... to save the NHS, says Ed Miliband.

My first thought was, gosh, that's nice, three months in which to kill it. I suspect that I am in a minority: the outpouring of love, loyalty and vows to defend the NHS unto death coming from the Guardian commenters to this report and to Miliband's own article resemble nothing so much as the frenzied cries of "Deus vult!" that greeted Pope Urban II when he declared the First Crusade. I further suspect that when it comes to this issue the knights of the Guardian would indeed get support from the peasants of the Sun and the Daily Mail.

Heigh-ho. Just for the record, I shall repost an article that is now more than ten years old. It is by Anthony Browne, once Health Editor of the Guardian's Sunday sister, the Observer, and at one time a passionate supporter of the NHS:

Even as you read this, in almost every hospital in the country, there will be elderly, vulnerable people left for hours and sometimes days on trolleys. Each year, thousands of British people - the young, the old, the rich, the poor - die unnecessarily from lack of diagnosis, lack of treatment and lack of drugs. They die and suffer unnecessarily for different reasons, but there is just one root cause: the blind faith the Government has in the ideology of the National Health Service, and our unwillingness to accept not just that it doesn't work, but that it can never work.

This morning I was prodded by the scourge of epidemiocracy, Chris Snowden, to read this piece by Theodore Dalrymple. What most struck me was not the main argument (I find predictable agreement almost as wearing as disagreement) but this piece of supplementary information:

A higher proportion of the Dutch population smokes than average for a developed country (27 percent), and fewer Dutch people are aware of secondhand, or second-lung, smoke — that breathed in from other people’s tobacco — than any other comparable country.

Why should that be? I think it demands an explanation. Certainly the Dutch population cannot easily be classed as ill-educated or poorly-informed. (I have been sworn at by a drunk tramp on an Amsterdam tram who switched instantly to English invective when he realised that it was going to be more effective in my case.) My mind leapfrogged towards ideas about the Dutch liberal tradition. They choose not to know, because they do not like to hassle people about their private behaviour, perhaps...

Unfortunately there are no sources quoted. When I looked for stats and background info, I found something even odder. That remarkable factoid contains no truth.

The OECD statistical library agrees with that 27% average - if it is actually daily smoking for males 15 and over. But it places The Netherlands fractionally below average, equal with Germany and slightly above Belgium for the proportion of males who smoke (26%), with slightly more women than either (20%).

How about "awareness of second-hand smoke". The points in the article about "relatively high" Dutch smokishness appear in less critical articles such as this one in Salon. (Which itself hints that it relies as a source on one Lies Van Gennip, director of the national tobacco control center.) Here we have a hint of the source for the "awareness" figure.

In a global survey on smokers’ awareness, only 61 percent of Dutch smokers agreed second-hand smoke was dangerous to non-smokers — much lower than smokers elsewhere, including Mauritius, China, Brazil and Mexico.

“Dutch smokers are among the least informed about the harms of smoking and second-hand smoke,” said Geoff Fong, at the University of Waterloo in Canada, who heads a program that monitors smoking policies worldwide.

Note the built-in interpretation: failure to agree counts as being ill-informed. I googled down the global survey mentioned. It appears in the BMJ for 4 April 2011 under the headline "Dutch smokers are "alarmingly" ignorant of harms of passive smoking, study finds." The original findings do indeed appear under the aegis of the University of Waterloo here (pdf) But are published on behalf of 'The International Tobacco Control Policy Evaluation Project: ITC Netherlands Survey' — the presentation of which suggests it is intended to drive Dutch policy, and the naming of which suggests we should worry about that 'global survey' point. Some (more) cherry-picking, perhaps?

Inspecting a bit further suggests there is reason to worry. See here. The ITCPEP doesn't do a global survey. It surveys different countries at different times using different methods. The most recent French survey (2009) was a telephone poll with respondents reimbursed; the most recent Dutch one (2011) was an online survey. The critical common question is not "Do you think your smoking harms others?" but "How often, in the last month have you thought about the harm your smoking might be doing to other people?" In both surveys, the critical question is preceded by questions about respondents' attempts to give up and their degree of addiction, but in the Dutch survey that is the beginning. In the French survey there is much prequalification apparatus including emphasis of the importance of the survey itself, and information sought about the individual respondent's household. Longitudinal comparisons on a single country might make sense if individual surveys are consistent; but comparing attitudes in two countries on this basis does not.

We know nothing from the ITCPEP about the beliefs of either Dutch or French smokers concerning the dangers of environmental tobacco smoke. They were not asked. But we cannot even compare their relative preoccupation with whether they may be harming others—what they were asked—because they were asked at different times, in different ways, in different contexts.

The only reason for making the comparison in the first place was to condemn Dutch views as "ignorance", but even the variance in views is a pseudo-statistical phantom, if you can be bothered to look into the detail.

I am interested in variation in public attitudes and in political culture and their relationship to policy. But it is devilish hard to find out about those relationships when even critical discussion, such as Dr Dalrymple's, is predicated on 'facts' whose selection and interpretation is determined by the attitudes of interested researchers. Even specialist commentators are seldom suspicious enough to do more than re-word the press release and cast it in the light of their own attitudes.

Even as supplied by an unscrupulous underground market and taken blind by consumers in a variety of unsuitable ways, they really aren't very dangerous:

According to the ONS data, in 2010 there were more helium deaths [32] than cannabis, ecstasy, mephedrone and GHB related deaths put together.

'Helium?' you may ask... It's classed as a drug but no, it doesn't do anything. But it is so hard to buy anything reliably lethal in the UK that helium is a sophisticated means of self-asphyxiation for suicide. So even those 32 cases should not be classed under malign side effect of drug-use. Death in those cases was a positive result.

Say what you will about the environmentalist and Guardian columnist Mr George Monbiot - not, apparently, the prototypical moonbat but merely a moonbat - he does have integrity. I have no doubt his recent conversion to a belief in the benefits of nuclear power cost him many friends in the green movement.

This article will not win them back. In it Mr Monbiot and Justin McCurry write that

The Green party's former science and technology spokesman is promoting anti-radiation pills to people in Japan affected by the Fukushima nuclear disaster, that leading scientists have condemned as "useless".

Dr Christopher Busby, a visiting professor at the University of Ulster, is championing a series of expensive products and services which, he claims, will protect people in Japan from the effects of radiation. Among them are mineral supplements on sale for ￥5,800 (£48) a bottle, urine tests for radioactive contaminants for ￥98,000 (£808) and food tests for ￥108,000 (£891).

and

Launching the products and tests, Busby warns in his video of a public health catastrophe in Japan caused by the Fukushima explosions, and claims that radioactive caesium will destroy the heart muscles of Japanese children.

He also alleges that the Japanese government is trucking radioactive material from the Fukushima site all over Japan, in order to "increase the cancer rate in the whole of Japan so that there will be no control group" of children unaffected by the disaster, in order to help the Japanese government prevent potential lawsuits from people whose health may have been affected by the radiation. The pills, he claims, will stop radioactive contaminants attaching themselves to the DNA of Japanese children.

Regarding that claim, Monbiot and McCurry write:

Gerry Thomas, professor of molecular pathology at the department of surgery and cancer at Imperial College, London, describes his statements about heart disease caused by caesium as "ludicrous". She says that radioactive elements do not bind to DNA. "This shows how little he understands about basic radiobiology." Of the products and services being offered, she says, "none of these are useful at all. Dr Busby should be ashamed of himself."

UPDATE: George Monbiot has also put up a blog post on Christopher Busby in the Guardian Environment section. There is fierce debate in the comments between pro-and anti-nuclear Guardianistas. Meanwhile the Green Party have made no statement on all this that I can see.

So, a company notes that its natural food product has scientifically documented positive health effects... and a bunch of underhanded bureaucrats underhandedly silences them:

Quote of the Day: "Experience should teach us to be most on our guard to protect liberty when the Government's purposes are beneficent." - Justice Louis D. Brandeis

Only an organization as evil as the FDA could manage to harm public health, free speech, and due process, with a single action.

The sample letter to Congress below explains how the FDA accomplished these things in the name of protecting you from . . .

Wait for it . . .

Walnuts!

But hey, is that not what we pay them for via our voluntary tax system?

“One curious and unintended consequence of the aeroplane ban [on smoking] was that airlines began to save money by changing the air in the cabin less frequently. Traditionally, this was done every two minutes and old air was never recirculated, but with no tobacco smoke to draw attention to the quality of air, the carriers reduced air changes to once every twenty minutes. This led to a musty aroma on board and, according to a report in The Lancet, contributed to the appearance of Deep Vein Thrombosis, a disease unknown in airline passengers until the 1990s.”

Page 163 of Velvet Glove, Iron Fist: A history of anti-smoking. By Christopher Snowdon.

Entirely selfishly, I am delighted that I travel in a smoke-free airline industry, although it is a shame that this change came about through the coercion of the state and not in reaction to consumer choice via a market. After all, there are many irritations involved in flying that might be amenable to a market solution, if it was available, such as screaming young children or patronising and idiotic flight attendants.

“Hitler remained closely involved with the crusade against tobacco to the very end. He banned smoking at his Austrian base, the Wolf’s Lair, and in the Fuhrerbunker in Berlin. In 1942, he voiced regret that he had ever allowed his troops a tobacco ration; a ration he would soon be forced to increase to boost morale when the war went from bad to worse. In 1943 he made it illegal for persons under the age of 18 to smoke in public places. A year later, with the Third Reich crumbling around him, Hitler personally ordered smoking to be banned on city trains and to protect female staff from second-hand smoke.”

“Hitler committed suicide in April 1945 and, after burning his body, SS troops lit cigarettes in the Fuhrerbunker for the first time. Within weeks, cigarettes became the unofficial currency of Germany, with a value of fifty US cents each. Hitler ultimately, if inadvertently, succeeded in reducing smoking in Germany but only by bringing the country to its knees.”

Pages 76 to 76 of Velvet Glove, Iron Fist: A History of Anti-Smoking, by Christopher Snowdon.

In Italy last week, where I holidayed, I also attended the ISIL conference with a great bunch of fellow libertarian conspirators, such as Kevin Dowd, Tom Palmer and Detlev Schlichter. One of the talks was by Mary Ruwart, who has worked for many years in the medical field and has first-hand knowledge of the destructive power of the US Food and Drugs Administration. She argued that the cost to life in terms of drugs and treatments that never got approved runs to several million people, far outweighing the likely number of deaths from drugs that might have dangerous side-effects.

As Ruwart said, one of the issues that comes up in any discussion about drugs are patents. She disapproves of them - she called the process of getting a patent a "game"; but at the same time she pointed out that if drug firms have no certainty of being able to recoup some of their research costs due to a patent, and those research costs are inflated by the FDA and other regulators, then abolishing patents without first removing such regulators would be bad. In my view, it would be disastrous.

I thought about her talk when I came across this rather lame article by the Economist, in which the publication wonders why US drugs are so expensive and why production of them has slowed. Wow, I wonder why that can be?

Update: the FDA has been carrying out an absurd attempt to hammer dietary supplements. US citizens who want to stop this nonsense can register their views at this site.

Felicity Lawrence. Describing her as a health dominatrix doesn't really work; some people find that fun. In this article, Why the new McDonald's menu won't make us thin, she writes:

The coalition government has chosen to cast public health as a matter of personal responsibility. It takes the classical liberal view that individuals should make their own choices, free from state intrusion. Nudging us to healthier choices is OK, but regulating is not.

On this liberal reading, the fact that your risk of being obese relates closely to your socio-economic status is not a question of social justice but a problem of the feckless poor being too ignorant or spineless to make good choices.

This is a dangerous misrepresentation. It conflates the right of the individual to freedom from interference with the right of business to the same freedom from government constraint. It ignores the fact that business intrudes on our choices constantly with its powerful marketing and sales strategies.

The part where she is projecting is the part I have put in bold type. It is Felicity Lawrence, not the supporters of a belief that individuals should make their own choices, who is conflating the right of the individual to freedom from interference with the right of business to the same freedom from government constraint. She is conflating the two rights so as to get her Guardian audience, generally hostile to business, to give up their residual hippy belief in freedom to do what one likes with one's own body in return for the quick thrill of an anti-business sugar rush.

Those who believe that individuals should be able to do what they like with their own bodies may also believe that businesses should be free from government constraint. I do. They are both freedoms. They are not the same freedom. I would say that the freedom to do what you like with your own body, and mind, and life, is the fundamental freedom - is, in fact, freedom. The specific freedom of businesses is merely an application of that to certain uses of your time and applied to specific types of groups.

I am a sarcastic cow, I am used to being a sarcastic cow and I am comfortable being a sarcastic cow. When the time comes to simply recommend an article in the Guardian my non-sarcastic mooing sounds all funny in my own ears. But, here goes: I recommend you read 'Freedom of information is for businesses too' by Heather Brooke.

A request by tobacco giant Philip Morris International has reignited concern about the use of freedom of information laws. The data it was interested in was collected as part of a survey of teenagers and smoking carried out by the university's Centre for Tobacco Control Research.

The UK's FoI law is meant to be applicant blind. This means anyone can ask a public body for official information and there should be no discrimination based on the identity of the person asking. In the case of scientific research conducted and funded in the public's name, there is a strong argument that the underlying data and methodology should be disclosed. It is precisely this transparency that grants research reports their status as robust investigations.

Taking a break from life in riot-torn London, I came across this item at the FT about some of the implications of longer lifespans. It is a mixed situation. Excerpt:

"Maxmin admits there are no miraculous solutions to the problems of a fast-ageing society. We will all have to work longer, save more and pay more in tax to cover the costs of a world with a greyer population. Even so, he thinks models like Elder Power can have a much wider application. Perhaps moments like the collapse of Southern Cross, he tells me, could (in the right hands) become moments of opportunity. More generally, models like Beacon Hill Village, ITNAmerica and Elder Power show glimpses of a future in which more elderly people can stay in their homes for longer. All three use innovative technology, make use of assets in their local community and bring together the resources of local businesses, volunteers and the state to solve problems none could have solved individually, at reasonable cost."

How we deal with ageing, and the issue of longer lifespans, is of course intertwined with the current fiscal breakdown of many developed economies. Healthcare costs are skyrocketing. And in that Greg Lindsay and John Kasarda book I have been linking to lately, about the impact of mass aviation, there is a segment on how said aviation can be used to dramatically reshape healthcare, such as by flying people with problems to cheaper, but arguably better run, hospitals in Asia. It struck me while reading this book that while automobiles and consumer electronics have been propelled by their Henry Fords, Michael Dells and Steve Jobses, we haven't really had, in healthcare, a similar set of individuals to drive innovation and push things sharply down the price curve. The dynamics of Silicon Valley, allied with cheap Chinese manufacturing and just-in-time stock inventory systems, hardly touches healthcare at all, although this is starting to change, perhaps. Of course, much of this is caused by how healthcare is seen, wrongly in my view, as somehow "different" from such vulgar things as selling flatscreen TVs or cars. Healthcare is political. That's the problem.

A few days ago Phlip Davies MP suggested that disabled workers or those with mental health problems could get work more easily if they had the right to voluntarily opt out of the minimum wage.

He said,

"Given that some of those people with a learning disability clearly, by definition, can't be as productive in their work as somebody who hasn't got a disability of that nature, then it was inevitable that given that the employer was going to have to pay them both the same they were going to take on the person who was going to be more productive, less of a risk, and that was doing those people a huge disservice."

Within hours so much outraged commentary flowed out of newspaper columnists, charity representatives and politicians of all parties, including Mr Davies' own, that you'd think there'd been an outbreak of indignation dysentery.

Let us look at a few of the responses.

"A lower minimum wage if you're disabled? Not acceptable, sorry," says Lucy Glennon in the Guardian.

"It is a preposterous suggestion," MIND spokeswoman Sophie Corlett was quoted as saying in the Yorkshire Post, "that someone who has a mental health problem should be prepared to accept less than the minimum wage to get their foot in the door with an employer.

"People with mental health problems should not be considered a source of cheap labour and should be paid appropriately for the jobs they do."

"Philip Davies's comments are another obstacle to disabled workers being treated as equal," said Paul Farmer, chief executive of MIND, writing in the Telegraph. He added, "He has caused offence to many people who work with a mental health problem and those who want to work on an equal footing, yet struggle to overcome the stigma they face."

Jody McIntyre in the Independent was also outraged. His suggestion that Members of Parliament should work for less than minimum wage was not bad, though. Of the mentally disabled, he said "A strong test of any progressive society is how it’s most vulnerable people are valued for their worth, rather than pitied for their faults. Philip Davies clearly places little value on the role of people with learning difficulties in our society; instead of celebrating their diversity, he chooses to reinforce the discriminatory myth that people with learning difficulties are more of a risk to employers."

There was more, much more. After reading loads of responses I noticed something that they all had in common... as not having.

Not one response of all the many I read even tried to argue that Mr Davies was factually wrong. They were outraged, disgusted. They asserted what no one denies: that mentally disabled people are equal citizens and often prove to be hardworking employees, valued by their employers. But I could not find one article that argued that Davies' description of the way things go when a person with an IQ of 60 or a history of insanity seeks a job was inaccurate, or gave reasons to believe his proposal would not increase their chances of landing one.

"Philip Davies is right, of course," says Tim Worstall. "But so profoundly unfashionable that no one will say so". He then goes on to argue that Davies is right. His views will not be purist enough for some libertarians, but the novelty of reading someone bother to put forward a chain of reasoning when talking about this topic is a bit of a thrill. The fact that he bothers to think about what will actually happen to disabled people, particularly mentally disabled people, under various scenarios shows a thousand times more compassion than the people whose response is mostly concerned with their own emotions.

A quote from Charles Murray: "It seems that those who legislate and administer and write about social policy can tolerate any increase in actual suffering so long as the system does not explicitly permit it."

Though a World Health Organization study concluded cell phones may cause cancer, some are wondering why, if their truly is a link, there not been a significant worldwide increase in brain cancers.

Go figure. But of course providing excuses for more regulations, and more funding for further studies, is the reason bodies such as the World Health Organisation exist.

The gradual but inexorable illegalisation of smoking is arriving at its end-game, as many bloggers of the sort I like have been complaining about, and no doubt as many bloggers of the sort I don't like have been celebrating.

Here is the Radio Times, describing a show done by Panorama last Monday (March 7th) entitled Smoking and the Bandits:

Criminal gangs are believed to be supplying half of all hand-rolled tobacco and in five cigarettes in the United Kingdom. ... their products are also up to 30 times more toxic than ordinary cigarettes.

I saw that coming in 1987. Under the bit in that pamphlet entitled THE BENEFITS OF ADVERTISING, AND OF PROPERTY (page 3) I wrote about how gangsters would, if the illegalisation process I was writing about even then continued, soon be running the tobacco business, supplying "these now genuinely lethal products". Not that I was alone in possessing these prophetic powers. Just about every libertarian then writing saw this coming. Illegality equals toxicity. You merely had to apply what everyone already knew about other drugs markets that already were, even then, illegal, or for that matter acquaint yourself with a one page summary of the story of Prohibition, and the pattern of future events, if they insisted on continue to bear down on smoking with the force of law.

But going back to that bit in the Radio Times, where I put "…" above, it also says this:

However, not only are the criminals depriving British taxpayers of £4 billion in revenue, ...

That's right, there goes the exact same warped logic as Natalie Solent noted in her posting earlier today, immediately below this one. No, Radio Times, depriving taxpayers is what you do when you tax them. These "bandits" are thriving because, unlike our tyrannical government, they are not doing that.

It seems that the commenter quoted by Natalie is mistaken. It is not "only in the mind of Ms Lucas" that such warped thinking is being thought.

I believe I am the senior Samizdatista, in years if not in eloquence or influence. And one of the privileges of advancing years is the right to inflict upon strangers the details of one's various medical infirmities and experiences. I can't, yet, quite manage the truly, Platonically essential, shameless way of doing this, which is: in a very loud voice on the top deck of a double-decker bus. But, a blog is a satisfactory next best, so here goes. Stop whatever else you may be doing or trying to do, stop talking amongst yourselves, and listen to me.

A few months ago, a crown that had been attached to one of my disintegrating British teeth started to loosen, and about one month ago, this crown fell off. My non-British dentist advised that what remained of the real tooth was now useless and that it all should go. This was not a wisdom tooth; those are long gone. It was the next one in, top left. But I wouldn't miss it, said my dentist. If I did, an "implant" could be contrived.

So, a week ago now, the tooth was duly removed. The NHS had been asked to do something about all this, as soon as the crown had become loose. But not a peep was heard from the NHS in three months (apparently a whole clutch of letters due to go out had been delayed for some obscure reason – waiting lists?), so when the crown finally did fall off, I decided to go private. Had I been content to lie about how much it was hurting (in reality it only started hurting after the tooth had been removed), the emergency bit of the NHS might have obliged. But, forced to choose, I preferred buying to lying, and so, for £150, the date was fixed and the deed was done.

Local anaesthetics do away with almost all pain, but I can't get used to the notion that all that grinding and sawing is not hurting, and I love it when it ends. But taking out a tooth involves flesh, not just teeth. I had supposed that once the tooth had gone, any discomfort involved would end, but gouging out a tooth does damage. It does less damage if all of the tooth comes out in one go, but mine did not. After most of the tooth had been removed, a long, thin root remained, and further damage was done to my gum while that was dug out. So, not surprisingly when I actually thought about it, it was only when the local anaesthetic started to wear off that the serious discomfort began. The pain has by no means been unbearable, but it started out quite bad, and has still not truly abated. For a couple of days all but the smallest mouthful, the shallowest spoonful, involved a painfully slow wrenching open of the jaw. I am still chewing only with the other side of my mouth, not least because the hole takes time to fill itself in. Further dentistry may be required to this end.

Okay, so much for the shouting on a bus bit. Now it gets a little more officially Samizdata-esque.

Just before yanking my tooth out, the specialist tooth yanker who was about to do it handed me a bit of paper, which he asked me to read and then sign. It said that Tooth Yanker:

... has fully explained to me the purpose of the procedure(s) and has also informed me of the expected benefits and complications (from known and unknown causes), attendant discomforts and risks that may arise, as well as possible alternatives to the proposed treatment, including no treatment. The attendant risks of no treatment have also been discussed. I have been given an opportunity to ask questions, and all my questions have been answered fully and satisfactorily. I acknowledge that no guarantees or assurances have been made to me concerning the results intended from the procedure(s) which the above-named dentist or his/her associates may consider necessary.

I also understand the financial obligation attached to this procedure and
agree to comply as listed below.

Total amount due £................ ("150" filled in by hand)

I understand that I am responsible for all fees. I also understand that as treatment progresses the above fees may have to be adjusted, but that I will be informed of these adjustments and how they will affect my payment plan. In the event that my payments are not received by their due date I agree to pay all costs, including, but not limited to, reasonable agency/solicitors
fees.

