level then the disease can take hold and spread. Failure to accept vaccination/immunisation in those circumstances puts others at risk. This is a matter of fact, not judgement.
If you do not accept compulsion in this case, the only other courses of action available seem to be expulsion or house arrest.
On a separate aspect, ‘birth defects’ can be a collective threat as Verity took great pains to point out in another thread when she called for a ban on cousin marriages. It pains me to say it, but she is probably right in this instance, and this is an area where state action is justified. Given greater levels of genetic knowledge we could probably screenout defective combinations and so accept marriage between even closer relatiosnhips- at least genetically – as Heinlein never ceases to remind us.
This is exactly what happens. Also, there is increasingly no other remedy because the production of new antibiotics is very difficult – not least because although many things kill bacteria, they often also kill humans – and this is nothing to do with patents, state involvement or foolish marketers, but rather the limits of biochemistry.
EG
A ban on marriage between first cousins would obliterate 30% of the birth defects in Britain and it is outrageous that this is not being done because these are “a drain on the NHS” – in other words, the most important crime you can commit in Britain today. On the other hand, this drain is being perpetuated by a protected species, so it’s a really tough call for the Trots and Marxists that make up the British government.
The news, in Perry’s post, that people should be forced to introduce a substance into their bodies in order to prevent some moron from having a kid with an easily avoidable birth defect is surreal. This is such a vivid illustration of what happens when you take responsibility away from people and give it to the all-powerful daddy state.
The NHS is how they manipulated outlawing smoking on private premises. Now, as I mentioned above, they want colour coding sugar/fat/whatever content on food packages. Food packages already have all that information on them. For morons who can’t read that extremely simple information, or can’t be bothered to read it, frankly, I would just as soon they got sick and died anyway. And what makes these little bossy boots (it’s bound to be one of the women ministers proposing this crap) think the twerp class is going to memorise the colour code. Hmmm, does pink mean “90% sugar” and blue mean “This product is pure fat; you will love it”, or is it the other way round? Tesco has told the government to go and stuff itself, but they will lose. Needless to say, Sainsbury’s can’t wait to cooperate. The government will win. In the cause of “conserving NHS resources”.
The NHS is a grotesque outfit.
Birth defects are NOT a collective threat. If my child has spina bifida, you cannot catch it from him. It is a several, not collective, issue.
Birth defects only become a ‘collective’ issue if they are caused by something unnatural in the food chain or some such (such as a toxic waste dump leeching into the water supply… in which case it is just like an infectious disease and does become a collective issue).
and this is nothing to do with patents, state involvement or foolish marketers, but rather the limits of biochemistry.
Nonsense, bacteria make quite juicy targets in comparison with trying to kill a virus or a cancer cell. The problem is that while the medical establishment accepts a cancer or HIV treatment costing £30,000 a course, the notion of an anti-bacterial being worth the same spending doesn’t occur, despite it in the case of MRSA being just as life-saving. They are just too used to penicillin at 5p a tablet. As such the level of research spending going into anti-bacterials is much less, and the sophistication of treatments correspondingly lower. As an example look at the fantastic success of HAART for HIV, MRSA presents a far easier target yet the drugs aren’t there, biochemistry is the last thing that should be blamed.
This is where the ‘like candy at a parade’ generosity of the patent office is the culprit. If two drugs have such a similar mechanism that resistance to one grants resistance to the other, we have to wonder if the second patent is truly different enough.
I didn’t say that all birth defects are a collective issue only that they can be. I don’t think spina bifida is one of them any more than say talipes. In addition it is often difficult to separate genetic from environmental causes – asthma is I suspect such a disease with multiple causation.
I should have known better than to give Verity an excuse for a rant however.
This begs the question of whether it is possible to arrange the incentives of patent examiners so that they don’t issue too many patents. I don’t have an answer to that one.
EG is right.