I confirm that I have read and fully understand the above and that all blank spaces have been completed prior to my signing.

I hereby consent to the proposed dental treatment.

All of which was so, and I duly signed.

Underneath, there was a shorter declaration from Tooth Yanker, saying that he had done his bit, in terms of explaining everything and supplying any required answers.

Really just to make conversation, what with Tooth Yanker being young and Irish and the sort who seemed to want to make "relaxing" conversation, I asked him when this form first started happening. Because, I'd never come across this before. When those original crowns were put on the remains of my British teeth, which was much more complicated and surely just as hazardous, I don't recall signing any consent form. How long have these forms been around?

Tooth Yanker's answer surprised me. They have, he said, been around for about one week! This was only the second time that he had deployed such a thing.

Some "guidelines" had apparently been issued, and they were the kind of guidelines that, if you are a low-on-the-dental-pecking-order tooth yanker, you are firmly guided by.

It reminded me of a weird conversation I had with an unfamiliar doctor just after my mother died, asking me if I thought there was anything untoward about the care she had been receiving. At first I thought he was accusing us of having murdered our mother. But it turned out that he was just checking to make sure that her regular doctor had not murdered her. Doctor Shipman, you see. More guidelines.

Please do not get me wrong. I am not complaining, just reporting. This form was clearly intended to protect honest dentists against dishonest patients, and honest patients from dishonest or incompetent, or even evil, dentists. I certainly had no problem about signing it.

However, I can't help feeling that all this tells us something about the way that British dentistry is now heading, and perhaps British life generally.

It is becoming more private sector. This all coincided, remember, with me going private to have my tooth out, the NHS having ignored me. I'm guessing that the NHS is protected by all purpose laws which say that the NHS can do no wrong, not even if it does do wrong, in fact especially if it does do wrong. But the evil private sector? Well, patients must be positively encouraged to sue those evil people, mustn't they? These guidelines are the latest defence against this new atmosphere. I don't know, I'm just guessing. But that is my guess.

I connect this form in my mind with the rash of television adverts there have recently been about how, if you have been careless at work and had an accident (like: you slipped on a slippery floor), then instead of just suffering like an old fashioned person of the sort who Won The War, you can instead blame someone else for your foolishness and ruin their life too.

I connect this form with the big signs that you now see, wherever there is a slippery floor.

More generally, I connect this form with the signs that you now see on building sites, like this one, listing all the many foolish things that you ought not to do on a building site.

You miss the point if you think that these signs are merely there to alter your behaviour. They are also, surely, legal documents. I have started particularly photographing such signs (and signs in general), because signs are, I think, and especially now, signs of the times that we live in.

One can perhaps sum all this up by saying that British dentistry, and British life in general, is becoming more Americanised. As in: less socialistic, but much more inclined to litigate and hence frightened of the litiginousness of others. And although I think it rather harsh to blame America for the annoyingness of lawyers everywhere, such an observation does suggest one particular thing that may get seriously underway in Britain. In the short run, changes like those alluded to in this posting probably mean a lot of turmoil, grief and added expense (they certainly meant added expense for me). But, in the longer run, does all this spell the demise of British teeth? Will British teeth in two or three decades time all be immaculate and sparkling? Maybe so.

The NHS traditionally has been rather indifferent to demands for mere beauty. But if customers are going to have to get used to paying, that means that dentists will be spending more time doing what customers actually want. And one of the things that more and more customers want is not just functioning teeth but pretty teeth. All of this will be too late for me, but it is surely one of the ways all this is heading.

About half way through this, I stopped shouting, but then started rambling, which is the other talking privilege of advancing years. I have, in particular, rather muddled together the increased litigation thing with the way that British dentistry is now being denationalised. But actually, I think, the two things do go together. Both are about dental customers moving from a world in which they take what they are given and suffer, should suffering be involved, in silence, to a world in which they demand, sometimes rather nastily and expensively, what they want. In the past, you trusted, and hoped for the best. Now, you distrust, and demand it.

As with so many discussions of clashing interests, not least those of lawyers, form printers and sign makers, this one makes me think yet again of the point made by Leon Louw in this publication (now over two decades old, linking to ancient things being another privilege of advancing years) that the society in which everyone's rights and interests are taken seriously is the most difficult to legislate and litigate about.

"The struggle for definition is veritably the struggle for life itself. In the typical Western two men fight desperately for the possession of a gun that has been thrown to the ground: whoever reaches the weapon first shoots and lives; his adversary is shot and dies. In ordinary life, the struggle is not for guns but for words; whoever first defines the situation is the victor; his adversary, the victim. For example, in the family, husband and wife, mother and child do not get along; who defines whom as troublesome or mentally sick?...[the one] who first seizes the word imposes reality on the other; [the one] who defines thus dominates and lives; and [the one] who is defined is subjugated and may be killed."

The quote is from Thomas Szasz, psychiatrist and libertarian. The race to get your side's definition in first perfectly describes the frenzy of the left wing media establishment to link the murders carried out by Jared Loughner to the right, the Tea Party, and Sarah Palin. I posted about the contrast between Guardian columnist Michael Tomasky's haste to explain Loughner's murders and his reluctance to explain Nidal Hassan's murders here.

Over the last few days further evidence has emerged that Loughner was (a) simply a drug-addled madman, judging from his strange pseudo-logical screeds on YouTube and (b) had began to fix his mad rage on Gabrielle Giffords in 2007, after she gave what he regarded as an inadequate answer to his question, "What is government if words have no meaning?" At that time Palin was barely known outside Alaska.

A prescient remark from Thomas Szasz, then. Yet anyone who knows anything of his work and writings will have predicted that I am about to say that an apt quote is not his only relevance to this situation. Szasz is famous for opposing the many authoritarian crimes of the psychiatric profession: among them imprisonment without trial or appeal, assaults under the name of "treatment" (such as lobotomies, electric shocks, injections of drugs against the patient's will), and collusion with the state to define dissent and eccentricity as mental ills. All very great dangers and he was right to oppose them, as he was right to oppose the prohibition of drugs.

And yet - there is Jared Loughner and the lengthening list of those like him. Lougher was is (Why do I keep saying was? He is alive and in custody!) a drug-addled madman who killed six people. "He should have been locked up before this" does not seem an unreasonable thing to think.

Clayton Cramer is a former libertarian. His article Mental illness and mass murder contains food for thought. This 2007 post by Brian Micklethwait is also relevant. I would welcome your opinions.

WikiLeaks: Cuba banned Sicko for depicting 'mythical' healthcare system.

According to the Guardian (!):

Cuba banned Michael Moore's 2007 documentary, Sicko, because it painted such a "mythically" favourable picture of Cuba's healthcare system that the authorities feared it could lead to a "popular backlash", according to US diplomats in Havana.

The revelation, contained in a confidential US embassy cable released by WikiLeaks , is surprising, given that the film attempted to discredit the US healthcare system by highlighting what it claimed was the excellence of the Cuban system.

But the memo reveals that when the film was shown to a group of Cuban doctors, some became so "disturbed at the blatant misrepresentation of healthcare in Cuba that they left the room".

Castro's government apparently went on to ban the film because, the leaked cable claims, it "knows the film is a myth and does not want to risk a popular backlash by showing to Cubans facilities that are clearly not available to the vast majority of them."

Back in 2007 I mentioned a milder version of the same reaction among British people to Moore's depiction of "empty waiting rooms and happy, care-free health workers" in the NHS.

UPDATE: Hat tips to commenters Jock and Alisa. The Guardian story has now been corrected to say that Sicko was shown in Cuba, confirmed on Michael Moore's own website. Pity. That was a fun meme while it lasted, but truth must prevail. Moore says that the cable was purely a lie. Not necessarily: indecision as to the "line to take" is not exactly unknown in totalitarian regimes. Both showing the film and forbidding it have their dangers from the point of view of the Cuban rulers.

This round to Michael Moore, but I shall defiantly repeat something I said in 2008:

When the history of Fidel Castro's rule in Cuba comes to be written all that stuff about the excellence of the healthcare system will turn out to be lies but the claim of high literacy rates will be more or less true.

Communist education gets results because force is near to the surface. I acknowledge but do not approve ... A further advantage of communist education is that the wishes of the teachers are given almost as short a shrift as those of the pupils.

Force works well in education because the forcers can look at the forcees all the time they are doing the forcing. It works less well in healthcare and very badly indeed in agriculture.

My id always said that an article by a Freudian therapist would be a sloppy half-cooked pizza of generalities and buzzwords, and this one in the Guardian by Darian Leader is much as expected:

Therapy occupies a unique space in the modern world. In a culture obsessed with surface and statistics, it allows the detail and narrative of a human life to be explored. Where society tells us what to be, therapy allows us to reflect critically on the imperatives that shape us. Challenging received notions of wellbeing and happiness, we can try to find out what is really important to us, often with life-changing consequences. It offers a system of values freed from the moral judgments of social authorities.

Then he whinges away about how his woo is going to be regulated, and throws in a couple of digs at the "market-led vision of human life" for good measure. While complaining about being regulated. Boo Woo Hoo.

There is only one thing stopping me having a really good laugh. His complaint is just. His concern is justified.

(And, unusually, Tim Worstall, whose blog is linked to by the word "woo" above, is wrong.)

If people, for reasons that seem good to them, want to pay to spend time with a therapist, what right does the Health Professions Council have to force the interaction into a tidy format of input and output? Who asked them to the party?

There seems to be a growing belief among our dear protectors that whenever money changes hands then their guiding presence is necessary. They generously allow us to speak more or less as we choose to our friends, lovers, and random blokes on the Clapham omnibus, but as soon as a cheque is written, they say, away flew an invisible invitation to make a threesome: me, you, and the government.

I see no logical justification for this. Some people might end up paying for therapy and then feeling they had wasted their money. That is sad. It is also sad that in my time I have wasted good money on dresses that looked bad on me, plays that I left during the interval, and exercise machines.

Come to think of it, money you can get back. Time is irrecoverable. I am still traumatized by the fact that in 1978 I watched 17 episodes of the original Battlestar Galactica thinking something interesting might happen. Some people who have experienced therapy say it was a waste of time; others say it saved their sanity. My only opinion on the matter is that the Health Professions Council has no right to an opinion on the matter. Certain clear categories of abuse or fraud by therapists have long been forbidden in law. If someone's beef with their therapist is big enough for them to sue, then the State might just have a role. Other than that, the bureaucrat should not intrude.

David Lucas, commenting on a posting at my place sparked by the fact that a relative of mine by marriage is celebrating her hundredth birthday today, pours cold water on the likelihood of serious life extension much beyond a hundred:

I believe increased life expectancy is due to decreased rates of death, initially in childhood, later on in mid-life and now in tackling old-age diseases. There is remarkably little growth in people living significantly beyond 100-110.

The future pattern is likely to be most people living to around 100 and then dying of multiple organ failure.

Which I find bleak, but convincing. You read about occasional people of long, long ago living into very old age even by our standards, even as you wince at the tales of multiple infant death, then and later. The statistics of how medicine and food and hygiene have affected life expectancy until now are surely just as Lucas says.

But does that mean that it will always be like this? Maybe, but maybe not. Maybe medical magic will trundle slowly onwards, from stopping half the babies dying, to stopping half the surviving adults dying with the onset of middle age, to stopping three quarters of the wrinklies from dying well before they are a hundred, to keeping everyone alive even longer, by means now not known about. Or perhaps now known about but not yet widely bothered about, because now too difficult and expensive, and crucially (to use a morbidly appropriate adverb), too uncomfortable.

In other words, the reason nobody now lives beyond about a hundred and ten is basically the same reason that nobody, two hundred years ago, ever travelled faster than a galloping horse. The techies just hadn't got around to repealing this seemingly fixed law of nature. And then, one day - puff-puff - the techies got that sorted, and a few people did start travelling at twenty, thirty, forty, a hundred, two hundred, three hundred, five hundred miles per hour, quickly followed by nearly everybody else who could afford it.

We'll see. Well, I probably won't see, but we as in humanity as a whole may.

And if people ever do routinely live to be four hundred or more, what will be the results of that? A crate of Tesco Viagra for whoever can come up with the most surprising yet likely consequence of mass super-longevity.

Doctor Zero:

ObamaCare is the most powerful job-killing force unleashed against our economy in decades. It dramatically increases the cost of labor, and applies huge fines against companies that resist its mandates. Companies such as Caterpillar, John Deere, Prudential, and AT&T responded by announcing thousands of layoffs. This is a perfectly rational reaction to a bill that dramatically increases the cost of labor, especially when the legislation keeps mutating and producing expensive new horrors, such as the nationalization of student loans that wiped out thousands of jobs at Sallie Mae.

I sort of get much of that, although I would definitely have to follow the second link to see how ObamaCare is nationalising student loans, and to find out what on earth "Sallie Mae" might be. But, speaking more generally about this huge furore, I have a real problem with ObamaCare. Not in the sense that it is causing me to lay off hundreds of my employees, but in the sense that I am finding the arguments about it very hard to follow. Mountains of verbiage have already been written about ObamaCare and many more will follow. But I am afraid I missed the early bits, where the actual blow-by-blow damage that ObamaCare will unleash (is now unleashing) was itemised, briefly and punchily. Anti-ObamaCare writers tend now merely to allude to the assumed harm of it, rather than yet again itemising it. Much is made by critics of ObamaCare of the immense length and complexity of the relevant legislation, which it seems most US politicians have no more read right through than I have. But what, approximately speaking, does it all say?

I suspect I am not the only Brit who feels this way. Not that long ago, for instance, I heard those comedians on Mock The Week take it in turns to denounce Americans for not welcoming ObamaCare, and I knew they were talking out of their smug and self-satisfied arses (especially that little bald one who is smug self-satisfaction personified, if you don't happen to agree with something he is saying). Death panels? No. It's free healthcare for those who can't now afford it, you obese God-frazzled morons. What could possibly be wrong with that?!? Do you all want to die prematurely of terrible diseases and accidents that the British health service cures immediately at no cost?

But had I been on the panel, trying to resist (in particular) the Smug Dwarf's relentless leftery, I don't think I would have done a very good job. Most Brits watching, if my reaction is anything to go by, either agreed that all American opponents of ObamaCare are indeed morons, or that they perhaps have their reasons for not wanting it, but that these reasons will for ever be a mystery, probably involving some Americanised version of God.

So, commenters, please fill me (us) in. Please help us Brits - this particular Brit especially - to wrap our brains around ObamaCare. What, briefly, are those "mandates" that Doctor Zero refers to? How are student loans involved? And what else is being inflicted?

I would like to be able to concoct a further posting entitled something like: "A brief but pretty much complete explanation for confused Brits of why ObamaCare is a really bad idea and why so many Americans are right to hate it". And maybe, with your help, I will be able to do that.

One particular request. What concerns me is not to dig deeply into any particular harm that ObamaCare is doing. What I seek is completeness, combined with as much brevity as can be contrived. In the event that I do manage that follow-up posting that I can now only dream of, I want an American to be able to wizz through it, and say something like: "Yup, that about covers it. That's why so many of us hate it. I actually don't think number three is quite as bad as your short description of it implies, and I think number five is far worse even than you say. But, nothing major is missing from that list. Good job."

Maybe such a posting already exists, and I need only read it, and link to it.

Or maybe (I've just been following the links in the quote above, just to check that they work), my question is wrong. Maybe what I really want is a brief guillotine-blow-by-guillotine-blow guide to the entire Obama legislative "achievement", of which "ObamaCare" is only a part.

Anyway, whatever help anyone can offer along these approximate lines would be most welcome.

Can anyone offer any confirmation or contradiction of this observation, which is one of the comments on this posting about the rights and wrongs of smoking bans:

One of the things I learned when going through insurance sales training was that life and health insurance companies do not take exposure to secondhand smoke into account at all when determining risk categories. Insurance companies have all sorts of super-detailed actuarial information for use in setting rates. None of this information shows any health risks associated with secondhand smoke.

I am actually a bit surprised if that is true. One of the reasons why there has been so much talk of "passive smoking" is that it makes such perfect sense that if smoking is very bad for you, smoke near you day after day would also be somewhat bad for you. This suggests no badness for you at all. Can that really be right?

This comment concerns the USA. I assume there is no particular arrangement there which actually forbids "passive smoking" being inquired into by insurance companies.

LATER: As I should have included in the above, the author of that comment also has a blog.

I used to be a matron but as a patient I was treated worse than an animal. That was one of the headlines in yesterday's Sun. I do mean headlines, too. Jean Emblen's account was not top story but it was right up there among the footballers' wives. The editor of the Sun thought the readers would go for a story criticising nurses.

When did that happen? When I was a kid everyone was all soppy over nurses. It was considered quite shocking when a 1970s BBC soap opera called, tellingly, Angels depicted them as less than angelic.

We can't simply attribute this loss in esteem to the NHS. For round about the first half century of the existence of the National Health Service, nurses continued to be loved by all (it is only fair to say there are plenty of people, including those with recent experience of the NHS, for whom that has not changed; a huge amount depends on the individual hospital). So what has caused it? Does it reflect reality - are nurses really not as good as they used to be - or is it just fashion, a last ripple from the wave that knocked politicians over in the 1960s and teachers in the 1970s?

One possible explanation is that nurses are no longer paid that badly. There is nothing like low pay for calling forth guilty affection. Once the pay improved people no longer felt they needed to make up the shortfall with love.

However my impression is that the downward trend on the nurse popularity graph best tracks the increasing moves for the nursing profession to become more... professional. It's all "nurse practitioners" and degrees these days, and being more like doctors. No one ever had any trouble hating doctors, once the thermometer went down. People think that nurses these days think themselves too grand to change a bedpan.

Is this charge fair? Lucky me: I don't know. You tell me. All I can say is that it would not surprise me if there was a tendency for both human contact and the dirty but necessary jobs to be de-emphasised in modern nursing, and maybe I can find a way to blame the NHS after all. It is what I would expect to see from an old command economy. Compared to most command economies, the NHS in its early years had a huge amount going for it: a sense of mission was in its collective blood. But as time as passed the blood has thinned, or done something else old and dry and sad that I lack the medical knowledge to build into my metaphor. (The blood of armies dries up in the same way, but then a war comes along and de-mummifies them. Or replaces them. ) An old and somewhat ossified organisation instinctively prefers its staff to have measurable, academic and relatively high status skills rather than unquantifiable, physical and and traditionally low-status ones. But no one was ever loved for academic skills.

In the US, I learn, there has been a similar move from plain old nurses to nurse practitioners, but if the American equivalent of the Sun has started on the anti-nurse stories then I had not heard about it. This might be because US healthcare is, for the moment, not provided by the taxpayer. At least, a lot of it is, but not so visibly. My impression is that the extravagant love for nurses in the past and the extravagant annoyance with them now are both British phenomena.

A simply astonishing story from Alex Deane of Big Brother Watch: Smokers harrassed - with the encouragement of a school, and the co-operation of the police

On one perfectly reasonable reading of this story, "harrassed" is too mild a term. The correct word is "assaulted". I am no lawyer, but this looks to me as though it could involve multiple crimes - not just assault but also theft, and encouraging minors to commit assault and theft, if those are separate charges.

Outrageously the fagins here are not underworld characters but the Hundred of Hoo Comprehensive School in Medway (cute name, shame about the Special Measures), Kent Police, and something called "A Better Medway", described as "a joint initiative between the council and NHS Medway that encourages healthy living". "A Better Medway" part-funded the project, paying for filming equipment.

According to This is Kent, quoted by Alex Deane, the first few filmed attacks featured stooges and then they went on to "other people". I can't quite figure out whether or not the"other people" were members of the public who participated voluntarily as "extras" in an admitted fiction or whether they were real victims. My spidey-senses are a-tingle with the suspicion of some hasty re-writing of history after hostile attention; the comments to the sycophantic This is Kent piece are gratifyingly hostile. Also, the video admiringly profiled in Kent Online has now been removed by the user.

Irrespective of whether the videos are real or fake, videos that show apparent assaults in an approving manner incite others to commit similar assaults on smokers for real.

Indeed, they incite others to commit any other type of assault that the attackers may deem is good for the victims. The law, of course, forbids people to rip the veils off Muslim women who go about swathed - though at least as many people the veils offensive as find cigarettes offensive, and there is a reasonable case to be made - as reasonable as the case for doing good by force being made by the Ciggy Busters - that having their veils ripped off might do them good in the end and help them kick the masking habit. The law also forbids incitement to such assaults. If I were to make a "burqa busters" video the police would be round in an instant, and the defence that everyone involved was only acting would cut no ice with the Crown Prosecution Service.

Why should not that law also apply in this case?

... so I would advise anyone of an even vaguely libertarian inclination who gets stressed easily to read no further.

This article by Felicity Lawrence, Nanny does know best, Andrew Lansley, displays the ideology of the Nanny State in an unusually pure and unapologetic form:

Can it be too that Lansley is not aware of all the literature about how individuals' "free choices" are shaped by marketing and advertising. Perhaps we should recommend some urgent remedial reading for his homework, starting with...

The Andrew Lansley for whom Felicity Lawrence is setting homework is the Secretary of State for Health. The fact that he consents to hold this position means that he too must be something of a statist, but nonetheless he recently said, "If we are constantly lecturing people and trying to tell them what to do, we will actually find that we undermine and are counterproductive in the results that we achieve." It is a measure of how deeply Nanny's rule has been accepted that even this pragmatic, rather than principled, objection to government health lectures aroused fury.

Now I am usually harsh in my criticism of the National Health Service and indeed I wish to see it abolished entirely... but credit where credit is due. This was a very, er, uplifting example of 'Enterprise Thinking' by the NHS.

Carry on, Doctor!

I am going to say naathing specific about this, but the best response to this sort of thing is for everyone to immediately make private copies of all the associated information and stash them somewhere.

The Internet is Forever, but some folk are just too dense to figure it out.

A quick entry from me: take a look at this item via Reason TV spot about the monster of a healthcare bill that passed at the weekend in the US. (I love the Incredibles-style music in it, by the way). As Gillespie puts it, the government underestimates of spending on things like health is not a bug, but a feature. The message that comes through, of course, is one that applies to governments worldwide. Do we honestly expect that politicians who are capable of the sort of accounting tricks surrounding building projects like the Olympic Games in London can be trusted to give accurate, costed predictions on things like healthcare spending, or education, or defence procurement?

Bear that in mind as we read the latest performance by UK finance minister, Alistair Darling, today.

"Congratulations, Democrats. Beginning now, you own the health-care system in America. Every hiccup. Every complaint. Every long line. All yours."

- Kathryn Jean-Lopez.

I wish that were true. Here in Britain, where filthy wards in NHS hospitals, for example, have been a regular staple of the UK newspapers, the standard response is usually to demand even more money, more rules, and so forth. If you challenge the model of tax-funded healthcare free at the point of delivery, then you are political dogfood. And Mr Obama and his allies know that. As Mark Steyn has been putting since before Mr Obama's election, Mr O. is counting on what the UK politician Sir Keith Joseph once dubbed the "ratchet effect": ratchet socialism a little more, and make it harder and harder for anyone to push back.

Of course, sometimes this argument will be proven wrong. I do get the impression that a lot of Americans, including those middle-of-the-road voters who gave Obama a chance in 2008, are now very alarmed at the huge debt that his administration seems to be encouraging. So it may be that Mr Obama is a one-term POTUS. But his legacy might take a lot longer to reverse.

On a more philosophical line, here is what I wrote a while back about the bogus nature of healthcare "rights".

Policy Exchange has just published a "research note" purporting to show that the tax on cigarettes in the UK should be increased, and that "that every single cigarette smoked costs the country money - 6.5 pence each time someone lights up."

If you read the paper [pdf], you will find it is an astonishingly dodgy dossier. Here is how the figure is made up:

Taxation of tobacco contributes £10 billion to HM Treasury annually; however, we calculate that the costs to society from smoking are much greater at £13.74 billion. Every cigarette smoked is costing us money. These societal costs comprise not only the cost of treating smokers on the NHS (£2.7 billion) but also the loss in productivity from smoking breaks (£2.9 billion) and increased absenteeism (£2.5 billion); the cost of cleaning up cigarette butts (£342 million); the cost of smoking related house fires (£507 million), and also the loss in economic output from the deaths of smokers (£4.1 billion) and passive smokers (£713 million).

The notion of "cost to society" is a pretty weird one.

Leave that aside for a moment. Add up costs and revenues to the state, which might be one semi-logical way of determining whether the smoking in some sense "runs a deficit", and using Policy Exchange's own figures you get a big surplus for the Treasury. Even if you assume all house fire costs are borne by the state and not partially by insurers and householders, and there are no errors in the headline figures, then you can only get to £3,549 million. (Have you noticed how public policy research generally involves implausible numbers of significant digits, and at the same time utter absence of error estimates?) On that basis smokers are contributing roughly £6Bn annually towards public spending.

But what are we to make of the suggestion that counting "lost output" is meaningful? To my mind the idea that an economic aggregate represents a collective wealth that may be politically attributed and redistributed is repulsive even if it is coherent (which I doubt). The state's royal We, which Policy Echange is channelling here, may in turn choose to impersonate you and me and everyone else, but it only controls the taxed margin of other's outputs. Output and taxation are apples and oranges. It is meaningless to add them together. Unless you want (or deserve) a punch.

And even were it not meaningless, there's an accounting fraud here. If you count output putatively lost to smoking, then you must also count the gains. There is the output of the tobacco industry, distribution and retailing in the UK to consider. Imperial Tobacco alone had a gross profit for the year ending September 2009 of approximately £5.3 billion. The CTC industry consists of tens of thousands of small shops. Honest research, however dubious its theoretical basis, would attempt to estimate the value-added, too. It would also be clear - without referring to a paper cited in the footnotes we cannot tell whether the cost-of-illness measure used in determining those "lost outputs" also includes the gains to third parties in pensions unpaid and public services unused by people dying early. If you are going to add apples and oranges, you should also tell us explicitly whether you have subtracted pears.

But what set me off on this chase was actually just one of those headline figures. Most of the margin of costs over gains in this strange sum is covered by the £2.9 billion allocated to the "output lost to cigarette breaks". How do they know? "[A] number of studies have investigated workers taking breaks in order to smoke, and have tried to quantify this time at between £915 million and £3.2 billion per annum." Hm.

Read through to p13, and you discover that the number of studies was... two. Er, no. It was one... Or some sort of strange interpolative hybrid... I cannot decide. Make your own mind up:

McGuire et al. estimated that £915 million annually is lost on the basis that average smokers spend tenminutes a day smoking, while light smokers and part-time workers would use approximately half of this time. The Royal College of Physicians (RCP) used similar initial assumptions on average smoking time to calculate that some £2.6 billion would be saved through the introduction of smoke-free legislation. Using McGuire’s estimates of 5.2 million working smokers, with the RCP’s estimates of ten minutes a day smoking reveals an intermediary figure of £2.9 billion.

I think that is 'intermediary' in the sense that a magician is an intermediary between a rabbit and a hat.

However they get there, if someone thinks that cigarette breaks ought to be a determining factor in public policy, rather than a matter for negotiation between employer and employee, then I suggest that it would be a good idea if they are kept as far as possible from the levers of power. This lot are said to be influential on the presumptively incoming Cameron team. Oh dear.

The new enemy is salt. Here is an interesting example at an early stage of how calls for legislation leap from study to implementation. A survey has looked at salt.

In the paper, Kirsten Bibbins-Domingo and colleagues, from the University of California, San Francisco, USA, undertook a computer simulation showing the effects of population wide reductions of dietary salt intakes in all adults aged 35 to 85 years in the USA. Reducing dietary salt intake by 3 g per day (1200mg less sodium per day) could result in 60,000 to 120,000 fewer cases of heart disease , 32,000 to 66,000 fewer strokes and 54,000 to 100,000 fewer heart attacks.

Just one study and even then, dietary recommendations are notorious for lack of reliability. But the recommendation follows like day after night:

A reduction in dietary salt of 3g per day, the authors went on to say, would have approximately the same effect on reducing cardiac events as a 50 % reduction in tobacco use, a 5% reduction in body mass index among obese adults or the use of statins to treat people at low or intermediate risk for CHD events. Furthermore, reducing dietary salt intakes by 3g per day would save $10 billion to $ 24 billion in annual health care costs

Precise, costed benefits that bear little resemblance to reality, but a comparison with the other devils of public health is utilised to define a 'collective benefit'. Thus the call for legislation by the European Society of Cardiology:

While individuals may use salt sparingly at home, around 75 % of the salt we eat is already in the food we buy. This, says the ESC, underlines the need for legislation to lay down guidelines. "The reality of international food production in Europe means that such public health initiatives need to be tackled on a European wide basis, rather than an individual country basis," said [Professor Frank] Ruschitzka.

Throw in a publicity week and the NGO for good measure:

Salt will again be on the agenda with World Salt Awareness Week 2010 , which runs from February 1- 7 (3). The week is being run by World Action on Salt and Health (WASH), a global group that works with governments to highlight the need for widespread introduction of population based salt reduction strategies

Add salt!

Helen Evans, who runs Nurses for Reform, a campaigning organisation dedicated to free-market options for healthcare in the UK, got to meet Conservative Party leader David Cameron a couple of weeks ago. The Daily Mirror [here, here and here] and the Daily Telegraph found out about the meeting and offered their own take on it.

Broadly, I agree that the proposals are in the right direction, although I have concerns about some of the tactics suggested and their formulation, which I deal with later. The bit that was not previously familiar to me was the idea that a barrier to entry should be at least lowered, by amending local planning rules to make it easier to open a new healthcare facility. I'm told the Conservative Party already favours this for schools, so the extension to clinics should not be difficult.

Having read the briefing document presented to the Leader of the Opposition, I disagree with one element of the strategy being proposed, specifically this passage: "the [National Health Service] NHS should be renamed the National Health SYSTEM and that under its auspices patients should benefit from a universal right to independent hospital care and treatment."

A "universal right" is something that a government could be justified in declaring war to defend, like "freedom from slavery" or freedom from the use of confessions extracted under torture in criminal trials. It could certainly be a pretext for new taxes, a new bureaucracy, more regulations, and the restriction of other "non-universal" rights. Sadly, this call for declaring that privately-provided healthcare is a right could become the very instrument for imposing regulations (such as US Medicare-style price controls, or French-style government control on where doctors can practise [link in French]) that violate patient and physician freedom. To give a specific example: could a private clinic be fined for not providing 24-hour accident and emergency access? I would expect a government agency to do just that. Meanwhile, of course, government facilities which operate "in the public interest" would be excused.

A second concern comes in a later paragraph: "health censorship must be outlawed and patients must be empowered with greater access to information." Outlawed? Must be empowered? By what agency, regulation, funded by what taxes or levies, with what powers of inspection and control?

These may seem like quibbles, but the law of intended consequences suggests that the wording of reforms can be as important as their spirit. Consider the US Constitution's First Amendment:

Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.

Does it say that Congress cannot give money to the Food and Drug Administration to hunt down anyone making claims about the alleged benefits to cancer patients of drinking grapefruit juice? No it does not. It means it, I think, but can I prove it to the US Supreme Court? Probably not.

It might be more boring to do, but the best way to remove censorship would be to revoke the clauses of those laws and regulations that allow it. As for "empowerment," if this comes from the government it will mean a Department of Truth in Advertising demand for a quarterly report from all private providers as to how they inform the public, with fines for not reaching a wide enough audience.

On the positive side, Nurses for Reform finds that the ownership by a government department of most of the UK's hospitals is a potential conflict of interest. There is the temptation to hide problems, to restrict information about alternative (often newer) treatments, the cozy relationship between the government employees in the NHS and those of the Department of Health who are supposed to watch them.

Dr Evans is therefore absolutely right to suggest the immediate transfer of ownership of NHS hospitals out of "public ownership," and she is also correct that the "Secretary of State for Health must no longer have any say over when or where hospitals are built, opened or closed."

On the issue of advertising, or freedom to communicate with the public in general, the major benefit would be that people could get an idea of which were the better brands (either cheapest, or best quality, or best balance between the two). If we think of how Aldi and Lidl can co-exist with ASDA, Tesco, Sainsbury, Waitrose and independent grocers, we can see how variety of branding can lead to beneficial competition: new treatments, more options and probably less queues.

Personally, I see no point whatsoever in delaying the reform of NHS funding: it merely prolongs unnecessary suffering and provides more opportunities for opponents of change to mobilise, like Gorbachev's "perestroika" versus the liquidation of the soviet system. Having little expectation of any progress under a new Conservative Party government this coming year, it would be a pleasant surprise if Dr Evans' proposals came to fruition. But at least no one can now claim that the case was not made.

[UPDATE: corrected link for Daily Telegraph article]

As FA Hayek pointed out many years ago in his masterpiece, The Constitution of Liberty, if healthcare is paid for out of general taxation and delivered free at the point of delivery, then in a world of scarce resources - and healthcare is always constrained at any time by the supply of doctors, drugs, etc - then such care must be rationed by some form of bureaucratic/political rule. As Dr Hayek presciently warned at the time (1950s), any such rationing will put doctors, politicians or other people in power in the position of a god, in having the decision about who gets treatment for what, or whether life A is more "worth saving" than life B. For example, one such utiltarian consideration might be that it is more "cost-efficient" to save the life of a young kid with his whole life ahead than an 90-year-old. That is what happens when socialised medicine is established. It transfers key powers to people in ways that raise disturbing issues of accountability and control.

Now a socialist might respond that it is still better for health care to be rationed by some rule they consider to be "fair" than by the supposed lottery of the market, although in fact, as I would respond, there is, due to the benefits of competition and entrepreneurship, far greater chance that all but the poorest will get better healthcare under a genuine free market in health than under the system of centralised, state-provided healthcare. Also, if the possession of a large fortune is partly a matter of luck, then luck, being blind, cannot be either just or unjust. It just is. Some folk have access to better dentists or whatever because they are richer. That may annoy someone who cannot afford the whitest teeth, but that is not proof of unfairness, as such. To prove it, one would have to construct an ethical theory that says that humans have an apriori claim on their fellows to receive a certain amount of healthcare/watever as a "right". But such "rights" are abuses of the term: one cannot have a right to X that requires that another be forced to provide X, such as forcing folk to train as doctors to serve the sick, and so on.

I was led to think about the latest twist in the US healthcare debate by reading an article by the US writer, Nat Hentoff. He totally bypasses the issue of how to deal with scarcity under socialism in ways that are fair. He rightly worries about the sort of brutal choices that state-rationed healthcare provides, but then does not see that any system of state-run, and socialised medicine, makes such issues of rationing unavoidable. Rationing by such tests of age, "need" and so forth is a feature of socialised medicine, not a bug.

(H/T: The Corner).

According to Radio Free Europe,

Rovshan Nasirli, a young Eurovision [song contest] fan living in the Azerbaijani capital Baku, says he was summoned this week to the country's National Security Ministry -- to explain why he had voted for Armenia during this year's competition in May.

"They wanted an explanation for why I voted for Armenia. They said it was a matter of national security,” Nasirli said. “They were trying to put psychological pressure on me, saying things like, 'You have no sense of ethnic pride. How come you voted for Armenia?' They made me write out an explanation, and then they let me go."

(Hat tip to Gene of Harry's Place and Robert Wright of the The Daily Dish.)

In other news, Health Secretary Andy Burnham has accused Tory MEP Daniel Hannan who said on US TV that the US healthcare system was generally better than the NHS of being unpatriotic. Senior figures from both the Labour and Conservative parties have denounced Hannan and demanded an explanation.

Here is a story suggesting that employees might use the outbreak of swine flu as an excuse to extend their summer holidays. I guess this is inevitable, given that some people will try anything on, although in a recession, it does seem rather dumb for staff to risk a disciplinary warning or outright sacking to lie about their health in this way.

Talking of holidays, in a few days' time, yours truly is heading off to Normandy, northern France, for a week's holiday with family, including, I am very happy to say, my father, who has recently made a recovery from a serious illness.

There will be lots of Calvados consumed. My blogging is likely to be slow next week.

I had to read the headline twice. Then I read the article twice. I still don't get it.

What I first thought it said was,

International development minister urges firms to pool HIV patients

Weird, obscure line, but no weirder than a lot of things that come out of the international development department, and potentially a lot more sensible. I suppose it might make sense for the big southern African companies, especially, to combine their employee health programmes. But if it were more effective, wouldn't they already be doing it? Wouldn't the South African government, in any case (now they have got rid of that barking health minister), be the one doing the urging?

What it actually said was,

International development minister urges firms to pool HIV patents

Now that makes a lot less sense. It is quite up to the standard we have come to expect from DFID, a real candidate for economic illiteracy of the day.

[Mike Foster MP] wants companies to contribute to a "patent pool", which the international drug-purchasing facility, Unitaid – set up by a number of donor countries, including the UK – is trying to establish.

"While it is absolutely vital that we work to reduce the human cost of HIV by focusing our efforts on preventing new infections, we must also face up to the stark reality of the treatment challenge we face. The pharmaceutical industry has an opportunity to act now to help prevent future human catastrophe. It is time for them to state their clear commitment to make new HIV medicines affordable to those who need them most."

According to the all-party report, if HIV patents are put in a pool, generics companies – which make the cheap combinations now used in Africa – will be permitted to make low-cost copies of newer drugs and devise new combinations in a single pill, which is important for people living in poverty.

What can this possibly mean? There's no real explanation here of how a 'patent pool' might work. It sounds like pharmaceuticals companies are being offered to the opportunity to swap an unstable legal monopoly for an internationally approved cartel, and to pose as humanitarians while doing so. Would that really lower the cost of HIV medication, and improve its effectiveness in general? It is far from obvious why that should be the case. Would medicines that are both cheaper and more effective be permitted to flow back to Western countries? I doubt it.

Which points up the weirdness of the whole exercise. In order to be economic in Western countries, HIV medicines have to be very expensive to buy there. That is not just because they are expensive to develop, but because the absolute numbers of people who need them are small. In the West, just as in poorer parts of the world almost no individual can afford to pay for their own treatment. So there's a different sort of cartel effect maintaining the oligopolistic market. Government protects the patentees; and government subsidies end up paying for the consequences.

You don't have to be a believer in the efficacy of beetroot and garlic as anti-virals to notice that the difference between the scale of the epidemic in parts of Africa and the richest parts of the world is not a consequence of the availabilty of drugs - or at least not the availabilty of anti-retrovirals. We have fewer people getting the disease in the first place. But we have fewer people with all sorts of infectious diseases. Malaria and dengue are not more treatable than they were when they were endemic in Europe, and the US, less than a century ago. The difference is better living conditions that everyone will work for if they have the chance.

Patent pooling, it seems to me, is no better than patent farming, in that it seeks to exploit artifical restrictions on innovation that just happen to be there for the benefit of a restricted interest group. It is an exercise in dinosaur husbandry, with little real relevance to improving the lives of us mammals. A reconfiguration of corporarate welfare, with its concentration on subsidising treatment of a particular disease, and bureaucrats swapping targets with bureaucrats, is a distraction from the less collectively 'manageable' task of avoiding the spread of infection, which is the invisible part of the virtuous circle of the people who are not sick getting better general health and more comfortable lives. That isn't going to come from government drug programmes. I suspect it might come from "people living in poverty" having a bit more access to the non-patent and never-patent - but still restricted - technologies of choosing their own priorities and exploiting their own comparative advantages.

A friend (you know who you are) informed me that the Economist magazine was "getting better", for example it had a lead story denouncing government debt. Of course this was the government debt that the Economist had urged government to take on (to bail out banks and other corporations and then to "stimulate the economy"), but it was good that it was denouncing the debt.

So I decided to give the Economist a chance and read their article ("editorial") on American health care. After drinking a bottle of cider to recover (what a nice new bottle shape Henry Westons have produced) these on my thoughts upon that article:

It starts with a lie - Barack Obama was elected in part because of his plans to "fix American health care".

In reality it was Hillary Clinton who stressed her health care plan during the Democrat primary campaign (Barack Obama just attacked her plan and made vague noises about his own). And during the general election campaign it was John McCain who came out with a specific health care plan, allowing people to buy health cover over State lines and switching the tax deductibility of buying health care cover from employers to individuals, whereas Barack Obama just (dishonestly) attacked the McCain plan and was vague about his own.

Barack Obama was elected President of the United States for several reasons (white guilt about mistreatment of black people, the total ideological devotion of the education system and the mainstream media, the insane judgement by John McCain to back the bank bailouts...), but stressing some specific plan to "fix American health care" was not one of them.

Still the Economist does not let the truth stand in the way of its articles, so it then outlines its position.

"Starting from scratch their would be a good case for a mostly publicly funded system" even for a magazine "as economically liberal as this one".

This is a standard Economist trick - propose some form of statism and defend it by saying even we, the free market ones (the European meaning of "economically liberal"), are in favour of this statism. Of course the Economist never actually produces any evidence that it is pro-free market - but it is at trick it has been using since Walter Bagehot (the second editor, the first editor actually was a free market man) so I suppose it is a lie hollowed by history.

However, we are not "starting from scratch" so the Economist reluctantly concedes that some little freedom (about half of American health care is already government funded and the rest is tied up in regulations - facts that the Economist avoids, see later) must remain for awhile - it suggests five years.

The first step, according to the Economist, must be to make everyone buy health cover by statute with the poor being subsidized by the government "as is done already in Massachusetts". That the Massachusetts "reform", introduced by Governor Romney, has turned out rather badly is a fact that the Economist article neglects to mention - even though the percentage of "uncovered" in Massachusetts was very low compared to other States so if this "reform" was going to work anywhere it would have worked in Massachusetts.

Of course, says the Economist, insurance companies must not be allowed to exploit government subsides for the poor. They must provide "affordable" plans (no prices are suggested - it is all left vague), and must not be allowed to exclude the old or the already sick from their plans.

In short - lower prices and covering high cost groups. As (contrary to the propaganda) American health insurance is already not a high profit margin industry, these "reforms" should be enough to bankrupt the insurance companies - even before the five year period comes to an end and the government plan the Economist suggests takes over.

However, just in case the private health companies are not bankrupted, the Economist also suggests that "anti trust" be introduced into the area. As the late Ayn Rand (and so many others) have pointed out, there are no clear principles (things that can be clearly defined in advance) in "anti trust" or "competition policy" in fact the whole thing is an excuse for arbitrary power for the government working with the politically connected. But the Economist either does not know, or does not care, about this point - and loves "anti trust".

Almost needless to say the Economist does not mean getting rid of regulation (such as the licensing regulations for doctors - exposed as a racket by Milton Friedman 60 years ago,. or the F.D.A. and its price inflating and new medical adavance preventing "health and safety" regulations). On the contrary the Economist means yet more regulations on top of all the ones that exist already.

Of course the Economist does not mention the real problems of American health care. Neither the ones I have mentioned already or the others. It does not mention how Medicare and Medicaid and SCHIP have vastly inflated prices (just as the subsidies for higher education have had the effect of inflating tuition fees over the decades) or how the vast web of Federal and State regulations prevent much of a real "market" in health care at all, or how American hospitals are forced to provide free ER cover in spite of the fact that an expensive (although terrible - rather like some British NHS hospitals in fact)) network of government "county hospitals" already exists, or... But of course it does not - because it wishes to add subsidy schemes and regulations, not get rid of them.

Lastly I must mention one other policy suggestion of the Economist.

It suggests abolishing the tax deductibility of employer health care provision - not to switch the tax deductibility to individuals to buy health cover themselves, but because the lower taxes "cost the government" lots of money (all money belongs to the government it seems - although it should kindly allow people to buy toys, not important things like health care).

This massive tax increase is something that even Barack Obama is wary about talking about (although it would only pay for a fraction of the costs of his plans), but have no fear the Economist will hold his hand - it is all about "The Renewal of America" to quote one of the most vile magazine front covers I have ever seen.

As for the Obama plan of one and half TRILLION Dollars (according the Congressional budget office in reality it will grow to far more than that, entitlement programs always do) that will only cover a fraction of the people he says it will. Well if the Economist is truly "economically liberal" it will help lead the fight against this evil - but judging by this article...

Of course it could be claimed that I am being unfair - that the American coverage of the Economist is the worst element in the magazine. Although I have not noticed the Economist denouncing the move to income support schemes and government health cover in India (in spite of the ever growing fiscal deficit) in India - or indeed in any country.

Be that as it may, it is the United States where the alternative of a free market current affairs magazine is most needed - an alternative to the statism of Time and Newsweek and the rest of the mainstream media. And the Economist utterly fails to provide this alternative.

So, friend (again you know who you are), do not ask me to give the Economist a chance again - to do so is not good for my liver.

All the existing [medical care] schemes, including the present American mixed corporatist/socialist model, represent a transfer from the young and healthy to the old and chronically sick (and to the medical cartel, of course). The way it's used in practice, the phrase "having health insurance" means having the right to place oneself on the receiving end of these transfers. No honest discussion of the situation is possible until the entirely false and misleading concept of "health insurance" is dropped.

- Commenter Ivan

Millions and millions of Americans support Obama's desire to even more massively intervene in the market for medical care than the US state already does. And of course Obama's moves are just the opening salvo in a desire to eventually end up with fully socialist healthcare, along the lines of Britain's ghastly National Health Service, which has intermittently tried to kill me over the years.

I have tried pointing Americans at the British example to show them what an appalling idea it is to have the state directing any industry, let alone medical care. But alas it is very hard to overcome that special kind of insular American optimism that does not think what happens in another advanced first world nation can teach them anything, because in the USA things will be different.