Reckless prescription of antibiotics may or may not degrede the longevity and value of the patent, but it also tends to result in antibiotic resistant bacteria. This is a problem not just for the patent owner but also, and rather more pressingly, for medicine and the wider treatment of disease.
Indeed, which is why I do favour controls on the use of antibiotics, though I think narcotics ought to be freely available. A body full of improperly administered antibiotics is the moral equivalent of the malarial swamp Perry alludes to in the original article.
Regardless of the damage to public health by breeding resistant bacteria, it is simply not true to say that:
If, after a few years of reckless over-prescribing, the antibiotic is rendered ineffective due to new strains of resistant bacteria evolving, then nobody will want to buy the drug and the patent owner can’t make any more money out of it.
People do buy (or in socialised systems insist that their doctor procure for them) antibiotics which are entirely ineffective and serve only to increase generalised bacterial resistence, when they demand them for viral infections and other non-bacterial maladies.
Verity,
A ban on marriage between first cousins would obliterate 30% of the birth defects in Britain…
No; 30% of the recessive genetic disorders, as we discovered investigating that same assertion on the other thread aforesaid. Most birth defects are not recessive genetic disorders.
OK, it would get rid of “the drain on the NHS” of recessive genetic disorders that are manifested by successive generations of first cousins marrying.
The NHS is a grotesque outfit.
Verity, I assume you were born on the NHS. I know I was. The NHS has also scrapped me up from the road following an RTA, saved my life at least once and the only reason I’m typing this now is because the NHS fixed my wrists when I fractured simultaneously both scaphoid bones. There are an awful lot of statist shennagins I object to paying for, but a free at the point of demand healthcare system is not one of them. Can it be run better? Obviously it can. Can it make more use of private enterprise? Of course it can. But I for one would not be around to debate the point if it wasn’t for the NHS. I don’t want to be forever fecking around with private insurance schemes with their wavers, get-out clauses and “you pay the first 15%”. The alternative is very simple. A portion of our taxes goes towards providing everyone with something everyone will need sooner or later. It’s very simple and remarkably cheaper than the spectacularly bureacratic system they have in the US.
Even so, the evolution of resistant strains of bacteria will still reduce demand for the antibiotic, even if some ignorant people use them to treat viral infections. It may reduce, but won’t necessarily eliminate the incentive on patent owners to prevent over-prescribing.
I’m interested in the cost-effectiveness of the measure.
How much will it cost to put all this folic acid in our bread/flour. How does this compare to the cost (to society) of the medical problems we currently have that would be prevented by such “putting in”.
I don’t know, but I found an old envelope and …
Let’s just consider the bread. If it costs 2p (£0.02) per loaf, and we, on average, eat one loaf each per week, and there are 59 million of us so eating, that comes to a bit over £61million. [A nice little earner for those in the folic acid business. But perhaps such thoughts are unkind.]
Now, if we assume that 100% of those 900ish spina bifida babies per year then don’t happen (and all the other benefits are ignored), the cost per baby “saved” is a smidgeon over £65K. And then we have the fact that only somewhere between 40 and 370 of those 900ish babies would be “saved”. [That takes the cost each to between £165K and £1.5M.]
[Please do all feel free to come back with a more informed and accurate cost-benefit analysis, even that already done by the Government.]
Now, £165K or so might well be good value to the nation, compared to the actual cost (above that for a healthy sprog) of bringing up a spina bifida one. [Again, do we have any more accurate figures?] However, might there not be, for a lesser sum than £61M or so, some other way of finding and medicating most of those with a combination of pregnancy and dietary deficiency?
Best regards
How much will it cost to put all this folic acid in our bread/flour
A million quid according to this.
Of course that is just the cost of the raw material, what they don’t cost is enforcement and the awareness campaign that is recommended regarding vitamin B12. But whatever the expense, it still comes down to what Perry states in his original post, government should not be interfering with my personal body chemistry.
@Nigel Cooper: Thank you.
That is £500K to £1M per annum, as the total to be paid by the government, according to the FSA.