Well yes, it will be different... in that the control obsessed Obama's of this world will find new, innovative and oh so wholesome American ways to end up with a third rate health care system much like Britain has today.

This might be a good time for Americans to invest their money in Swiss medical clinics as I suspect in the coming years expatriated medical care will be a serious growth industry... plus it has the added benefit of getting your money out of the USA and US dollar.

"It is rare that governments successfully cut costs by first spending more money."

- Tyler Cowen. He was talking about Mr Obama's plans to socialise US medicine. I am sure that when the NHS was set up here in the UK, the advocates of said argued that it would "save" money in the long run. Meanwhile, here is some useful commentary from Arnold Kling.

Oh dear... seems the EU is being beastly to us again.

I wonder if I can buy brain futures or it is just pork bellies?

As here, for instance. Via Liberty Alone, I learn of a remarkable new recruit to the ranks of those who are panicking about the pandemic. Yes, it is none other than the US Libertarian Party. They have just issued a press release reprimanding the US state for not being statist enough about this medically trivial event, which is in any case only being plugged up in order to divert attention away from other governmental blunders and to excuse further governmental usurpations, despite all the blunders. Why can't they see that? Or don't they care about such things any more? One can imagine a true "pandemic" that really did need measures like draconian border controls to defend against it (sickness is the health of the state), but if this trivial flu variant is it, then, to put it mildly, an explanation to that effect should have been added.

The UK Libertarian Party should treat this pandemic pandering as an awful warning of what happens to small parties - parties "of principle" - who become gripped by the desire to pile up lots of mere votes, and who forget what they were started to accomplish. First they pick a regular politician to lead them, and he then picks more regular politicians to help him, and before you know it, they are behaving like regular politicians.

But it is more fundamental than that, I fear. Start a political party, and before you know it, it is behaving like a political party. LPUK beware.

One of the beauties of the blogs, I find, is that the link-rich medium enables you to fly off on all manner of tangents and think through issues that might otherwise not arise or come into one's head so fast. The recent posting on Samizdata about Ayn Rand - which seemed to trigger a rather bad-tempered and long comment thread - led me to a site put together by this fellow, who wrote a rather rude comment about Rand - nothing very new there - and I decided to take a look at his own blog. This is what I found. James Hooper is a socialist who once, apparently, was a "teenage libertarian". I guess one does not come across many libertarians who imbibed their Hayeks, Rands, or Rothbards and later decided that what the world really needed, in fact, was lots of collectivism, progressive taxes, and the rest of it. I suppose John Gray fits a similar path, although as Brian Micklethwait has noted, Gray is consistent in his pathological gloomsterism.

Anway, back to James Hooper. In his latest post, he writes this:

"Healthcare is an area where the market has proven utterly inadequate, indeed it’s hard to find any pure market approach outside of the Third World (company insurance is decided by CEO boards and unions, state insurance by governments), although I’d imagine that those who have died in America owing to lack of insurance didn’t rate the distinction that much."

Now it seems to me that there is something very wrong about this statement. Human beings require health care, just as they require food. Now, in the West, food is - mostly - produced by the free market, although as a libertarian I'd be the first to note that there is a lot of regulatory control over food production (ask any farmer, slaughterhouse owner, food retailer, etc) and a lot of subsidies, such as under the EU's Common Agricultural Policy. But by and large, the process by which we get our fruit, veg, meat and carbs is via capitalism. This seems to work tolerably well. It could work a heck of a lot better, of course, but in general, you don't see people, even the very poor, starving in the streets as happened under communism in Russia (1930s) or Mao's China (1950s, 60s), or see the sort of state-induced disasters in Zimbabwe, etc. So clearly, something as basic as food seems to work best when left to the market.

So what is so different about health care that it can only - according to various statists, including many right Tories - be provided by a mixture of private/public operations or even, only by state monopolies, such as the UK's National Health Service? For sure, some people, such as the very poor, will not be able to afford all the healthcare they want, but then the same issue applies to very poor people who cannot get all the food or housing that they want. Their problem is poverty, not something peculiar about food or housing. I understand that healthcare purchases tend to be less frequent than purchases of food; there may be inefficiencies or supply-demand issues that perhaps don't let a market in health care function as well as in say, baked beans. But even so, for a person to state as a bald fact that a market in health care does not work seems, well, to be a case of ideology trumping experience and elementary logic. This article by Ronald Bailey lays out a good argument for a free market in health.

Of course, if, like Marx, Mr Hooper believes that a socialist society will be based on the "From each according to his abilities, to each according to his needs", then that of course begs all kind of momentous questions of interest to defenders of liberty and prosperity. As I have pointed out before, if you say, for example, that I have a "right" to "free" healthcare, what that really means, in practice, is that I have a right to coerce someone who is able to work as a doctor/nurse/lab technician to give me what I want. In short, the Marxian "from each according to his abilities" presumably means that the state must have the power to decide what are the "abilities" that Johnathan Pearce, or James Hooper, etc, actually have, and then have the power to harness those abilities to fullfill the needs, as the state has defined them. In short, the Marxian formulation requires conscription of abilities.

There is a word for this state of affairs. It is called totalitarianism.

This story is bizarre: China is ordering folk to smoke to boost the economy? Maybe the Chinese authorities figure that with air pollution already so bad, what could be any worse?

It goes without saying that being a good liberal that I am, I consider it as outrageous for a government to encourage smoking as to use invasions of property rights and censorship of things like adverts to stop it. This sort of issue cuts both ways. What next: forcing folk to get hammered every evening?

What is the worst case scenario for swine flu cases in the United States? About 1,700.

This is not a pandemic, and the ballet of institutional panic in government combined irresponsible media coverage over the last few days has been instrumental in ticking public health as another area where contemporary alarmism, fanned by governments, signposts higher mortality when a crisis finally arrives.

Reported by Lucy Bannerman in today's Times:

Fire kills child, 3, and parents as police prevent neighbours from trying to rescue them

A pregnant woman, her husband and their three-year-old son were killed in a house fire early yesterday as police who arrived before the fire brigade prevented neighbours from trying to save them. The woman screamed: “Please save my kids” from a bedroom window and neighbours tried to help but were beaten back by flames and were told by police not to attempt a rescue.

By the time firefighters got into the house in Doncaster, Michelle Colly, 25, her husband, Mark, 29, and son, Louis, 3, were dead. Their daughter, Sophie, 5, was taken to hospital and believed to be critically ill.

Davey Davis, 38, a friend of the family, said: “It was the most harrowing thing I have ever witnessed. Michelle was at the bedroom window yelling, ‘Please save my kids’ and we wanted to help but the police were pushing us back and not allowing us near. We were willing to risk our lives to save those kiddies but the police wouldn’t let us.

“Tempers were running very high, particularly with the women who were there, but the police were just saying we have to wait for the fire brigade because of health and safety.

“There were four or five police officers. They were here before the fire brigade. We heard the sirens and we came across to help but they wouldn’t let us.

“I thought the police were there to protect lives. At one time they would have have gone inside themselves to try and rescue them.

“When a family is burning to death in front of your eyes, rules should go out of the window – especially with kids. Everybody wanted to try and help.”

In a previous post about loss of nerve in our public services I said, referring to instances in which firemen and policemen had "broken procedure" to save life, that despite their personal courage "institutional gutlessness surrounded them, was embarrassed by them, and will kill off their like eventually. Poisoned soil does not long give forth good fruit."

Seems like the poison has worked its way well in. Note: I do not know whether the Colly family could have been saved had the attempt been made while Mrs Colly was still alive to scream for someone to save her kids. A spokeswoman for the South Yorkshire Police said, “The senior officer in charge is confident we handled this incident as professionally as possible. In a situation like that you could end up with more deceased bodies than you had in the first place.”

One of the lesser known sights of London is the Watts Memorial in Postman's Park. I gather it featured in the film Closer, starring Natalie Portman and Jude Law. No, I am not being funny, suddenly veering off into a travelogue in the middle of a post about the deaths of a family. I wish there were something to laugh about. The memorial was set up by a Victorian artist, George Frederick Watts, to commemorate those who died saving others. It consists of hand made plaques each bearing the name of a person who sacrificed his or her life and a brief citation. Very quaint they are, with their crowded lettering with the extra-large initial capitals and little swirly plant motifs and curlicues in the corners. Even the names are quaint, laboriously given in full. Police Constables Percy Edwin Cook, Edward George Brown Greenoff, Harold Frank Ricketts and George Stephen Funnell are among them. I wonder what PC Percy Edwin Cook, for instance, who perished when he "Voluntarily descended high tension chamber at Kensington to rescue two workmen overcome by poisonous gas" would have made of his successors in the South Yorkshire force.

Perhaps the police spokeswoman was right. Perhaps if health and safety had been less comprehensively assured and the Colly incident handled rather less professionally, we would have ended up with more than the three "deceased bodies" - no, make that four, when you count the child expected to be born in two weeks - that we did end up with. Still, more than four dead bodies is quite a lot and quite unlikely, I cannot help thinking. And I also cannot help thinking that there is more to this than just counting the dead under different scenarios. If the critically injured five year old girl does survive she will be burdened by more than just the fact that her family died. She will eventually have to know that those who might have answered her mother's last desperate appeal were held back on grounds of "health and safety." Not theirs, obviously.

UPDATE: Other accounts give the spelling of the family name as "Colley". They confirm that the police actively prevented rescue attempts.

FURTHER UPDATE: There is a thoughtful discussion in the comments regarding several moral and practical questions, and whether the press accounts are to be trusted. Quite possibly not. Yet I must add that if the South Yorkshire police are trying to convince me that they are not abdicating responsibility in order to follow rote "health and safety" procedure (as commenter "sjv" put it), then best not claim, as they appeared to in the Mail report linked to in the word "other", that the reason they will not tell us exactly how long elapsed between the arrival of the police and the arrival of the firemen is "'data protection' rules."

There is no stated national consensus that as a country we should substantially reduce overall masturbation, but such a reduction would benefit the health of many who wank – and those affected by passive wanking- the concept I invented a few sentences ago and am now treating as a genuine problem.

In 2006, 180,000 people died from pornographic-related causes. Wanking has a major impact on individual wanker's health: it causes cancers of the liver, bowel, breast, throat, mouth, larynx and oesophagus; it causes blindness, hairy palms, a pale pallor and insanity ...

Some point to the potential benefits of self-pleasuring, but these tend to be greatly overstated.

Despite its known harms, one-quarter of the adult population – about 10 million people – now wank above the recommended low-risk levels. I made this figure up but as the Chief Medical Officer I can cite myself because I am in a position of authority.

Here is a graph to illustrate how many people are killed by masturbation. It actually represents something completely different, possibly cat food sales, but I'm guessing that most of you are actually too stupid to actually look at the graph in any detail ...

- some Unenlightened Commentary sadly not actually supplied by Sir Liam Donaldson (with thanks to Obnoxio the Clown)

The blogger Slugger O'Toole expresses a very sensible view, in my opinion, about the recent case of a NHS nurse who was disciplined for offering to pray for a patient. I am all in favour of the separation of church and state, but then would reflect that this case shows just what happens when hospitals are part of the state and not part of the non-state sector, where they can be run by secular or religious groups without such issues arising. If a hospital is run by a church or has an endowment froma religiously-minded gazillionaire, and staff want to pray with its patients and the patients are okay with that, what exactly is the problem? Many UK hospitals, as their names often suggest - such as St Thomas's Hospital in London - were founded by churches and religious orders. For all that I am not a religious person, I can greatly admire the spirit of compassion that motivated many religious believers to work in or endow hospitals with funds. Many of Britain's greatest hospitals were started by churches and their history goes back hundreds of years.

This is wonderful, funny and true.

Via Radley Balko.

More support comes from the medical profession that regular, moderate intakes of red wine is good for health. (Via this blog).

This makes me happy.

Random link-chasing brought me here. "Leg-iron" writes:

I have a pack of tobacco with no hideous picture. Instead it has a phone number and the words:

Choose freedom. We'll help you get help to stop smoking.

Freedom? Really? That would be nice. I don't have the freedom to smoke in a bar, at a bus stop, bus station or on the open platform of a railway station.

There is more, please do read it. I should explain for foreign readers that British cigarette packets must by law bear an anti-smoking slogan such as "smoking kills" or "smoking causes impotence" and often, these days, a repulsive picture showing the bad consequences of smoking. I do not smoke so I do not often need to look at these pictures, but nothing about their appearance repels me as much as the fact that our laws force people to publish material designed to humiliate themselves. Truly, that does repel me. I neither like nor dislike cigarette manufacturers or those who work for them as a category, but when I imagine whichever bureaucrat thinks up these rotating slogans sneeringly transmitting the latest one to some servile flack in a cigarette company along with orders to start the print run - then I feel a faint echo of the shame someone living in Mao's China must have felt at the sight of a wretch bearing a placard saying "I am an enemy of the people."

I scrolled down Leg-iron's blog and found another good post on the same topic:

On the first one I bought was one of those pictures that are supposed to terrify us into stopping smoking. This one shows a pair of eighty-year-old hands with the slogan 'Smoking causes ageing of the skin'.

Interesting. I was under the impression that ageing was the main cause of ageing of the skin.

After ruminating on the lameness of these propaganda efforts, Leg-iron writes that it is almost

...as if ASH have realised that, should we all give up smoking, they'd have nobody left to torment and they'd all be out of a job.

ASH refers to a body called "Action on Smoking and Health." It is a fake charity - in fact, I learn, it is the original fake charity - receiving just 2% of its money from voluntary contributions. The rest of its money is paid to it by the government. It exists in order to allow the government (I should say "the State" since it has been the tool of several successive governments of both major parties) to pretend that when enacting new forms of repression it is merely responding to popular demand; in other words, it pretends to be servant the better to be master. There are many such. Some call themselves charities, others "NGOs". As the EU Serf asked years ago, "I always thought that NGO meant Non Governmental Organisation. How come any of them get money from the state?" Some are funded by the British government, some by the European Union, although trying to to establish the extent, if any, to which the former category is not a subset of the latter, would not be a good use of anyone's time.

Devil's Kitchen is sick of fake charities. He has put forward a modest proposal, and has registered the domain name http://fakecharities.org/ in order to put it into practice. His co-blogger, "The Filthy Smoker" wrote about the staggering dishonesty and corruption that the existence of these shills brought to a Department of Health "consultation process" here.

All these lies and deceptions spread out and reinforce each other - until we come to a stage where someone can force someone else to publish the words "choose freedom" and feel no shame.

I suppose it is a sign of advancing years, and having lost some close friends to cancer or having been scared by a close relative's condition that the notion of a cure for the gremlin should weigh on my mind a bit more than it used to. (You are definitely getting old, Ed). I cannot help noticing, when reading Instapundit as I do every day that Glenn Reynolds has been putting up regular links to the growing use of nanotechnology in delivering cancer-busting chemicals to the body with incredible accuracy. Here's another one. The more accurate the delivery of the drug, so the reasoning goes, the fewer the unpleasant side-effects associated with things like chemo treatments, and the greater chances of beating the cancer. The steady trickle of news items and articles has yet to become a flood, but I have this sense that the flood may be pretty close.

When I read Engines of Creation by Eric Drexler back whenever it was, the idea of tiny nanobots being used to treat cancer was, then, still on the edge of what folk thought might be possible. There is a way to go yet but it is a mark of how certain stories get below the radar of current events that nano-medicine has crept up on us so quickly, rather as the internet did about 20-odd years ago.

Faster please!

These pictures are pretty cleverly done. (Via Andy Ross).

We are sometimes told by its defenders that the National Health Service is the envy of the world. Well, I wonder if all those countries yearning for socialised medicine are dreaming of this?

I used to visit the South of France as a kid and one day, walking down the beach in St Tropez, yours truly, then a pretty wet-behind-the-ears lad from Suffolk, espied a whole row of lovely French women lying on the beach with nary a stitch on. Mon dieu! After my silly childish embarrassment wore off, I thought nothing of it after a while.

It appears that for health and fashion reason, though, that the lovelies of Europe are covering up. One of the main factors may be a concern about skin cancer. Also, I notice that in France, a lot of the men and women's skin gets very lined and aged if they sit out a lot in the sun, so for reasons of vanity or beauty - depending on your point of view - it makes sense to cover up. I have to watch it in the sun as I am pretty fair-skinned.

I did sort of half wonder whether any of this story from France has something to do with the large Muslim immigrant population in the South of France that takes a dim view of baring any female flesh at all. It does make one wonder. I hope not.

Last night, flicking through the TV channels after watching Andy Murray get pulverised by Nadal, the muscle-bound Spaniard, in the tennis, I watched in bemused fascination as ITV and the BBC both devoted quite a lot of air time to celebrating - that word was used repeatedly - the 60th anniversary of the National Health Service. There has even been a church service, attended by Prince Charles and the Prime Minister, Gordon Brown, to mark the anniversary of Britain's monopoly provider of health care, an essentially socialist creation that is hardly emulated anywhere else in the world, and for good reason. None of the major objections to health care that is provided via tax and distributed "free" at the point of use were mentioned. Last night's stories gave no balancing comments from skeptics or opponents of the NHS to counter the general feel-good presentations.

At the Institute of Economic Affairs, here is a rather more sober treatment of the NHS. As the US writer PJ O'Rourke once warned his countrymen about socialised medical care, if you think US private sector healthcare is expensive, just wait until it is "free".

Here is a great new book to cheer libertarians as we draw close to the sixtieth anniversary of the National Health Service. Written by the director of Nurses for Reform, Dr. Helen Evans, and published by the Institute of Economic Affairs, ‘Sixty Years On: Who Cares for the NHS?’ not only shows that the country’s top 100 health opinion formers no longer actually believe in nationalised healthcare but, gloriously, this book fundamentally challenges the medical monopoly inherent in all health systems around the world.

Citing a huge array of free marketeers the work is awash with glorious quotes like this one from David Friedman:

Both barbers and physicians are licensed; both professions have for decades used licensing to keep their numbers down and their salaries up. Government regulation of barbers makes haircuts more expensive; one result, presumably, is that we have fewer haircuts and longer hair. Government regulation of physicians makes medical care more expensive; one result, presumably, is that we have less medical care and shorter lives. Given the choice of deregulating one profession or the other, I would choose the physicians.

Quoting our own Brian Micklethwait we again read:

Far from being obvious to me that a truly free medical market would be disastrous, I believe on the contrary that such arrangements would be of huge benefit to mankind, and that the sooner medicine is done this way the better.

Things would not, inevitably, be perfect. Some fools would make crass blunders, by ignoring manifestly superior medical services for the most frivolous of reasons, and by patronising the most notoriously incompetent. Some such fools would perish from their foolishness. Others would merely be unlucky. No law can prevent either stupidity or bad luck, although the world is now filled with the particular stupidity which consists of refusing to face this truth, and with the many luckless victims of this stupidity.

Powerfully, he concludes:

Given that for most people the avoidance of suicide rather than suicide is the objective, a truly free medical market would enable them, for the first time ever, to purchase steadily improving medical advice and medical help, and at a steadily diminishing price.

One of the most pernicious restrictions on medicine imposed by the current medical regime is the restriction on advertising. In a free market rival medical procedures, rival medical 'philosophies', rival views on the relative importance of confidentiality, hygiene, speed of treatment, riskiness of treatment, and so forth, would all battle it out in the market place. 'Alternative' therapists would be allowed to prescribe potentially dangerous drugs, as only government favoured therapists may now. It would be up to the patients to pick therapists who seemed to know what they were doing and their look out if they chose badly. The already thriving medical periodical press would assist with voluminous comparative advice, praise and criticism.

In such a free market, any number of different medical styles could be practised, and patients would make their choices.

Evans’s book is a must read for libertarians. It is also a tonic for the period of NHS propaganda we will no doubt endure over the next couple of weeks.

Looking for a real boost in the morning? Someday you may be able to do better than coffee. According to New Scientist (via the Foresight Institute):

Human cells could have their metabolisms upgraded without altering their genes by inserting tiny plastic packages of enzymes, Swiss researchers have shown. They hope the technique could allow advanced cancer therapies, or even upgrade a person’s metabolism.

I can hardly begin to imagine the applications. With this technique you could correct chronic genetically caused disorders. It makes drugs old hat. You could boost athletic performance from inside the cell and really give the luddite sports crowd something to worry about.

Imagine the battlefield applications! It could keep the 21st century soldier alert despite little sleep; alive when injured; fed from sunlight or other external energy sources and performance enhanced when under threat.

Over at ConservativeHome there's a survey suggesting the social conservatives are doing the Guardian's work for it by trying to make one's position on abortion a party-political issue in Britain. The next generation of Conservative MPs support a lower time limit for abortions says an email questionnaire to 225 candidates, answered by just under half. I'm as irritated by this sort of spinning of some very doubtful evidence as I am by the contrary stuff - to the same effect - from the Guardian, which has recently started to suggest (as a measure of its desperation) that no-one who favours abortion choice should vote Conservative.

What really winds me up, though, is the mendacious presentation of their position by the proponents of this staged debate. The legal position of abortion in Britain is the sort of muddy compromise people with a clear ideas about the question are quite right to resent. But the approach of many abortion-banners (as they actually are) is anything but frank, and reminiscent of the step-by-step strategy of the anti-smoking lobby. For every principled (usually religiously principled) pro-lifer, there is someone who secretly shares their conviction, but makes the case for just a little cut in the time-limit now "because science tells us that babies of that age can now survive outside the womb".

It's nonsense. Without a lot of help a two-year-old can't survive outside the womb. And the prospect of those few born at the limit of current paediatric technology surviving uncrippled to live a normal life is tiny even with a massive input of medical and nursing resources. But worse, it is mendacious nonsense - they don't care about "viability" in the slightest. What they want is a plausible excuse to cut the availability of abortion just a bit.

So I have a test to flush them out. It is provided by that ghastly muddy compromise. Britain doesn't in law permit women to choose abortion, unlike most rich countries. It is an extraordinary construct of bureaucratic paternalism.

What British (mainland) law does is to permit pregnant women to petition doctors to give them permission to abort on the grounds that it will be bad for their well-being to carry the baby to term. With two doctors assenting to this opinion in writing (that is, as the doctors' professional opinion - the woman's view doesn't matter in law), you may have an abortion. Where the 'time-limit' comes in is that those two doctors can only approve an abortion to preserving the patient's social or mental well-being before a certain point. After that terminations may only occur where there is a substantial risk to life or health, or in cases of severe foetal abnormality.

So in practice, in the UK you have a choice only if you approach the right doctor armed with the right argument. A naive or poorly educated, woman who seeks help from her GP when the GP happens to oppose abortion, or who mistakenly calls a pro-life charity canvassing itself as offering help to the unexpectedly pregnant (as opposed to one of the pro-choice groups who do the same thing) may never find out how to get an abortion, or at least not until it is too late. The late abortions themselves aren't occuring as a lifestyle choice - which is another mendacious narrative element in the pseudo-debate.

My test is this: Next time anyone says they want the time-limit for abortion cut to because "science shows" the baby can survive outside the womb after X weeks. Say, "And of course you support changing the law to allow abortion on demand before that date, don't you?" Then watch them flounder.

I am interested in this story as I am one of many people for whom the hopefully sunnier weather of summer is accompanied by the irritation of hayfever. I do not suffer from it as badly as when I was a child but it is still unpleasant sometimes. I once played in a cricket match and my symptoms - streaming eyes and sneezing - got so bad that I could hardly continue to play the game.

Anyway, it may be soon be possible to significantly nail the problem with a vaccine.

Belatedly, I joined the craze and had a go on one of my friend's Wii games the other weekend. Terrific stuff: I played the golf, tennis, ten-pin bowling and shooter games. Bloody marvellous. You do need to get a large-enough television to make it work; unfortunately, I don't really want to mess up my sitting room by putting a huge plasma screen on the wall, but some of my friends seem to be less squeamish.

The main downside, I find, is that if you are playing this game and have not stretched and warmed up properly first, you can actually do a bit of damage. The next morning, when I woke up, the left side of my back was quite painful. This is what happens to a 41-year-old wealth management geek who has not spent enough time doing sport for real. Time to turn off the technology and put on the training shoes.

A link to some Wii-related injuries. I wait for the first politician to try and bleat about the "Wii menace".

William H. Stoddard of San Diego, California has some interesting commentary on the state of the debate between Clinton and Obama on what they want for US health care policy

Health care policy is a major issue in the Democratic Party's choice of a presidential candidate. The final debate between Hillary Clinton and Barack Obama, in Ohio, spent a reported 15 minutes on it. Yet the mainstream news media in the United States consistently report that there are only very minor differences between the positions of the two candidates. Given this, the argument looks like little more than semantic quibbling over the meaning of the word "universal," all too typical of Clinton's struggle to contest Obama's unexpected rivalry for the nomination.

But the mainstream news media have it wrong. There is, in fact, a vitally important difference between the two positions, though one that their worldview makes them ill equipped to recognize. The difference is that Clinton would compel everyone to purchase health insurance; Obama would not. The standard label for this difference in health policy debates is "mandate," for what Clinton wants.

Clinton has been evasive about exactly how she would compel the purchase of insurance - which is not surprising, as talking about punishing voters is not a good selling point in an election. The state of Massachusetts, which has a mandate, imposes fines on adults who do not have health insurance. Clinton has not talked about fines, but has suggested garnishing wages or making enrollment compulsory on admission to any hospital.

Of course, Clinton promises to make health insurance affordable to everyone, through subsidies and through massive new regulation of the insurance industry. So does Obama. But what if their plans do not work out? Under Obama's plan, adults who thought even subsidized health insurance cost more than they could pay would remain uninsured, and at least be no worse off. Under Clinton's plan, they would be forced to sign up, or penalized for not doing so - and either way they would be hurt. And given that Clinton predicts that fifteen million Americans would remain uncovered under Obama's voluntary plan, it seems that she anticipates that fifteen million people would have to be hurt financially to make her plan viable - or, perhaps, simply to justify her in calling it "universal."

Obama, in fact, has fairly clearly called attention to this difference. In the debate, he said, "We still do not know how Senator Clinton intends to enforce a mandate, and if we don’t know the level of subsidies that she’s going to provide, then you can have a situation, which we are seeing right now in the state of Massachusetts, where people are being fined for not having purchased health care but choose to accept the fine because they still can’t afford it, even with the subsidies..."

For libertarians, of course, which plan is less bad is a fairly straightforward question: the one that allows a measure of free choice is a lesser evil than the one based on coercive social engineering. And a non-trivial part of the electorate may feel the same way; where hard-core Democrats often favour Clinton's views, independent voters are reported as less supportive of mandates.

But there are hard questions about mandates even from the perspective of the Democratic Party itself. On one hand, people between fifty and sixty-five (where Medicare comes into effect) consume substantially more health services than younger people. Younger people are more likely to decide their low health risks do not justify paying for insurance. So forced enrolment would compel many younger people to pay for insurance they would not purchase voluntarily - but the benefit of enlarging the pool and lowering insurance costs would go disproportionately to older people. And on the other hand, those same older people are much more likely to own houses, to have savings and investments, and in general to be able to afford health care. So what Clinton is proposing is a regressive redistribution of wealth, from the worse off to the better off. It is hard to see how this makes sense within the publicly announced ideology of the Democratic Party.

It does make a kind of sense, though, within a different framework - the version of class analysis propounded by the libertarian economist Murray Rothbard, which emphasized conflict between the people who pay for taxes and redistributive schemes, and people who benefit from them.

Who supported the two candidates? Leaving aside the obvious "identity" politics (blacks favoured Obama; women favored Clinton; Hispanics, a group often in conflict with blacks, favoured Clinton), Obama had unusually strong support from younger voters, and Clinton from older voters; that is, Obama from Democrats who would be hurt from Clinton's scheme, and Clinton from Democrats who would profit from it. And Obama was favoured by Democrats with incomes above $100,000 a year, Clinton by Democrats with incomes below $50,000 a year. This is less obvious, but higher income people are more likely to be self-insured (so that forcing them to buy insurance would be to their disadvantage as they see it). So it looks rather as if Obama has managed to put together an insurance proposal that is more favourable to the very people who have been voting for him all along, and Clinton one that similarly appeals to her base. And the conflict between the two is a struggle between net victims and net beneficiaries of Clinton's redistributive scheme.

Whether Clinton and Obama recognize this is not clear. Of course, neither of them discusses such issues in their speeches; they both have to present their ideas as being best for everybody. Health policy theorists certainly do not see any conflict - and most of them favour Clinton's approach. But Obama's statements suggest that he is aware that mandatory health insurance could hurt some of the worst off people in American society; that he thinks this is a bad idea; and that he is prepared to make an issue of it. In a small way, this seems to make him the lesser evil as far as health care is concerned. If nothing else, he does not seem to cherish the idea of forcing everyone into a comprehensive administrative scheme for its own sake, regardless of the cost to the people it claims to help. Health care policy experts seem to feel otherwise - and so does Clinton. This is, of course, the core position of the established Democratic Party, the authoritarian liberal party of American politics. Obama's support might represent a realignment of less authoritarian voters increasingly unhappy with the Republican Party's fall into militarism, theocracy, and big government. The Democrats could only be improved by playing for their continued support.

What is innovation? A difficult question but would this effort modestly fit?

The Inter-Faith Gown is a new hospital gown for patients who would like to be more modestly clothed....

The Problem

Some people may be reluctant to be admitted into hospital due to the revealing nature of traditional patient gowns.

The Solution

The Inter-Faith Gown is designed to preserve the modesty of patients whose culture or religion requires them to be more modestly clothed.

It is made up of five pieces – three head garments, a gown and trousers. These elements can be mixed-and-matched to enable the patient to obtain the required degree of coverage. The sleeves of the gown have elasticated cuffs to cover the patients' arms.

Pictures are added in a tasteful jade green. Is this really what our taxes should be spent on?

This article is in the LA Times titled Doctors balk at request for data:

The state's largest for-profit health insurer is asking California physicians to look for conditions it can use to cancel their new patients' medical coverage. Blue Cross of California is sending physicians copies of health insurance applications filled out by new patients, along with a letter advising them that the company has a right to drop members who fail to disclose "material medical history," including "pre-existing pregnancies".

Firstly all aspects of medical care, including insurance, are regulated to bits in the United States (especially in California), and it is the government regulations and subsidy programs (such as Medicare and Medicaid - but in recent years SCHIP as well) that are at the root of the high price of medical cover. But to turn to the specific question:

If someone lies about their medical history when filling out a contract, in order to get less expensive medical cover, they are guilty of fraud. In an alternative world, which I am not saying I would support, they would not only be dropped by their insurance company when their fraud was exposed - they would also be prosecuted.

Of course, in our world, they will not be prosecuted and would not be convicted if they were prosecuted. It is much the same with all the political talk about "fraudulent lending" in the mortgage market. There has been vastly more fraudulent borrowing, but I doubt that the vast number of people who lied on their mortgage applications (for example claiming to have an income much greater than they really have) will be prosecuted.

However, in an alternative world (which, again, I am not saying I support) prosecution and conviction would solve the problems of customers guilty of fraud - medical cover and a roof over their heads.

Prison provides both.

Considering how many health-scare news items there are these days, it makes me want to smile in a wry way when I also read about the supposed problems caused by an ageing, greying, population. The first and obvious question is: if we are all at such risk from obesity, drugs, booze, stress, pollution or the angst of watching Jonathan Ross, why are we living so much longer than our parents or grandparents? If this is what happens when the sky is supposedly always about to fall in, then what must a healthy population be like? And yet there is something in the human psyche, or our culture, that rebels against the happy prospect of a longer life. We are told, or at least have until recently accepted, that three-score years and ten is Man's rightful due (perhaps a tad longer for women); it is almost a hangover from religion to believe that it is impious, even blasphemous, to want to live for much longer. Andrew O'Hagan, writing in the Daily Telegraph today in a moan about how the elderly are treated in Britain - a valid subject - makes this point:

Growing old is now considered more of an option than an inevitability, something to beat rather than be resigned to, something that is thought to take away from one's individuality rather than deepen it.

I don't really know how death, or its inevitability, adds to one's individuality. I think I know what O'Hagan is trying to say: We are unique, precisely because we are mortal. We cannot be replaced, or copied.

The trouble, though, is that I don't see how one's uniqueness is somehow reduced by living for 200 years rather than say, 100, or 50, or 30. Were the ancient Romans - average lifespan about 35 - more individualistic and unique than a 21st Century Brit? How on earth can one measure this? Also, the desire to keep the Grim Reaper at bay surely attests to a love of life, not a denial of its value; if one believed in a craven acceptance of the inevitable, then why do we have doctors and hospitals?. I value my life rather a lot and am in no hurry to see my hair go all grey, my face resemble tree bark, and my limbs to seize up. Sorry, Mr O'Hagan, but I'd rather not suffer that fate any time soon. I go to the gym and try to keep fit despite my enjoyment of red wine. I have not signed up for cryonic suspension or anything like that but I keep an eye on life extension research and have been greatly impressed by the work of people such as Aubrey de Grey, among others. (Don't be put off by the immense beard, he's not a nutter). I lost a good friend and intellectual mentor, Chris Tame, nearly two years ago to the horror of bone cancer - he was in his mid-50s - and I am pretty sure this most unique of people could and should have been around for many more decades among us. (I particularly miss his outrageous jokes).

I remain to be convinced of the idea that to value one's life, it must be short, or that we should resign ourselves to it meekly. Meekness did not build the space rocket, the Aston Martin DB9 or even produce modern dental surgery.

Update: Glenn Reynolds has interesting thoughts on this subject. He's been writing on this for some time. Ronald Bailey, whom I met over a year ago during a book tour of London, is also well worth reading on this and related topics. I read this Peter Hamilton novel which touches on rejuvination; it is not one of his best tales, unfortunately (the Amazon.co.uk book reviews are not very flattering).

Via the excellent engadget blog, here is a nifty item to put on the wall for all you health-freaks out there. Perhaps I should strap my arm to one of the controls the next time I read about the Archbishop of Canterbury, the eco-Leninist thoughts of Madeleine Bunting, or watch the English rugby/cricket/football team give up a lead?.

Or maybe I should stop doing all these things for a longer, happier life.

On some, if not all issues, Rod Liddle is a man of sound views. He loathes the nanny state; he is unconvinced that we need to crack down on freedom of speech in order to avoid giving offence to religious groups. He is a patriot. In this week's edition of the Spectator, where other authors rant away splendidly, Liddle rails against the six-month-old government ban on smoking in all public buildings, including privately owned ones (apart from private homes), such as pubs and restaurants. He makes a good case and some of his paragraphs are cheer-out-loud material:

Of course, one shouldn’t drop a policy simply because the pubs are having a rather hard time of it as a result. But in which case, don’t bother to pretend that they’re not, that actually there are queues all down the street consisting of shiny, happy people who wish nothing more than to drink in a new, healthy, smoke-free environment. Stop lying. Say, instead, that the smoke ban is putting pubs out of business but actually we couldn’t give a toss. Truth is, the government — and the health charities — are caught by their previous, gerrymandered poll findings which purported to suggest that the entire country was in favour of a complete ban on smoking everywhere, when — and again, do a quick vox pop if you doubt this — the reverse was true. People would like to see genuinely smoke-free areas of restaurants and pubs, for sure — but only chose a complete ban on smoking when the alternative on the poll sheet was ‘or would you like your testicles sawn off?’.

Or this:

Perhaps it is true, though, that because of the ban, I shall live for ever, for which many thanks, Dawn. But I doubt it; we will have recourse to one or another means of killing ourselves, such as driving a car (4,000 deaths per year), drinking more (40,000 deaths per year) or visiting a doctor (30,000 deaths per year through negligence or incompetence: never forget that figure. It exceeds the numbers killed through smoking-related illness. And it really, really hacks off the doctors).

But as always with Mr Liddle, the carelessness with which he chucks around numbers makes me wonder if any reader will want to get past his first paragraph:

I am still not sure what I hate the most about this government: its decision to invade Iraq and thus either effect or facilitate the murder of 500,000 Iraqis, or its decision to stop me from smoking in pubs and restaurants.

500,000 Iraqis? Is that correct? Liddle gives no source for this or attempts to do so later in the piece. Now Rod may be right to suggest that the overthrow of a power-mad, dangerous dictator was even worse than letting him stay in power (I occasionally wonder why a certain type of right-winger is so indulgent towards evil men like Saddam). But if he is going to make an argument with statistics as part of his core argument, it is probably not a great idea to kick off an argument with a massive figure based on, whatever.

Oh, in case anyone asks, I don't smoke, except on National No Smoking Day.

The European Union has its uses. While rootling around for stuff to link to from CNE Competition, I came across this:

Left-wing Labour MPs are girding themselves for a rebellion over a European Union plan which they say could spell the end of the National Health Service.

When left wing Labour MPs rebel, I at least hope for possible goodness.

The European Commission will publish its health directive next week and it is meant to make it easier for people to travel to get specific medical treatment in another EU country.

Ah, the age-old dilemma of the EUrosceptic. What do you think if the EU imposes something sensible?

British diplomats say that this is NOT the same as making sure that if you fall sick in Slovakia or have an accident in Austria you can get treatment straight away.

When British diplomats say that something is NOT something else, it means that they have been told to say that by their political masters and that the small print of their argument will be about a very small difference. The feathers on the other something will definitely NOT be the exact same colour, but the other something will otherwise waddle and quack in an identical fashion to the original something, and will in fact be just another duck. For "NOT", read " ", in other words.

It is what some people call "health tourism" and both critics and fans say it will allow people to shop around for health care.

Sounds great. So what if it is just a plan to sell Eurostar tickets; I still like it.

In the end, there is nothing like people preferring something else to whatever bogus nirvana is being peddled by the bogus nirvana peddlers. The one argument against the much vaunted Soviet Communist nirvana that the vaunters could never wriggle free from was the fact - for fact it was - that this was a nirvana that millions wanted to escape from, through minefields if need be, and with only the clothes they were wearing at the time of their escape if that was all they could take with them. A similar process is now under way with Britain's similarly vaunted NHS, the best healthcare system in the world except for all the others.

A story on the UK news last night gave statistics on trauma patients. Those are the seriously injured who must be transported from an accident site to a trauma centre. The percentages of trauma patients who die are:

UK - 43%
US - 16%

Draw your own conclusions.

I happened to be near a TV last night and was so stunned by the numbers that I pulled out my clipboard and wrote them down. The news feature also noted that ambulance first responders were insufficiently trained and often did not carry out measures such as clearing air passages. It also discussed the idea of having specialist regional trauma centre's. If any one else was watching last night, their inputs on this TV report and the data behind it are welcome. The only thing I have found so far on the net is this

The smoking ban was a mere tasty morsel. It has roused the appetite of the beast without bedding it back down again. The hungry beast has drawn blood and it wants more:

Government ministers should shrug off media accusations that they are running a nanny state and introduce tougher public health measures, experts say.

The Nuffield Council on Bioethics said the time had come to consider a whole host of interventions in the UK after the introduction of a smoking ban.

Its proposes raising alcohol prices, restricting pub opening hours and better food labelling to fight obesity....

The report by the panel of experts, which include scientists, lawyers and philosophers, said there was a balance to be struck between individual freedom and wider public protection.

Welcome to the latest phase of the old 'public choice' paradigm. You have to choose between freedom and prosperity. You have to choose between freedom and fairness. You have to choose between freedom and safety. And the wheels of the world turn round and round to the music of the rhythm of history.

Okay. let's gird our loins, saddle up and prepare for battle again but, this time, let's make sure that we don't go charging off in the wrong direction. It would be easy to lose this stage of the war and, as always, the odds are stacked against us. But lose we will for sure if attempt to fight it on the enemy's ground and what I mean by that is accepting that there is a such a thing as a choice between freedom and health and then attempting to persuade people to choose freedom and to hell with their health. If the public believes that this is the choice they must make, then they will choose to be healthy and, before we know it, we're standing around scratching our arses and wondering what went wrong while the triumphant, braying beast tramples everything in its path.

We must not make the mistake of arguing that health does not matter. It does matter. As every exhortatory elderly relative has croaked at one time or another, health is the most important thing. But that is exactly why we need more freedom and less compulsion. The healthiest societies are the the most liberal and prosperous ones, while the unhealthiest are invariably the poorest and most statist and centrally planned prescriptions for health will be no more successful than centrally planned prescriptions for the economy. The public must hear, again and again, that the "choice" being presented to them by the likes of the Nuffield Council on Bioethics is vexatious, counterfactual and perverse.

The beast will not stop. It will not change its mind, grow tired, get distracted or give up. The stakes are too high. But that is not the same as saying that it is unstoppable. We just have to make sure that we shoot its legs from under it. Nothing less will do.

Who'd'a thought we'd see two shout-outs to King Canute in as many days in the health care arena? Yet there he is, popping up again in Business Week in the service of opposing more government intervention in health care.

According to legend, King Canute of Denmark facetiously tried to stop the rising tide by simply raising his hand and commanding the waters to roll back. The tide, of course, kept rising. Yet policymakers throughout history have followed Canute's lead. From Hillary Clinton and John Edwards to Mitt Romney and Arnold Schwarzenegger, politicians across the spectrum have tried or vowed to solve America's health-care woes by enacting an individual mandate - a law requiring every adult to purchase health insurance. Despite its bipartisan support, the individual mandate is bad policy, a vain attempt to command a better result while doing nothing to achieve it.

An excellent discussion of the folly of individual mandates follows. Of some interest is the way the estimate of the size of the problem meshes with that made below.

According to an Urban Institute study released in 2003, uncompensated care for the uninsured constitutes less than 3% of all health expenditures. Even if the individual mandate works exactly as planned, that's the effective upper boundary on the mandate's impact.

If you do the math, I think you will find that Mark Steyn's number of the poor uninsured comes out to about 3% of the population.

More importantly, Whitman points out the major flaws in the individual mandate proposal - it would not work (people will still refuse to buy health insurance), and it will make the problem worse by driving costs even higher.

Even now, every state has a list of benefits that any health-insurance policy must cover - from contraception to psychotherapy to chiropractic to hair transplants. All states together have created nearly 1,900 mandated benefits. Of course, more generous benefits make insurance more expensive. A 2007 study estimates existing mandates boost premiums by more than 20%.

If interest groups have found it worthwhile to lobby 50 state legislatures for laws affecting only voluntarily purchased insurance policies, they will surely redouble their efforts to affect the contents of a federally mandated insurance plan. Consequently, even more people will find themselves unable to afford insurance. Others will buy insurance, but only via public subsidies. Isn't that just what the doctor didn't order?

His prescription for incremental policy reform strikes me as being pretty sound, as the fundamental shift that needs to be made in health care insurance is away from first dollar coverage, low deductibles and copays, etc. and toward catastrophic insurance. First dollar coverage has proven to distort if not destroy any semblance of financial responsibility on both sides of the health care transaction, and is one of the primary drivers of high costs. Catastrophic coverage fulfils the true function of insurance - protection against risks you can not afford - without creating the disastrously misaligned incentives that our current system has.

Our theme for today comes from George W Bush: "Freedom is the desire of every human heart."

Whether or not freedom is the desire of every heart, I think it is abundantly clear that most people are indifferent or hostile to their neighbor's freedom, which is why a mere democracy, unencumbered by principles of limited government, is assured of devolving into some sort of Total State in short order. But the inimitable Mr. Steyn is not content with observing that most people think of freedom as "fine for me, but not for thee." No, he has in mind the apparent eagerness of so many to give up their own freedom.

A year ago, I wrote that, "The story of the western world since 1945 is that, invited to choose between freedom and government ‘security,' large numbers of people vote to dump freedom — the freedom to make your own decisions about health care, education, property rights, seat belts and a ton of other stuff."

This is what makes being a small-government libertarian so frustrating. Our patron saint should be King Canute, for it often seems like we are standing on the shore, trying to stop the tide. The reply to Mr. Steyn, if it is not couched in shallow democratism ("we are just giving the people what they want") is usually couched in terms that imply that freedom is not possible, or at least can not be enjoyed, without material security provided by the State. This inversion of real freedom (the freedom of self-ownership) was perhaps best catechized by FDR, the man most responsible for freeing demagogic democracy from the strictures of the constitutional republic, as "freedom from want."

FDR's heir is Hillary Clinton, and she is pushing (again) for nationalized health care in America. The battlecry this time is that there are "45 million uninsured" (or whatever spurious number is trotted out).

My first response is "so what?" Anyone in America can get health care simply by walking into the nearest hospital, as all hospitals are required to give an exam and emergency treatment regardless of ability to pay.

But, as always, one should not let the factual assertions of the advocates of the Total State go unexamined. Mr. Steyn continues:

So, out of 45 million uninsured Americans, nine million aren't American, nine million are insured, 18 million are young and healthy. And the rest of these poor helpless waifs trapped in Uninsured Hell waiting for Hillary to rescue them are, in fact, wealthier than the general population. According to the Census Bureau's August 2006 report on "Income, Poverty and Health Insurance Coverage," 37% of those without health insurance - that's 17 million people - come from households earning more than $50,000. Nineteen percent - 8.7 million people - of those downtrodden paupers crushed by the brutal inequities of capitalism come from households earning more than $75,000.

In other words, if they fall off the roof, they can write a check. Indeed, the so-called "explosion" of the uninsured has been driven almost entirely by wealthy households opting out of health insurance. In the decade after 1995 — i.e., since the last round of coercive health reform — the proportion of the uninsured earning less than 25,000 has fallen by 20% and the proportion earning more than 75 grand has increased by 155%. The story of the last decade is that the poor are getting sucked into the maw of "coverage" and the rich are fleeing it.