Presumably too, there will be no significant costs to be borne by the consumer, under effective legal compulsion through lack of folic-free competition.
Then I must agree that that makes my back-of-the-envelope figures very pessimistic, and makes the concept look much more cost-effective.
Best regards
Apologies, Noel.
Noel Cooper – correct. All this fiddling around with figures is trivialising the critical issue – the government is contemplating putting something into your body against your will. In the name of NHS “resources” – meaning the tax money extracted from you under pain of imprisonment and spread around lavishly and recklessly by unaccountable people.
The NHS must be destroyed and people forced to take responsibility for their own health and their own pregnancies. If the doctor tells you to take folic acid, take the folic acid for god’s sake, don’t expect the ship of state to be put at your service by forcing the entire population to ingest folic acid possibly against their will.
This is so Brave New World, yet other people here don’t seem to share my horror. Just Perry and Noel Cooper. Everyone else is picking nits about costs and patents, as though those were the issues.
The NHS must be destroyed and private systems allowed to spring up – including private charities that want – of their own free will and raising their own funds – to run cheap medical facilities for poor people. There should be an entire spectrum of private health care available at all levels, and government facilities do not have any role to play.
Guy – don’t bother arguing with [killfile]Verity[/killfile] – the grounds of the argument will shift faster than a F1 car.
But what does that mean? I too have used the NHS on the theory that as they force to to pay for it and will not let me take that money and opt out of the whole system, I might as well try and get some of my stolen money back by using it. Yet does that mean I should not dislike the NHS because it ‘saved me’ too? Does that mean if the NHS was not around, you assume there would be no medical care at all??? Had these things happened to you in, say, the USA or Switzerland, are you under the impression that no one would treat you?
The French system consistently comes in even with the American system in rankings and that is state-funded, but it treats the patient like a customer. Individual clinics, diagnostic labs, hospitals and so on vie for trade; they’re welcoming and courteous and that gives the patient a superb choice and excellent treatment. It is still, though, funded on the tenet that most people would be too feckless to provide for their own health care and is thus just as paternalistic as the dreaded NHS.
In addition, because it is so good, and free, people overuse it and there is a lunatic over-prescribing of drugs. So the government’s started keeping computerised tabs, via the pharmacies, on which doctors are dishing out too many prescriptions and they get a visit from the man from the Ministry.
While France does illustrate what can be done with intelligent application, it is still funded on the communist system and is thus wrong.
At the risk of violating Godwin’s Law might I suggest that “cost effective” and “morally sound” are not synonyms.
It would appear that for some libertarians at least “cost effective” is the definition of “morally sound.”
EG
I can just smell that home made [folic acid free] bread baking already
It would appear that for some libertarians at least “cost effective” is the definition of “morally sound.”
EG
So you’re saying that wasting other people’s money, taken from them at the point of a gun, is not morally unsound?
The problem is in the taking, not the wasting.
Actually, I’m saying there’s more to life and morality than pounds, shillings and pence.
What is it with you guys and “men with guns?” Yes, tax law is ultimately enforced at gunpoint, but ALL laws are ultimately enforced at gunpoint. This includes the laws preventing shopkeepers giving you short measure and the laws preventing someone deciding for himself which side of the road he should drive on and how fast, and for that matter the laws defining your rights over your property.
The state has no monopoly on wasting other people’s money, and private companies manage to do this on a regular and sometimes spectacular basis. Enron? Savings and Loans scandal? South Sea Bubble?
EG
@Midwesterner, who wrote: ‘At the risk of violating Godwin’s Law might I suggest that “cost effective” and “morally sound” are not synonyms.’
and @EG, who wrote: ‘It would appear that for some libertarians at least “cost effective” is the definition of “morally sound.” ‘
I think I would like to argue that the “morally sound” needs to be “cost effective”. Doubtless some others will not agree, and I see that their case might have merit enough for reasoned argument.
I would not like to argue the case the other way round (which seems to be implicit in EG’s understanding of what I wrote), and so obviously not both (which seems to be Midwestener’s point).
Actually, I wrote neither.
Concerning what I did write, it was an “acceptance” of the FSA’s figures on cost of the folic acid addition to UK flour production, as given in Noel’s link to “http://www.food.gov.uk/multimedia/pdfs/folicacid_disease_annexa.pdf”
Actually, it still strikes me as very surprising the one can buy (even in bulk) at a price of less than £0.02 (2 pence) per person per annum, enough folic acid to dope (without explicit cooperation) everyone sufficiently to have a material effect on the occurrence of spina bifida.
However, if Professor Sir John Krebs FRS (erstwhile Chairman of the FSA) is willing to attach to that view, his professional credibility, I will think carefully and research further before calling him out.
Best regards
If my fag-packet arithmetic is right, then at an RDA of 400 micrograms per capita per diem the total needed to dope the entire British population to 100% RDA is some 8.6 tonnes per annum. If the raw material cost is £1M, then the stuff costs an impressive £116 per kilo.
Incidentally, America has been doing this for the best part of a decade and has apparently seen a 25% reduction in spina bifida cases.
EG
Under this plan, how much will it cost to NOT have folic acid in your bread?
For those entitled to not have it, is this cost effective?
There is an implicit acceptance here of a government right to deny this alternative.
I just went and looked at my bread wrapper. No folic acid listed anywhere.
I understand that in America one can buy fortified or non-fortified bread, so you get the choice of taking on extra folic acid. I believe the British proposal is to add folic acid to white bread and white flour, so one can avoid it by buying wholemeal breads and flours.
However, the FSA is embarking on a consultation process to cover four options, of which mandatory doping of certain products (as in American practice) is only one and the most extreme. The others are: do nothing; encourage women to take supplements and/or improve diet, and encourage further voluntary doping of certain foods.
Have a look here for a history of the FDA process on folic acid doping.
EG
And see here the 1996 FDA press release which, inter alia, lists the foods which are fortified.
EG
Yes, tax law is ultimately enforced at gunpoint, but ALL laws are ultimately enforced at gunpoint.
An argument that does not differentiate between just laws and unjust ones, however.
The fact that law is enforced does not in and of itself make law unjust.
EG
The fact that law is enforced does not in and of itself make law unjust.
Thanks for stating the obvious.
Try this, then: the fact that taxation is taken at the point of a gun does not make taxation unjust, because all laws are so enforced.
EG
Euan Gray makes me regret Kodiak, who at least had an off-centre sense of humour and a fetching, bonkers panache. Even if he constantly, and irritatingly, disrupted threads, he wasn’t a plodding lecturer and stater of the mind-bogglingly obvious.
Hovis
There’s plenty of fluoride in our tap water. In fact it turns out there is even an organisation that has set up to prevent the addition fluoride to water.
I must (unusually) agree with Verity on this one. There seems to be a lack of urgency here in wanting to dismantle the NHS, a monstrous machine that needs ever more of our taxes to sustain itself.
The paternalism of this govt and of the NHS (e.g. food labelling, banning smoking etc) is taking the responsibility of looking after themselves away from the individual and onto the state. Consequently if people become fat or their teeth fall out, they do not blame themselves for their own poor diet but they blame the govt for failing to properly alert them to the dangers.
“properly alert” them, Pommy? Or properly “forbid” them from pursuing their dangerous and outlawed habits? If they weren’t forbidden, it wasn’t their fault! So the establishment that failed to ‘forbid’ them is at fault. Nothing is anyone’s fault in the happy land of Tony.
Try this, then: the fact that taxation is taken at the point of a gun does not make taxation unjust, because all laws are so enforced.
Indeed, And recall that in any society, the laws are tacitly accepted by most people because they make sense. With punitive taxes, however, they undermine respect for the law. It is usually deeply oppressive, stupid laws that have to be imposed by violence, Euan.