At a conference on health law last week, I predicted (only half in jest) that Hillary would be signing the bill nationalizing health care at the beginning of her second term. The more I think about it, the more likely it seems. The tide of the Total State never sleeps.

Edward Paul Brown was a premature baby whose birth and death took place within minutes of each other on February 23rd 2007 in a lavatory in Queen's Hospital, Romford.

Eighteen weeks into her pregnancy, his mother, Catherine Brown, was told that there was no amniotic fluid surrounding the baby in her womb. This meant that the baby's chances of survival were minimal and her own life was threatened. Catherine Brown took the "devastating" decision to abort. Even those (such as I) who generally oppose abortion, will see this as a hard case - and I hope that any comments do not get sidetracked onto that issue.

So. We have a woman in hospital waiting for the procedure that will abort her baby, a child she had wanted to bear and raise. Not a pleasant situation at any time, but what followed next was disconcerting to read about even for those who have grown weary of NHS "war stories".

I first saw this in the Times (Baby's birth and death in lavatory of hospital with no trained staff), but there is a considerably more detailed account in This Is London (Mother forced to give birth alone in toilet of 'flagship' NHS hospital) (A very similar account appeared in the Daily Mail.)

Both headlines understate the peculiarly modern horror of what happened. The reader gets a picture of nurses trying to help, but out of their depth because Queen's Hospital did not at that time have a proper maternity unit. That picture is wrong. The part of it that is wrong is the "trying to help." The nurses declined to help.

This Is London quotes Catherine Brown's mother, Sheila Keeling, who was present as her daughter went into labour:

"I was running around frantically trying to find gas and air for her and pleaded with nurses, who seemed very matter of fact, to assist," she said.

"The staff I did find told me they did not have the training to help. Catherine was left to deliver the baby alone with just me for help before cleaning herself up and going back to bed. It was horrific."

(Emphasis addded.)

Not just could not help, would not. Would not even be present, as far as I can see. Modern nursing has moved on, you know, since the days when the role of the nurse was to hold your hand and wipe the sweat from your brow. They don't do that any more!

What caused these nurses to hang back from offering the ordinary, unskilled comfort that would once have been seen as the heart of their calling? I am tempted to simply blame it on the NHS. Certainly this case is something to set against all those stories we hear from those benighted lands where healthcare is not financed by taxation. Of course I do blame the NHS for the dreary catalogue of delays and mismanagement that Catherine Brown suffered before the birth; the wait for a scan, the further wait for pain relief, and the fact that she had to lie in a mixed sex ward and the fact that they nearly dumped Edward's dead body. But that is old hat. Things were no different a decade and a half ago when I was in labour in another hospital in Essex and the midwife was obliged to run out into the corridor and yell "Where's the fucking obstetrician?" And my would-be epidural man popped his head round the door and announced that he was ready to begin twenty minutes after the birth. I did not hold it against them. It was a difficult day, lots of births happening at the same time. At least they tried. In Queen's Hospital as Catherine Brown crouched over the support bar of a disabled person's lavatory to deliver her doomed child, they felt themselves unqualified to try. More than their jobs were worth.

No, this gutlessness is new, and although I do see it as yet another consequence of the command economy of the National Health Service, to add to the melancholy consequences we knew about already, I seek a more specific explanation as well. One major factor might well be fear of getting sued. Yet that, too, does not wholly explain it. The nurses concerned must have known that their chances of being held personally liable were tiny and they must also have known that the chances of their hospital getting sued for neglect of duty were significant. (None of the reports I have read in the press say whether this happened, although clearly some official inquisition took place and reached the verdict that press has been reporting over the last few days.)

The loss of nerve is not just seen in hospitals. One can see it in the other public services too.

Looking at the fire service, fireman Tam Brown nearly drowned saving a woman's life in the River Tay - and was rewarded by being threatened with disciplinary action by Tayside Fire and Rescue, on the grounds that he had "broken procedure" by entering the water. He was meant to use the correct ropes and poles and since his crew did not have the correct ropes and poles he was meant to watch her die. Possibly he was meant to put the down time to good use by filling in a safety report on the incident. As it happens he not only got away with his archaic belief that that was not what he had joined the fire service to do, but was belatedly praised for it by his superiors - but, make no mistake, as Squander Two says, that will be because of the publicity.

Looking at the police - Julia Pemberton was murdered along with her son by her estranged husband. She called the police as he rampaged with a shotgun through the house. You can read the transcript of her last 999 call here. "Officers are on the way," says the operator. That was moderately close to being true and the fact that the police could not even find the address of a woman whose house they had fitted with a panic button is not really relevant to this post. They got there in the end and saw the son, William, lying on the drive. At this point three unarmed officers vainly but creditably attempted to help him. Guess what? They were breaking procedure. In the words of Julia Drown MP,

However, the irony is that the officers who stand out as having done everything, and more, that the family could have expected from the police, were the ones who breached the police's policy.

What Julia needed was a firearms response, but it was more than one hour after she picked up the phone before the first armed response arrived outside the grounds. Armed units did not enter the house for almost seven hours, despite the fact that no sounds from it had been heard for more than six hours. Instead of going directly to the house, armed units were sent to a remote rendezvous point, and further problems were caused by poor communication among the police. The wrong silver commander was initially called, with the correct one not called for more than an hour after the start of the 999 call. When the silver commander finally arrived, he moved the rendezvous point and did not take command until three hours and 26 minutes after the call started.

During that time, it was not known whether Julia was dead or alive. The police priority was to preserve the lives of officers rather than the lives of victims.

The police did not actually go into the house for hours. Goodness, no. There might have been a violent criminal in there! Probably it made no difference. The victims were already dead. But for all the police knew Julia Pemberton could have been alive but desperately wounded and praying for help. Time was when the ordinary village policeman, unarmed as he was, would have gone in.

Let me say (before someone says it for me) that I do not claim that I would have the courage to go into a house where a killer might lie in wait, or that I would have jumped in the bitter, fast flowing waters of the Tay to save some stupid woman who wanted to top herself. But such were the traditions that were honoured in the police and fire services. In fact, when I talk about "gutlessness" and "loss of nerve" here I am not talking about individual physical courage. Fireman Tam Brown showed great courage. At least three of the policemen in the Pemberton murders did as well and all of them showed more guts than I would. But institutional gutlessness surrounded them, was embarrassed by them, and will kill off their like eventually. Poisoned soil does not long give forth good fruit.

Going back to the Queen's Hospital example, I do not have the personal qualities to be a good nurse, though I do think I could have bestirred myself to help in this case, when even standing around being useless because untrained would not have been useless and was clearly what the patient wanted. All the training nurses have these days appears to have trained the initiative and compassion right out.

I keep asking myself why anyone wants the new way?

Perhaps, in the case of those who will not act because unqualified in that speciality, it is a fear of finally having to be the real thing. When your whole life has been one long rehersal the raising of the curtain for the First Night is not always a welcome event. So Nurse Smith listens to the howling through the lavatory door rather than act wrongly and Constable Jones watches the stripy tape flutter around the perimeter of the silent house and waits for the Armed Response Team.

Perhaps, in the case of those who make these regulations, it is a peverted delicacy. Some are offended by the eruption of death or violence into their paper world, by the bloody evidence that not everything is covered by their rules. Below that delicacy, deeper and colder than mere personal malice, is a hatred of efficacy.

How do we get our nerve back?

In his defence of classical liberalism and critique of 20th Century state welfarism, F.A. Hayek argued that one of the dangers of socialised medicine (Michael Moore, please note) is that if health care is not rationed by price and expanded by the freely chosen actions of patients and doctors, then some other means of allocating scarce resources, and making them hopefully less scarce, will be needed. That "other" way is state coercion and control. Because healthcare is delivered in Britain free at the point of use - of course it is not free at all - the individual patient does not directly see the price of the health care he or she receives, such as in the form of an insurance premium. There is no price incentive, therefore, for a person to, say, cut out smoking, cut the beer and the beef burgers, get in shape by frequenting a gym, etc.

I wrote some time ago about the scarcity of human organs such as kidneys and livers, and how much of the western world suffers from a strange form or hypocrisy: we say it is great that people volunteer to donate organs (the libertarian writer Virginia Postrel has done just that by donating a kidney to a friend) but we recoil in horror at the idea that a person might ever be persuaded to sell an organ or be paid for such a donation, even though there is, in some countries, a commercial market in the business of using such organs and the related human tissue. (There is some legitimate worry that very poor people who do not realise the health implications might undergo surgery to sell their body parts, to be fair).

I thought again about such mixed attitudes when I saw the front page of the Sunday Times this morning:

THE chief medical officer wants everyone to be treated as organ donors after death unless they explicitly opt out of the scheme.

Sir Liam Donaldson believes the shortage of kidneys, livers and hearts is so acute that the country needs a donation system that will presume patients have given consent for their body parts to be transplanted.

Those who wanted to opt out would have to register in a similar way to those who now carry organ donor cards. This could be done through a central NHS database or through other documentation, such as driving licences.

But ranting away about the presumptious tendencies of a state doctor is all very well for relieving a bit of blood pressure, but there clearly is a problem with shortages of organs and how to save the lives of people in desperate need. Donation, either for no money or for a payment (with safeguards, if need be), can work only so far. We need to encourage biotechnological fixes: and a good place to see what sort of fixes might be out there is this interesting study by Ronald Bailey.

The doctors are right to highlight that there is a problem, but how less depressing would it be if they could think about ways of solving it without recourse to asuming that your body belongs to the collective, just for once.

This comment was left by a person calling herself Jasmine, responding to Sam Leith's fine piece bemoaning the attitude of mind that led to the UK smoking ban in privately-owned places:

Has it occured to you that this is a nanny state because we need nannying? I don't think anyone can dispute that smoking is not good for you. I read somewhere that having a smoking "section" is like having a peeing "section" in a swimming pool. It's just not enough to have a partial ban and wait for the natural goodness of people who simply don't know any better, to stop. They need to be forced to stop.

A question I would put to this woman, and quite a few of the other control-freaks out there is this: what gives you the right to tell an adult that he or she should adjust their habits for "their own good"? Does Jasmine think of herself as being some sort of god? Has it never occurred to these people that their obsessive desire to regulate all aspects of existence is in fact a sign of a deep psychological problem, which needs to be fixed?

Those idiots want health. But what we need is more life.

- Tattooed Marie, a Parisian barmaid, quoted à propos smoking bans on Spiked.

"If Michael (Moore) thinks healthcare is expensive now, just wait when it's free."

P.J. O'Rourke, in a remark attributed to him in this nice takedown of Moore's latest "documentary", Sicko, a film making the case that we would all be better off in having tax-funded healthcare free at the point of use, like the magnificent British National Health Service that is the envy of the world (cue sarcasm alert, sounds of hollow laughter).

Arnold Kling has thoughts on the movie. Here is what I wrote about some of the issues arising when people want healthcare free at the point of use (ie, they want someone else to pay for it).

Do not misunderstand me: private healthcare in some countries, such as the US, is far from perfect. For a start, it does not have a lot to do with unfettered laissez faire capitalism, as anyone who has encountered the powerful American Medical Association will point out. The insurance system in the US encourages inflated prices for treatment, and there are other regulatory and legal costs which have become a lot worse in recent years. But if Moore thinks British cinema audiences will be wowed by his paean of praise for Britain's Soviet model of healthcare, he needs to have his head examined.

Mind you, I have often wondered whether Moore is for real, or a sort of performance artist secretly working for Dick Cheney.

(Update: further thoughts on whether Moore is a clown damaging the already-weak case for socialised medicine can be seen here.)

When Perry referred to the recent comments of US Presidential hopeful Barak Obama, we had another example in the ensuing comment thread of how people lazily refer to the idea that healthcare should be 'free'. Of course, unless Obama is a total idiot - and I doubt that - he realises that health care, like roads, clean water, defence or food is not free in any sense at all that matters in a world of scarce resources that have alternate uses (such scarcity and the fact they have alternate uses is a classic element of what economics is). Healthcare is not free - it must be paid for, paid out of the time and trouble of other people. The problem, however, is that a lot of people, not just socialists, think that some things in life 'ought' to be free although one often finds they are at a loss to say why. Indeed, if you challenge a person by asking, "Why should health, clean water or defence be free"? they will either change the subject, or go bright red with anger, or fail to understand the question at all.

To attack the idea that certain services and resources should be 'free' is not, alas, all that easy in today's politically dumb climate. However, I think I have a partial solution in how to frame the point. If you ever encounter a person who says that healthcare should be free at the point of use, and it should be a 'right', then point out that this means that someone else has a corresponding duty to be a doctor, a nurse, a hospital orderly or an administrator. Unless people can be forced to perform these roles, then all talk of health as something that ought to be free is meaningless. Of course, at this point the socialist will blather on about incentives and so on, but what if no one wants to be a doctor or a nurse, regardless of pay? Does this mean that anyone who shows an inclination to like medicine should, at an early age, be conscripted into a hospital like a draft for the Army?

I ask these rhetorical questions because I think that when we try to frame our arguments, it is sometimes easy to lose sight of the fact that actual flesh and blood human beings are involved in talk about "the right to free health care". Most people these days oppose the idea of military conscription so it ought to be possible to make the case against medical conscription. If we can point out that medical conscription would be a bad thing, then it would be a step in nailing the nonsense that healthcare is a 'right'.

Here is a book I highly recommend about the whole noxious doctrine of 'welfare rights' and how they erode respect for the original, far more coherent rights doctrine of classical liberalism.

I just saw Barack Obama on television saying that he would introduce Universal Socialist Medical Care in the USA and for people who already have insurance policies, the only difference would be such people would pay less in premiums... everything else would be just as good. Yes, you too in the USA can have something as 'wonderful' as our decrepit National Health Service. You lucky, lucky people.

And presumably this conjuring act of creating wealth out of nothing with government impositions will come to pass purely via the Triumph of Barack Obama's will.

Talk about delusional.

He [Michael Moore] travels to London to show off the beauty and brilliance of the British National Health Service. He talks to an unstressed doctor who has a four bedroom house in Greenwich and a £100,000 salary from the NHS. He films empty waiting rooms and happy, care-free health workers. He even talks to Tony Benn about how this wonderful marvel came into existence in 1948.

What he hasn’t done is lie in a corridor all night at the Royal Free watching his severed toe disintegrate in a plastic cup of melted ice. I have.

- James Christopher, reviewing Michael Moore's film Sicko in the Times.

Continuing in movie-talk vein, one force that has swept through the western film industry to greater and lesser degrees is the current hatred of tobacco and the tobacco industry. The Michael Mann film, The Insider, starring Russell Crowe and Al Pacino - with a fine performance also by Christopher Plummer - is a good example. All the pieces are in place: a big, evil ciggie firm makes its products more addictive by dark scientific means; Crowe, who plays a scientist, leaves said evil organisation and blows the whistle on its practices. He is hounded, threatened, his marriage and career collapses. Pacino, as the hero-journalist, tries to expose all this, and in the process gets leant on by his big-bucks media empire bosses. The viewer comes away from the production in no doubt that cigarette companies are just a few inches short of being Nazis.

If you take a random look at any major Hollywood production these days, you seldom see stars light up a cigarette, except possibly some of the more dubious or "troubled" characters. When I watched Steve Martin's hilarious spoof film of 1940s film noir, Dead Men Don't Wear Plaid, I was reminded of how in the movies of the time, everyone smoked. Even the pet dogs would have smoked, given half a chance. And the cinema audiences smoked like chimneys as well. This is now a distant memory. The modern James Bond in Casino Royale does not smoke his Morland Specials, whereas Connery smoked and of course 007's creator, Ian Fleming, puffed away heroically. Bogart got through several packs of Luckies in a movie, and so did the various hot dames who acted with him. Spencer Tracy was unusual in that he did not smoke. Can you imagine Hugh Grant smoking, or George Clooney?

Of course, there is a bit of a backlash from time to time, creating wonderful satire. Thankyou for Smoking, the film based on the humorous novel by Christopher Buckley, is one such. And the great Denis Leary tries to keep the flag flying. But for real defiance of the health-obsessives, the French cannot be beaten. Last night I watched the French cop film 36, starring the usual roster of craggy-faced Jules and Jacques with their Galoises and Gitanes attached permanently to their lower lips. I counted, or tried to count, the number of cigarettes smoked in the film and gave up at about the 200 mark.

If Sarkozy is to be a great president of France, he needs to smoke.

In the beginning God covered the earth with broccoli, cauliflower and spinach, with green, yellow and red vegetables of all kinds so Man and Woman would live long and healthy lives.

Then Satan created Dairy Ice Cream and Magnums. And Satan said, "You want hot fudge with that?
And Man said, "Yes!" And Woman said, "I'll have one too with chocolate chips".
And lo, they gained 10 pounds.

And God created the healthy yoghurt that Woman might keep the figure that Man found so fair.
Satan brought forth white flour from the wheat and sugar from the cane and combined them.
And Woman went from size 12 to size 14.

So God said, "Try my fresh green salad".
And Satan presented Blue Cheese dressing and garlic croutons on the side.
And Man and Woman unfastened their belts following the repast.

God then said, "I have sent you healthy vegetables and olive oil in which to cook them".
And Satan brought forth deep fried coconut king prawns, butter-dipped lobster chunks and chicken fried steak, so big it needed its own platter.
And Man's cholesterol went through the roof.

Then God brought forth the potato, naturally low in fat and brimming with potassium and good nutrition.
Then Satan peeled off the healthy skin and sliced the starchy centre into chips and deep fried them in animal fats adding copious quantities of salt.
And Man put on more pounds.

God then brought forth running shoes so that his Children might lose those extra pounds.
And Satan came forth with cable T.V. with remote control so Man would not have to toil changing the channels.
And Man and Woman laughed and cried before the flickering light and started wearing stretch jogging suits.

Then God gave lean beef so that Man might consume fewer calories and still satisfy his appetite.
And Satan created McDonalds and the 99p double cheeseburger.
Then Satan said, "You want fries with that?" and Man replied, "Yes, and super size 'em".
And Satan said, "It is good."

And Man and Woman went into cardiac arrest.
God sighed. And created quadruple by-pass surgery.
And then Satan chuckled, and created the National Health Service.

Some people get disgusted - I guess it is the 'yuck!' factor - at the idea that a person can sell his or her own kidney for money, for example. We seem to live in an era of warped values about the donation and use of human body parts, as this article in Reason makes clear. It appears that in some jurisdictions, just about everyone is allowed to make money from the business of using human tissue and bone for medical purposes - except the people from whom the tissue and bone is taken (I think we can take it as read at a liberal blog like this that killing people for their body parts is wrong).

Virginia Postrel, the US-based writer, underwent surgery to give one of her own kidneys to a friend and made sure said friend is alive today (what a great woman Virginia is). As a classical free marketeer, Postrel does not understand why it is so terrible that such acts should be done for financial gain. She has a long and typically thoughtful piece on the subject here. She responds to those who fear that poor or gullible people might be led into selling their body parts out of financial desperation, but that is an argument about curbing poverty, not reducing human freedom. Ultimately, I own my body, and not the state, not the rest of the UK population, not Tony Blair, not god or the Great Cheese Monster in the sky. Of course, a "market in organs" may attract shysters and unscrupulous doctors, but as the Reason article I alluded to makes clear, there are plenty of shysters in the system now.

Of course, in a country like Britain where a lot of the population drink like fish, it is debatable whether anyone would want to buy our kidneys, or even take them for free.

There is a class of drugs called 'cognitive enhancers' that could potentially raise the intelligence, skills and productivity of users. Pharmocological enhancement is an anticipated bonus of the information revolution, and has been welcomed by many in the transhumanist community. These issues are now cognitive blips on the unenhanced specialist offices that civil services establish to monitor that horrible outcome of progress known as the Future.

When governments begin to understand that people could use a new set of drugs for improvement, they grasp for an improper P word, Prohibition. Their Puritanical wish to maintain a level playing field between themselves and the Populace demands that these substances be controlled, classified, prescribed, monitored and hopefully banned. Enhancement is a dirty word, but if these drugs have to be accepted, then they will make sure that we will use them on their terms:

Foresight, a Government think-tank, believes that "cognitive enhancers" could be "as common as coffee" within a couple of decades to help a person think faster, relax and sleep more efficiently....

The Department of Health has become so concerned about these drugs that it has asked the Academy of Medical Sciences (AMS) to assess the potential impact of the substances, some of which are licensed in Britain to treat narcolepsy or acute tiredness.

They are already being bought illegally over the internet in the US by people who think they will enhance their performance in the classroom and in the office.

Government attention in these drugs is unwelcome, since the report of Foresight or the Academy of Medical Sciences speculate about social problems as an excuse for regulation. One argument raised is that the pharmaceutical industry could abandon research into mental health and switch to 'cognitive enhancers' because of greater demand.

All of the evidence indicates that civil servants, politicians, and public sector professionals would not benefit from 'cognitive enhancers', since their increased intelligence would be expressed in greater fiscal and regulatory complexity. These classes should be prohibited from employing cognitive enhancement.

As if the threat of being bullied and labelled a fattie is not enough, there is now the risk that the state and its agents will take a child into care if that child is deemed "obese". Over the last few days, the press has carried reports of how a young boy, weighing in at a powerful 14-stone (196 lbs/ 89 kg), narrowly avoided such a fate.

My first instinctive belief is that the state has no business telling us about what should be the shape of our butts. In the case of children, responsibility lies with the parents, and there has to be real and sustained proof of neglect and abuse to trigger any form of intervention. In nearly all cases, my view is that the "cure" of taking an "obese" child into care will far worse than the supposed problem. Yes, extreme obesity, as measured in terms of excess fat vis a vis overall body shape, is not something to laugh at or dismiss. Although I have been lucky and born with a slim physique, I still try to build on that good fortune by keeping fit. There's no doubt that many people in Britain are unhealthily overweight. Lack of exercise, sedentary lifestyles and the demise of hard, physical labour all have an effect. But while I would encourage folk to look after themselves, ultimately, what people choose to do with their lives is their business, not mine. In the case of this youngster, realising that he is overweight should be incentive enough to do something about it. His parents may not be the brightest lights in the harbour, but from what I have read, they plainly adore their son, although they probably could exert rather a stricter control over his diet.

As we have also found in so many cases, paternalistic state actions often start to "protect the kids" and end up spreading towards adults as well. I hope this young man learns to take pride in his own health and can look back in future to this time in his life as one where he learned to control his appetite and also realise how dangerous the state has become. There are plenty worse things than having a large tummy, that is for sure.

If water were not so obviously essential, I wonder if it would now be even allowed:

If you drink too much water, eventually the kidneys will not be able to work fast enough to remove sufficient amounts from the body, so the blood becomes more dilute with low salt concentrations. "If you drink too much water it lowers the concentration of salt in your blood so that it is lower than the concentration of salt in cells," says Professor Robert Forrest, a consultant in clinical chemistry and forensic toxicology at the Royal Hallamshire Hospital in Sheffield.

Professor Forrest continues:

"When the brain swells, it is inside a bony box so has nowhere to go," he says. "The pressure increases in the skull and you may get a headache. As the brain is squeezed it compresses vital regions regulating functions such as breathing."

Eventually these functions will be impaired and you are likely to stop breathing and die. Warning signs included confusion and headaches.

No sniggering. This is exactly what happened to a Californian lady after she had taken part in a water drinking contest (a sport which should obviously be banned forthwith).

A government task force is clearly needed to keep a constant eye on the water threat. Once that happens, health warnings on water bottles are only a matter of time. "Water can seriously damage your kidneys", and so on. "Big Water" will be accused of peddling scaremongering stories about the alleged need for water, and the alleged benefits of water, and even nonsense about how, if you don't regularly wash with it, that might be a danger to your health.

Some time ago, I recall someone translating "water" into "hydrogen oxide" or "oxygen di-hydride" or some such thing, and listing all the dangers of this profoundly dangerous fluid, such as the definite danger of contracting cancer if you drank, say, forty gallons of the stuff at one sitting, and quite a few safety nazis fell for it. Well, now such anti-water campaigners have some hard evidence to work with.

Professor Aziz Sheikh has called for the National Health Service to provide separate (privileged?) services for Muslims to take account of their religious requirements. The Professor is of Muslim orientation and has written an article for the British Journal of Medicine, giving reasons for his argument:

Writing in the British Medical Journal, he said the NHS should record patients’ religion as well as their ethnic grouping. “It is absurd that we do not, for example, know the perinatal mortality or smoking prevalence among Muslims,” he said. Male infant circumcision should be available throughout the NHS, he added. Although some NHS trusts do offer circumcision, most parents are forced into the poorly regulated private sector, he said.

Aziz Sheikh is conflating two issues here: matters of health provision and providing specialised services for particular communities. Whilst there may be problems amongst Muslim communities in terms of infant mortality and chronic illness, it is unclear why their status as Muslims should predispose them to these. Indeed, habits of smoking, an inability to speak English in the United Kingdom as an immigrant and living in relative poverty are better indicators for life expectancy and health. Therefore, these arguments may demonstrate that Muslims suffer from these problems, but that the causes are not specific to Muslims in particular, but are generally prevalent amongst the poor and immigrant communities.

It is not absurd that we do not gather statistics on the basis of faith, as faith is not a primary indicator for health, unlike social class, education or the country of origin for your family. Aziz Sheikh has cited this argument to add ballast to his call for discrimination in favour of Muslims on the NHS. This points the article away from a public health agenda towards a medical version of the 'identity politics' that has hindered the effectiveness of other governmental institutions.

The NHS should be more accommodating to the religious needs of Muslims. Many Muslims would prefer to see a same-sex doctor for reasons of modesty, but this was often not possible, despite the increasing number of female doctors in the NHS. More information about drug ingredients should also be available to allow Muslim patients to avoid porcine and alcohol-derived drugs.

If a patient who is Muslim wishes to receive treatment that is compatible with his religious inclinations, the National Health Service is unlikely to meet their requirements. The rationing of healthcare is resolved in a mediocrity of outcomes based upon the equality of all - though contact with NHS personnel or class will often result in a better quality of care.

Aziz Sheikh's call for services in line with the Muslim faith could be interpreted as the natural demands of a community that has found its feet and started to request personalised treatment, in line with the oft-quoted rise of consumer expectations in health. Some could also see this as the further development of separatism within the Muslim community, demanding special treatment for itself.

The common factor is the state monopoly in health. It encourages communal responses to health issues, allowing professional leaders to make calls for particular treatment, with the corresponding balkanisation and backlash that we would expect from those who perceive that they have been missed out in any sharing of the tax spoils. Hence, the unedifying advance of 'white welfarism' in the leafy suburbs.

This would not be reported if health was a choice of individuals purchasing their requirements in a free market. The particular institutions would cater for those who wished to apply these requirements, and one would expect multi-faith alliances to obtain the critical mass that health provision often requires.

The problem is not Islam, it is the National Health Service.

It is a reflexive tic among libertarian types to describe Britain's NHS as 'Stalinist', in reference to its vast monolithic structure and institutional preference for central state planning. Now some indications that the parallels run a little deeper.

The Department of Health's first reaction to the campaign for people to opt out of the "Spine" medical records database, that I mentioned a couple of days ago, is not to attack it as 'irresponsible' as I was expecting. It is to demand that doctors report any patients who try to the authorities. "Let us deal with them," it appears to be saying.

The Guardian reported yesterday:

The Department of Health provoked uproar among doctors yesterday by asking GPs in England to send in correspondence from objectors who do not want their confidential medical records placed on the Spine, a national NHS database.

Sir Liam Donaldson, the chief medical officer, said letters from patients who want to keep their private medical details out of the government's reach should be sent to Patricia Hewitt, the health secretary, for "full consideration".

You will recall that such suggested letters were personal communications with doctors, asking them personally to do something: to code patients records so that they would not be uploaded to the Spine. That's something that can only (as I understand it) be done locally. "Consideration" by the Secretary of State defeats it.

It also seems to me that it would be a fundamental breach of confidentiality, and if the letter were posted, possibly a criminal offence contrary to the Postal Services Act 2000, for the letter to be forwarded to the Secretary of State without patient consent.

But neither law nor morals may stand in the way of the great plan.

...

BBC Radio 4 had another example this evening. Its File on 4 programme considered endemic MRSA and other antibiotic resistant bacteria in NHS hospitals. It interviewed a couple of epidemiological specialists who said with the current control regime slow progress was to be expected and the government target of 50% reduction in MRSA infections by 2008 is unrealistic. Andy Burnham MP, usually characterised as one of the brightest and best of the Primrose Hill group of New Labour heirs presumptive, was asked to comment. He said the complacency and defeatism of the clinical scientists was unacceptable: there was a target and the Health Service would meet it.

The CNE Health blog reports that Pfizer is to take UK's National Institute for Clinical Excellence (NICE) to court because of its refusal to allow tax money to be spent on its new drug for Alzheimer's disease. In a perfect system, NICE would not exist. But given our socialist healthcare system, I do not really like the idea of companies like Pfizer expecting that taxpayers must cough up the cash regardless of whether a treatment offers value for money. And to be fair, under a social insurance system or other private system, insurance companies would still make NICE-type decisions about whether something delivers value.

Meanwhile, Pfizer continues to lobby for taxpayers to pay more for pharmaceuticals by arguing for the end of the free trade in pharmaceuticals in Europe.

Take my advice, never trust a politician. When a politician tells you they are going to look after your child’s education, it's perhaps time to go private - or even to home educate. When a politician tells you they are going to ban guns – expect vast increases in gun crime. When a politician tells you they are going to ban dangerous drugs – watch out for your community being awash with these substances. My heart sinks when politicians get involved in anything. Invariably, they promise the earth, coercively tax you out of your hard earned money, and then they deliver bugger all when you really need the service.

- Helen Evans in the Nurses for Reform blog today (I thought it might liven up)

I particularly like it when blogging is being done, or is about to be done, by people whom I know quite well. And my friend Helen Evans has just this very day started a blog about nursing, called the Nurses For Reform blog.

That said, the prose style so far is rather corporate and armour-plated for my taste. However, despite the rather baffling word "contestability" - which is presumably some kind of Blairite code-word, for something or other - I think it is reasonably clear what is intended by the following:

NFR rejects bland egalitarianism in favour of contestability. Above all else we believe that greater partnership with the private sector is to be actively welcomed and that this sector’s contributions are good news for patients and healthcare professionals alike.

That suggests to me something quite like free market medicine, and of course I am totally for that. This next bit is definitely about free market medicine:

NFR believes in fundamental change. It believes that only by putting patients and consumers interests first will healthcare improve. It is only when healthcare is opened up to real consumers and trusted brands that nurses will find themselves working in a sustainable environment and with the incentives, resources and encouragement to deliver a responsive, popular and truly high quality service.

This says stuff I agree with, but in the manner of a corporate mission statement, and I loath and detest nearly every corporate mission statement that I have ever encountered.

Wouldn't it be fun one day to read one of these things starting with something like: "We believe only in superficial change. Fundamentally, things should stay pretty much as they are." And how about someone just occasionally admitting that he aims to supply an "unresponsive, unpopular" product or service? Many splendid tradespersons do just that and are richly rewarded.

However, since this is a corporate mission statement, I really ought not to carp. And since this is medicine and nursing care in Britain that is being talked about, well, I admit it, I do believe in "fundamental change". Nor can I reasonably object to the ambition that nurses should work, if at all possible, in a "sustainable environment", nor to them delivering a "responsive, popular and truly high quality service".

To be more serious, I have quite often heard Helen Evans say, in the plainest of English, that one of the many problems of Britain's National Health Service is that its nurses do not now have a proper career path in front of them. As soon as they get really good at their job, they tend to leave. The NHS has lost many of what would now be its NCOs, so to speak, good and experienced senior nurses being to hospitals what good and experienced sergeants are to armies. And where have they all gone? To get married, or to the private sector.

When the postings at this new blog get more specific and personal, as I am sure many of them will, I will surely read them with interest and pleasure. There will be more links from here to there in the future, I promise you.

I came out of hospital yesterday. La Belle Dame is in America making money (one of us has to) so Dave picked me up and steered me home. I live quite close to the Chelsea & Westminster and needed some air to clear my head so we walked back. I felt surprisingly well considering I have been under a general anaesthetic and had quite a few squishy bits from inside lopped off me. In fact I felt amazingly well.

The journey back home was interesting. The colours were so very bright and someone seems to have turned up the contrast. Sometimes when I looked closely as the things written on the back of people's tee-shirts whilst walking down King's Road, the words seemed to suddenly zoom away from me towards some vanishing point.

Getting home and having a nice shower was a transcendent experience but the thing that really kept me captivated was the way the water fell down, coming from hundreds of feet above my head and travelling downwards towards the gleaming ceramic floor perhaps three yards below. I could feel the vibration of the water spiralling down the plughole and the strange flute-like sound it made.

I looked forward to getting some good food as being chopped up had not dented my appetite and the hospital food was moderately dreadful. When it came time to eat, for some reason Dave would not let me near the hot stove. The smell of bacon was almost erotic.

Dave and I work together and I had been struck by some really good creative ideas whilst pacing back and forth in the ward the night before last, waiting for the frigging painkillers to actually do something. The ideas kept pouring out of me and Dave just absorbed them like the 185 IQ colossus he is. For a while at least.

But then I noticed that I was having to force the ideas out through clenched teeth and they kept bouncing off Dave's head rather than going in. To make matters worse although the bacon surrendered to me willingly, the sausages were staring at me with ill concealed contempt. I stabbed a couple to death as punishment and gave the rest to Dave.

Today I find the internet in front of me and deep throbbing pains from within. Be prepared from some bad tempered blogging over the next few days when I can drag my fingers to the mouse. Tramadol, Co-Codamol and Diclofenac are pallid impostors. Sister Morphine is a fickle lover and she would not come home with me.

The threats to liberty in Britain are too numerous to keep track of. Thanks to Josie Appleton on Spiked! for this, which I had entirely missed before now:

The Safeguarding Vulnerable Groups Bill, due to return to the House of Commons next week, will mean that 9.5million adults - one third of the adult working population - will be subject to ongoing criminal checks.

It is a House of Lords Bill, but has Government backing.

The Bill would create an Independent Barring Board (IBB), which would maintain "barred lists" preventing listed individuals from engaging in "regulated activities". "In respect of an individual who is included in a barred list, IBB must keep other information of such description as is prescribed." [cl.2(5)]

As the Bill was originally presented, you would have no right to damages if you were mistakenly or maliciously included in a barred list, and nor would anyone else. And the IBB would have been an absolute finder of fact, with appeal allowed only on a point of law. So among the things the IBB would have been independent of is responsibility for its actions.

Now things are slightly better, but there's a cunning pseudo-compromise. You can sue. And you can now appeal the facts. But the criteria applied in the application of policy to an individual case - the core of what the IBB would do - is expressly (with a shade of Guantanamo) deemed not to be a matter of law or fact, and are therefore not to be subject to examination by the courts [cl.4(3)].

The schedule of "regulated activity" is 5 pages long in the printed copy. So you'll have to look it up yourselves if you are interested.

The practical effect? Well, as an example, as I understand it, if the Bill were currently law, I would be committing a criminal offence in paying someone I trust to look after my elderly mother, who is currently convalescing from an operation, without both of us being made subject to official monitoring first.

Once it is in force, if you wish to be self sufficient - even if you don't value your privacy, and are confident that theree's nothing about you to which an official could possibly have objected in the past, and that you might not be confused with anyone else - you'll need to know if a family member is going to be ill in sufficient time to fill in all the forms and wait for them to be processed. Better leave it to the state - which is of course always perfect.

The obesity crisis, epidemic, or whatever (is fatness contagious?) continues to keep the chattering classes busy. In the Daily Telegraph today, Andrew O'Hagan, of whom I was blissfully unaware until about a month ago when he sprung to the defence of Mel Gibson after he made his anti-Jewish rant, argues for stuff like taxing "junk food" and encouraging a whole cultural battle to get the moronic lower orders off their dietary habits. It is an article reeking of disdain for vast swathes of the UK population. Perhaps it is deserved. Many Britons are disgusting people, I suppose, but being the wild-eyed libertarian that I am, do not consider it my business to nag them into eating better by a mixture of state exhortation, punitive taxes and compulsory five-mile runs.

I am not entirely sure what to make of Mr O'Hagan, or indeed the decision of the right-leaning Telegraph to hire him. I thought his article on Gibson was a terrible piece, both patronising towards Jews, other groups, and offensive but perhaps a one-off lapse, one which might not be repeated. But pretty much everything he has written since seems to be entirely lacking in humour, grace or wit. I fear that paper is in one of its down-cycles. O'Hagan may perhaps fit in nicely into the modern Conservative Party.

For a related article on obesity, diet and the nanny state, read this by Jacob Sullum.

Scientists have observed that smoking pot may stave off Alzheimer's Disease. Hmm. I am not a medical expert, but this is not the first time that people have claimed medicinal benefits for smoking this substance. There appears to be quite a steady drumbeat of support for the idea that marihuana may beneficial and that some of the scare stories are just that - scares. Of course, there are certain downsides to a "spot of blow": such as a desire to suddenly consume the entire contents of one's fridge (I speak from
experience over several years' ago).

The War on Drugs is a disaster on many levels. Besides the encouragement to organised crime, the corruption of the legal system, and the obvious assaults on individual liberty, one of the stupidest aspects of said war has been the way in which substances like pot, which might have useful properties in dealing with certain conditions, are ruled off-limits by the law. It is high time ('scuse the pun), that the law was changed.

Remember, when was the last time you heard of a bunch of young British youths getting into a fight because of lighting up a large bong as opposed to being blind drunk?

Last month, it was this:

A report published by the government predicts more than 12m adults and one million children will be obese by 2010 if nothing is done.

And this month, there is this:

Culture Secretary Tessa Jowell has called for "stick-thin" models to be banned from the catwalks during London Fashion Week...

Ms Jowell said "stick-thin" models pressurised girls to starve themselves.

Damn these wretched sheep! Can they not get anything right? One minute, they are stuffing their ovine faces with calories and the next minute they are starving themselves. Have they no pity for the suffering of the Nagging Classes?

That the BBC can earnestly report, almost simultaneously, two flagrantly contradictory agenda-driven hysterias is symptomatic of the fact that we have too many paid worriers with too little to worry about.

I am sure that ours is not the first civilisation to undergo spasms of a sociological St. Vitus' Dance nor will it be the last. But have there ever been so many popular hobgoblins surrounding the subject of food and eating? Could it have something to do with the fact that ours is possibly the first (or maybe second) generation that is more than one rainy season away from famine? Is it all just a part of the struggle to find a cultural narrative within which to fit this apparently easy abundance?

Who can say? But the sheep will graze on regardless.

This seems like a good idea

The Financial Services Authority (FSA) is to hold a six-week exercise to test the resilience of the UK's financial institutions to an avian flu pandemic.

Starting on 13 October, some 60 banks, insurance firms and other financial businesses will take part.

The exercise will look at a number of factors including how firms could cope with a greatly reduced workforce

Yes, I know that we free market purists might argue as to why we need a big regulator like Britain's FSA to set this up, but even in the absence of such a body, smart businesses would be looking to stress-test their systems against a potential serious problem like avian flu. And it is serious. Naysayers may jest about how much effort was expended on the Y2K technology issue (remember that?) but I am encouraged that these sorts of issues are taken seriously. The health of the London-centred financial system is critical, not just to the British economy, but to the wider trading system as well.

Tyler Cowen, hardly a scaremonger, has thoughts about possible preparations that should be taken.

The journey from environmentalism to sanity may not be so far after all:

The World Health Organization (WHO) has reversed a 30-year policy by endorsing the use of DDT for malaria control.

The chemical is sprayed inside houses to kill malaria-carrying mosquitoes.

And about bloody time too! The prohibition of DTT was a product of wrong-headed, fashionable green dogma and Lord only knows how many people in the developing world have paid for it with their lives. Just how many neural transmitters do you have shut down in order to hand-wring about poverty and premature death in the developing world while simultaneously campaigning against everything and anything that stands a chance of tackling them?

I sincerely hope that the greenslimers are seething with thwarted rage. In fact, I hope their blood boils until they have a collective stroke. I wish a pox on them (before they unleash a pox on the rest of us).

London calling! London calling! Reports are coming in of growing resistance to the brutal occupation of the Food Nazis:

Pupils at a South Yorkshire school are being fed fish and chips through the gates by parents who say the canteen is not providing what their children want...

The move is being seen as a backlash against TV chef Jamie Oliver's campaign for healthy school dinners..

"We aim to provide good quality food which is within government healthy eating guidelines and helps the children's learning in the afternoon "...

"The food that these parents are handing out is not part of a healthy eating diet and on top of that I have to question the morality of delivering it from the grounds of a cemetery."

Smuggling food into prisoners is a time-honoured practice but I have to admit that the cemetery angle is cool. They may need to start digging tunnels though.

Hopefully, this is a 'line in the sand'; a message from the public to the ruling class paternalists and busybodies that their food fascism is an intervention too far.

British government scientists claim that Britain faces a growing crisis of obesity. And of course such predictions, which carry all the usual credibility of such things, are accompanied by calls on the powers-that-be to "do something" about it, including the likes of bans on advertising for sinful foods, funding for sports and so on.

First point: even our waistlines are expanding, is it any of the state's business? At present, one might argue that because we have socialised medicine in the form of the National Health Service, taxpayers, both slim, chubby and positively enormous, have to pay for the consequences of bad health habits. So the neo-puritans will argue for controls on how we all live to reduce the tax cost of bad habits, which is an example of what economists might call a 'negative externality'. Surely though, the approach that would encourage good habits and treat citizens like adults is one based on private medical insurance. If people want to cut their insurance premiums, then they will have a strong market-driven incentive to do so. In a private sector model, there may be much more encouragement from health providers to get in shape and give up the triple cheeseburgers. Of course, there will always be feckless people who do not give a damn and end up demanding some kind of handout when things go wrong, but I do not see why the liberties of the majority of us should be tossed away to deal with people who are too weak willed or plain stupid to act differently. In any event, I imagine that as in the days before the NHS came along, there will be health care available for those who cannot afford it - as James Bartholomew pointed out in his book - provided through charitable means. I actually think that a charity which supports doctors might, for example, insist that if a poor person wants to get medical care for his or her obesity-related problems, then as part of any treatment, that person has to do something about their problem.

Such an approach may, at first sight, appear to be 'unaring' or harsh, but I think there is no greater respect that one can give to one's fellows than to accord them the ability to act like adults.

Goodness, all this venting has made me hungry. Anyway, as I head towards the kitchen, may I recommend this collection of articles by Reason magazine on the obesity issue.

Bon appetit!

The British Medical Association's response to a proposal by the British government to allow optometrists more leeway to prescribe medication for eye problems.

"In order to safeguard patient care, the BMA's ophthalmic committee can only envisage extremely limited opportunities for optometrists to make therapeutic interventions."

I wonder whose interests are really being 'safeguarded' here.

It seems there is a shortage of certain drugs in Britain's National Health Service.

Joe Fortescue from Alfreton, Derbyshire wants the government to provide more diamorphine, which has been in short supply since 2004. He said his 49-year-old ex-wife from Nottingham was screaming in pain in the days before her death because it was not available.

Horrendous. We are not talking about sophisticated and costly cutting edge drugs here, just a strong painkiller. As someone personally currently gobbling none-too-effective codeine painkillers every four hours after a close encounter with the NHS yesterday, dare I say I 'feel the pain' of those relying on the NHS in their time of need.

Perhaps the ex-husband of the hapless woman who died in agony for want of the correct drugs should have just scored some himself, available to anyone driving slowly with their windows open in the crappier parts of most large British towns and cities. Diamorphine is essentially just heroin after all and needless to say the 'free market' in heroin has no difficulty supplying public demand. Only the state could be inept enough to be unable to find heroin for a dying woman.

Truly the state is not your friend.

The NHS is now being instructed to turn its back on 'alternative' treatments such as homeopathy. This is a very good beginning... now all we need is for it to turn its back on non-alternative treatments too and Britain can start to allow a First World healthcare system to develop.

I recently had a very interesting chat with my good friend, Steve Edwards, who is currently without his own blog - although probably not for much longer. He is a regular at libertarian.org.au, however. In the course of our conversation, he informed me that HIV risk-of-transmission rates are not nearly as high as I previously thought. Consider this - for every 10 000 exposures to an HIV-infected source, it is estimated 5 will contract HIV via insertive penile-vaginal intercourse. 10 will contract HIV via receptive penile-vaginal intercourse. These figures assume no use of a condom. Click the link for the risk via other routes of exposure.

This got us both thinking about the HIV/AIDS epidemic epicentre of Sub-Saharan Africa. Given the very low rate of HIV transmission through sexual intercourse, is it really feasible that a country like Botswana has an infection rate of 30%+? If the ratio mentioned above is correct, an African male with an average number of vaginal sexual encounters can have unprotected sex with only HIV positive partners for a lifetime and still stand a reasonable chance of not contracting the virus. How could a virus that difficult to catch spread through a population so comprehensively?

I am not saying that HIV/AIDS is not an enormous problem in Africa - of course it is. And I do not discount the anecdotal evidence of health professionals who report a multitude of AIDS orphans and hospitals groaning with AIDS-riddled patients. I am sure this is the case, however from the limited perspective of a person's experiences, how could they possibly tell if this casualty rate represents 30% of a population of several million or 3%? 10% or 1%? Sick people do tend to cluster in hospitals, and health professionals go where the need is great. Given this working environment for doctors and nurses treating HIV in Africa, they could be forgiven for believing an inflated number. Conversely, if a foreign doctor spent a month in the wealthier parts of Nairobi, they would probably report to the folks back home that they saw no signs of HIV/AIDS at all.

I do not doubt that there is a large amount of research that has gone into producing the figures commonly cited when detailing the scope of the HIV outbreak in Africa. I would, however, ask sceptics to ponder the beneficiaries of an inflated threat of this disease. The NGOs, university teams and (most) African governments are in accord regarding the magnitude of the AIDS threat. To use the old saying; well - they would be, wouldn't they? This issue is a magnet for foreign aid and grant money. After all, African despots need to keep their wives in the style they've become accustomed to. Not to mention one's stooges who require regular buying off. NGOs need to run their fleets of SUVs, hold their conferences in five star hotels and generously employ their "support staff". University professors need grants to carry out their research. I should not forget the UN - regarding that sprawling organisation's potential conflicts of interest, the mind boggles. These people all have a stake in talking up the HIV/AIDS problem. These are also the people who provide us with data concerning HIV rates in Africa.

I am not a scientist, and I have no specific expertise in this field. I could be omitting important variables that make the scale of the HIV/AIDS problem in Africa that we're told about more tenable. However, when considering the far lower than popularly believed HIV contraction rates, I smell a rat. What makes me even more suspicious is the fact that the beneficiaries of an overinflated HIV threat in Africa appear to be African governments, NGOs and foreign researchers. Even in rich nations, resources are scarce. We need accurate information to distribute them in optimal fashion. Please set me straight if I am wrong to question, but are we being lied to about the scope of the HIV/AIDS problem in Africa?

Life is far more fun when you have a really good book on the go, and the only thing wrong with mine just now is that it weighs too much to be lugged about comfortably on my pedestrian journeyings around London. It is The Lives & Times of the Great Composers by Michael Steen. For me, this book is perfect. I know what most of the music that the great composers composed sounds like. But I am enjoying hugely learning more about the circumstances in which this wonderful music was composed and first listened to.

After an Italian prelude, the first big name composer Steen deals with is Handel, the German who ended up living in London for most of his life.

Handel's London was an exciting place (p. 39 of my unwieldy paperback):

The year before Handel arrived, Sir Christopher Wren's St Paul's Cathedral had been completed at a cost of £1,167,474 paid for largely by the import duty on coal. Sir Isaac Newton, the great scientist was still at work. London, with its sounds of wheels rumbling on cobbles and cries from the street vendors, was well into a century of commercial and cultural prosperity: the country's population grew by 71 per cent over the century; its merchant fleet more than doubled in tonnage between 1702 and 1776.

London, in other words, then as now, was making lots of progress. Perhaps because music itself can be such an otherworldy thing, even when composed by such a worldly figure as the energetically entrepreneurial Handel, Steen chooses in this book to emphasise the material aspect of things when describing the world in which this music was created.

The kind of people who enjoy the fruits of material progress, but who enjoy them more than they think about how they were first devised and are now cultivated, often dismiss progress as a small thing, perhaps because they dislike the kind of people who are needed to make it, and the methods they must be allowed to use. (Basically: commerce. And insofar as "public spending" is involved, someone has to make that money first before it can be spent.) Such people should ponder pieces of writing such as what Michael Steen says next about Handel's London:

Behind its superficial prosperity and elegance, London was overcrowded, squalid and full of beggars. People had fleas, lice and few teeth. Most people defecated in nooks and crannies, or used public lavatories built over rivers such as the Fleet. For the more refined, with a small fee, the 'human lavatory' would provide a pail and extend its large cape as a screen. Lavatory paper did not exist, the alternatives ranged from a sponge on a stick in a container of salt water, to stones, shells and bunches of herbs.

Delightful.

But the most chilling observation Steen makes about the trials and tribulations of material life in the early eighteenth century - instead of the early twenty-first, say – is this, a couple of paragraphs later:

The political outlook was uncertain.

So? When was it not? But now, hear the reason:

Queen Anne, who was in her late 40s, had borne seventeen children; mostly still-born, none had survived.

Let an anti-progress person of now read that, and then try telling us that material progress of is no great importance, or of no "spiritual" significance, that it is merely a matter of brute, animal comfort. The Queen of England, no less - who presumably enjoyed, if that is the word, the very best medical attention then available - scored zero out of seventeen in the deadly game of childbirth and child-rearing; which meant that there was no obvious royal heir, which meant that the political outlook was uncertain. Poor, poor woman.

Later (p. 54), Michael Steen throws light on another kind of material progress, of a sort that is far more widely and deliberately scorned than progress in things like plumbing or medicine (which is often merely forgotten about), namely cosmetics. Steen has this to tell us about the way that the sort of women Handel often had dealings with - such as the highly paid and outrageously indulged and pampered opera singers whom he supplied tunes for, the crazy rock stars of their day – tried to beautify themselves:

Their faces were painted with compounds of white lead, rice and flour, with washes of quicksilver boiled in water with bismuth.

Suddenly, the progress made in female adornment, which has put incomparably more convenient and healthy – to say nothing of far more visually appealing - methods of adornment into the hands of any modern woman with a few quid to spare who wants them, appears almost as impressive as progress in plumbing, medicine, nutrition, travel, civil engineering, electronic entertainment, or even the wondrous progress that was about to be made in the two centuries after Handel, in music.

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.

Fans of the great Stanley Kubrick satire, Dr Strangelove, will struggle to suppress a wry smile over this story:

Fluoride in drinking water - long controversial in the United States when it is deliberately added to strengthen teeth - can damage bones and teeth, and federal standards fail to guard against this, the National Academy of Sciences reported on Wednesday.

The vast majority of Americans - including those whose water supply has fluoride added -- drink water that is well below the limit for fluoride levels set by the U.S. Environmental Protection Agency (EPA)

Maybe all that stuff about flouride in the water being a crazy Commie plot may not have been so nuts after all. On the other hand...

This story about advances in creation of artificial limbs and muscles caught my attention:

Scientists have developed artificial, super-strength muscles which are powered by alcohol and hydrogen. And they could eventually be used to make more advanced prosthetic limbs, say researchers at University of Texas.

Writing in Science, they say these artificial muscles are 100 times more powerful than the body's own. They said they could even be used in "exoskeletons" to give superhuman strength to certain professions such as firefighters, soldiers and astronauts.

As we ponder the flow of day-to-day news, it is easy to overlook the tremendous advances going on in fields like this. As the article mentions, applications of such medical technologies apply not just to repairing existing injuries or coping with the terrible effects of losing a limb (a sobering reality for victims of terror, car accidents, conflicts, etc), but even for perfectly healthy people looking to augment their physical strength.

The story demonstrates how blurred the boundaries now are between medical technologies that can be used to repair or heal injuries and those used to make what we have picked up in Darwin's great lottery draw even better. The genetic fatalists will decry all this for tampering with God's Will or whatever, but I don't see any difference between this and say, laser surgery for the eye, or technologies to make it possible to vastly increase our hearing strength, or enhance our cognitive capacity, and so forth.

Mind you, it makes me wonder how this technology, if it really works, is going to affect sport. At the moment the sporting authorities controlling events like the Tour de France cycling event, say, or the Olympic Games, treat any form of human augmentation or performance enhancement as off-limits. I guess so long as participants agree in advance not to use such techniques, then they cannot complain if they are caught breaking the rules. But in some occupations like those mentioned in the story, such as astronauts experiencing the effects of zero-gravity environments, this sort of stuff might be a basic necessity rather than a luxury.

Meanwhile, here is an interesting story about nanotech and possible cures for blindness. And I can recommend this book by Ronald Bailey.

Makes a change from writing about Tony Blair, anyway.

Exhibit A from the United States. That 100 pattie burger looks tasty...

(Spotted on Marginal Revolution)

Exhibit B from the United Kingdom - wait a few seconds to be diverted.

Both sites for the epicureans amongst us, most certainly.

I have come across a press release from Britain's National Health Service. The NHS is currently trying to prevent obese people from having hip replacement operations as they do not "deserve" to have such treatment, despite the little matter of their having been taxpayers like the rest of us.

"The NHS, like any proud creation of a socialist, inclusive Britain, has to operate under certain priorities. Indeed its founder, the great Soviet leader Nye Bevan, stated that socialism is about priorities. Well, there is no place and certainly no priority to treat people, who, by laziness, sloth and lack of intelligence, choose to make themselves ill or incapacitated. In fact ill people are a positive nuisance. It is the fit, able-bodied and alert people of Britain who deserve to be treated by the Greatest Health Service Devised by Mankind. No more obese people. No more smokers. No more drinkers. No more red meat eaters and chocolate fans. Such habits have no place in a socialist Britain. Let such vile habits wither away."

I am still trying to vouch for the authenticity of this release. Looks plausible to me.

As Christmas is almost upon us, it is a pleasure to read a nice article by a doughty basher of nanny-state puritanism, Jacob Sullum. Sullum states what many of us probably instinctively know to be true - a bit of what you fancy is good for you. Dark chocolate (yeh!), red wine (yeh again!) and even red meat (thrice yeh!).

So in the interests of good health, I am now eyeing a bottle of fine Rhone red wine sitting on the rack in the kitchen.

I have long gotten a laugh from Dilbert, the socially inept engineer comic created by Scott Adams. Usually, Dilbert is harmless, but occasionally he causes real damage. Last Sunday's cartoon, which features Dilbert's mother in an excessive shopping adventure that ends with organ harvesting struck me as rather amusing, but according to Scott Adams' blog, dozens of people failed to see the humour in it:

Recently I killed thousands more people. I don�t have exact numbers yet. The problem stems from my comic that ran on 11-20-05, implying that retail stores might harvest organs from bad customers and sell them on eBay. I�ve received dozens of letters (long ones!) from very angry people who assure me that the Dilbert comic will reduce the number of organ donors. The concern is that people will think their parts will end up on eBay and so they won�t be inspired to donate.

This would only have an impact on exceptionally dumb potential organ donors. But as you know, that�s a large block of the general population. Now I have to wonder how many people are smart enough to read an entire Dilbert comic and still dumb enough to think that the first person on the scene of an accident might be there just to harvest organs for eBay. It can�t be more than 1%. Let�s see, we estimate 150 million people read Dilbert, so 1% would be 1.5 million. And only 10% of them might have donated an organ anyway, so I�m probably killing 150,000 people.

It�s times like this when �oops� doesn�t seem sufficient.

I bet you did not know that cartoonists could be so dangerous. If you ever meet Scott Adams, approach with extreme caution.

One of the concerns appearing on the radar is the impact of a flu pandemic upon Africa, where a rudimentary infrastructure for health is combined with the largest number of individuals with HIV and AIDs. A common mistake is to view this latter group as the most vulnerable to a flu pandemic, with a potentially catastrophic death rate.

Recent comments by Dr. Robert Webster, at an avian-influenza conference, organised by the Council for Foreign Relations, in New York, theorised that HIV positive patients and those suffering from cancer could act as incubators for the virus, leading to more virulent strains. However, there is evidence to support the view that immunologically compromised individuals will not facilitate the spread of the pandemic:

Stephen Wolinsky, chief of the infectious diseases division at the Feinberg School of Medicine, concurred that prolonged shedding of the virus was a definite problem but referred to a study published earlier this week that stated that immunodeficiency may in fact be a benefit in the face of avian influenza.

The study, published in the journal Respiratory Research, indicated that the young and healthy may be those most seriously affected by avian influenza, as the body's immuno-response was to produce a storm of cytokines that can lead to respiratory difficulties.

Wolinsky opined that, for Africa, the lack of access to doctors and hospitals may prove to be a greater concern in the fight against avian influenza than the continent's HIV/AIDS epidemic.

This region has been identified as a potential outbreak region for the pandemic. Farming practices that bring farmers into close proximity with poultry, are compounded by non-existent public health schemes and a large proportion of the population suffering from ill-health and malnutrition.

The H5N1 virus overstimulates the immune system, and many of its powerful effects are caused by what medical expert call a "cytokine storm", after the immune molecules excited by the disease.

It was the cytokine storm that overwhelmed so many victims of the 1918 flu pandemic. Aids patients may be spared that fate.

But equally possible, with their immune defences down, they could succumb easily to the disease.

"In that situation," said Laurie Garrett, "vast populations of HIV positive people could be obliterated by the pandemic flu."

Laurie Garrett, senior fellow for global health at the Council of Foreign Relations, was identifying the worst case scenario.

Alexia Harriton, an Australian woman who is deaf, blind, physically and mentally disabled and requires round-the-clock care, is suing a doctor for allowing her to be born, with the full support by her mother. Never mind that rubella during pregnancy does not guarantee what happened to Ms. Harriton.

I have a better idea. If she is competent to sue the doctor, she is competent to tell the people giving her round-the-clock medical care to get lost and let nature take its course. Hell, she could tell one of them to leave a nice sharp knife or a cup of water and a bottle of sleeping pills within reach if she wants to expedite things and if she cannot manage that, well seeing as how her mother is so supportive...

Why should a doctor be liable for an 'act of God'? So he did not diagnose how thing would shake out correctly. Too bad, no one is perfect.

Seems to me that Alexia Harriton and her mother were born moral and emotional cripples too. Nature dealt them a seriously crap hand and that is truly tragic but it is no one's fault. It happens. Deal with it, but please, deal with it yourself. Think I am being a little harsh? Well I do not think so and I have my reasons.

A study claims that the long-term effects of smoking tobacco can impair mental functions. My goodness, what other horrors can the dreaded weed be held responsible for? I don't smoke and dislike the pong of cigarette smoke in my clothes after visiting a pub, but is there no limit to the ways in which our blessed medical profession want to condemn smoking? The claim rings false to me (I am not a scientist mind so if this can be verified in a peer-reviewed journal, I'll stand corrected). There have been lots of brainy smokers over the years, surely.

I wonder how many members of Mensa have been smokers?

Just as the NHS is the darling of the British people, it will come as no surprise that its failures are increasingly covered by the tabloids, who have found that the crisis in health provision is a concern to those who have to rely on the state through no fault of their own. High taxes and expensive private health care denies choice to the majority of the population.

One of the latest (and incredible) stories to emerge is a lack of mops in Victoria Infirmary in Glasgow:

PATIENTS spent two days in "grotty" wards - after a hospital ran out of mops.

Cleaners at the Victoria Infirmary in Glasgow were left stunned after bosses told them of the shortage. And it took two working days for the hospital to replace all the mops.

A source at the closure-threatened hospital said: "We knew things were bad here but this takes the biscuit. Cleaners went to work on Wednesday and were told there were no mops and nothing could be done about it

Only scenes such as these could be caused by a state monopoly of health:

After replacement mops arrived on Thursday, a source revealed that hospital staff celebrated.

The insider revealed: "People were dancing around the boxes, singing and chanting, 'We have mops.' " The source added: "No wonder our hospitals are riddled with MRSA superbugs and such like if they can't get something as simple as this right."

Only the NHS could ration health and mops!

"Organic farming has been put forward as one of the major pillars of a new, more-sustainable human society that would be "kinder to the earth". Unfortunately, organic farming cannot deliver on that promise. In fact, organic farming is an imminent danger to the world's wildlife and hazard to the health of its own consumers."

Dennis Avery, quoted in Fearing Food, (page 3) by Roger Bate and Julian Morris.

Something for George Moonbat to ponder, I reckon.

The pharmaceutical industry has been running an ad campaign in the United States saying that reimportation of drugs from Canada were allowed, those drugs might be counterfeit, unregulated and unsafe. This is simple propaganda and nothing more.

Pfizer's Chief Executive Officer Dr Hank McKinnell has come out and contradicted his industry's advertising. On page 69 of his new book, he says that: "Drugs from Canadian pharmacies are as safe as drugs from pharmacies in the United States." Pfizer vice-president Dr Peter Rost says that drug company lobbyists "know full well" that drug reimportation has "been done safely and cost-effectively... in Europe, for over twenty years... The German Federal Health Ministry has verified that not one single confirmed case of a counterfeit medicine has ever come through the parallel trade chain. The UK regulatory authority has described the level of pharmaceutical counterfeiting as 'virtually undetectable'."

They were not speaking on behalf of their employer.

Dr Rost's view is confirmed by Donald MacArthur of the European Association of Euro-Pharmaceutical Companies who in November 2003 testified at a US Senate committee. MacArthur said: "As far as can be ascertained there has never been a single, proven case of a counterfeit medicine leaving the parallel trade supply chain in Europe. Certainly, none has been reported in the two largest markets for incoming parallel trade - the UK and Germany; in the case of the latter, the government has recently verified this fact".

In the US, where reimportation is illegal, counterfeiting is on the rise. The ban on reimportation has led many people who cannot afford the cost of drugs from their local pharmacy to use online shops they have never heard of to illegally get cheap drugs. Some of these websites, which are marketed through spam e-mail, claim to be in Canada but are based in developing countries and fail to deliver anything or supply counterfeit drugs.

If the US wants to fight counterfeit drugs, it should follow the European model and let legitimate, properly-regulated businesses, which consumers can trust, safely and securely reimport pharmaceuticals. That way, the drugs get imported from legitimate wholesalers in Canada and Europe. Contrary to claims of pharma's lobbyists, it is America's ban on reimportation that promotes counterfeiting. The US government should adopt free trade in pharmaceuticals not just to reduce prices but to reduce counterfeiting, too.

Crossposted from the Globalisation Institute Blog.

Last summer, I went on very public record with my opinon that the überhyped and screechingly hysterical 'obesity epidemic' was nothing but a crock of shit, cooked up (in this country at least) by grasping public sector vested interests and amplified by their MSM handmaidens.

While I will continue to do whatever is in my power to undermine this whole wicked, mendacious plot over here, I am pleased to note that there is also some serious fightback going on over on the gun-toting side of the Atlantic:

One would be forgiven for thinking CDC stands for Center for Damage Control. Just a year after its widely-publicized and exceedingly controversial announcement that excess weight kills 400,000 Americans annually, the agency is rumbling, bumbling, stumbling toward an explanation for a new study that says the real figure is just 26,000.

Unfortunately, trial lawyers who see dollar signs where the rest of us see dinner have seized on the CDC's 400,000 deaths number to justify their frivolous crusades.

Now word comes from experts within the CDC that excess weight is about one-fifteenth as dangerous as previously thought, and has a lower death toll than diseases like septicemia and nephritis. Each death is of course tragic. But has anyone heard of the septicemia "epidemic" or the nephritis "tsunami"?

It's said that a lie can travel halfway round the world while the truth is putting on its shoes. Well, the truth about obesity is finally lacing up. And that's bad news for trial lawyers pursuing obesity lawsuits against food and beverage companies as well as the self-appointed diet dictators seeking extra taxes on foods they don't like.

Not that that will stop them, mind. Truth has little currency when compared to the value of a well-forged career-path or the tantalising lure of brimming public coffers. (By the way, the link above is to the website of an American organisation called the 'Center for Consumer Freedom'. Not only do they appear to be on the side of the Angels but their website looks like an excellent activist resource that is well worth a bookmark).

Still, the backlash has to begin somewhere, somehow and debunking the fraudulently inflated statistics is an important part of that process. However, it is equally important to maintain the principle that, even if all the har'em-scar'em statistics were true (which they clearly are not) then the responsibility for and solution to the problem of obesity lies with the obese themselves and not with judicial system or the apparatus of tax-collection.

Story here that says that far from being a bad thing, sitting outside in the sun for at least 15 minutes a day is good for you, latest medical findings suggest. It certainly is a bit of a change from the period, I well recall, in the 1990s, when it appeared to be the case that any exposure to sun was fraught with danger as a result of the supposed hole in the ozone layer. I recall the constant worries, fuelled in the press and elsewhere, about skin cancer and the dangers of overdoing the sunshine.

Sometimes you have to just laugh. Of course being exposed to the sun is good for you in moderation! Mankind was not meant to sit indoors or conceal every aspect of the body all the time. Anyone I know who spends the vast majority of his or her time indoors looks, well, unwell, in my opinion. I always make the effort to break out of my office at lunchtime to get what passes for sunshine in this damp country of ours. It is not rocket science.

Coming next: medical experts reveal that regular exercise, eating vegetables and playing sports can do you some good.

The steady advances in cloning technology holds a great deal of hope the future of the species and the news from Korea and Britain has been pretty damn encouraging over the last few years. It now looks like we could be on the brink of being able to mass produce stem cells and that, boys and girls, could be the gateway to a new era of medical possibilities.

�This is really the destruction of the National Health Service."

- Professor Vincent Marks of the University of Surrey on the Today programme this morning discussing the modest government announcement to allow more private involvement in the National Health Service.

It takes some nerve to announce this on the day of a General Election. Mind you, I doubt very much that it would at all influence the outcome:

Patients should be refused treatment because of their age in some cases, government advisers have proposed.

Where age can affect the benefits or risks of treatment, discrimination is appropriate, the National Institute for Health and Clinical Excellence said.

Charities representing older people said the recommendations were outrageous and sent out mixed messages.

Wrong. The message is quite clear and will gradually become more acceptable. Within five years, people over 75 will be offered euthanasia when they get sick. Within 10 years it will be mandatory.

The fine U.S. blogger and libertarian scholar, Tyler Cowen, who's blog Marginal Revolution is well worth a visit (as if I did not have enough things to read, aarrgghh, Ed) has started a specialist blog devoted to tracking developments and medical research surrounding avian flu. Tyler is clearly worried about the spread of new and more powerful viruses and the threat this poses to the health to millions of people around the world.

Rather interesting, I think, that the Internet, which helps to spread ideas with the speed of a virus, is now spawning blogs which are devoted to actual, existing viruses.

Terri Schiavo died this morning.

I hope that her husband and family can find some peace, if not with each other, than at least within themselves.

Now that the emotional flash point of the debate is gone, I hope that we can have a more considered policy discussion over who should make medical decisions for non-decisional patients, and under what restrictions.

Nobody is willing to take the position (at least in public) that a person should not be able to refuse medical care in person, on their own behalf. However, many of those now engaged in the struggle over end-of-life health care are, wittingly or not, arguing that some health care decisions should be removed from private hands and made by the state.

The current baseline rule is that your personal autonomy with respect to consenting to or refusing to consent to medical care is pretty much absolute (I am discussing medical care, not mental health care, which operates in a parallel universe on these issues). I note that there are some second-order restrictions on what kind of care is actually available to you, arising from various licensing and regulatory regimes, but leave those aside for now. You can refuse any and all kinds of care, ranging from the most extreme life support to the most mundane blood transfusion, and people do all the time, even when the refusal puts their life at risk.

Things get more complicated when you are unable to decide for yourself (or, what amounts to the same thing, unable to communicate your decision). Someone has to decide what care you will be given. Your ability to make such decisions in advance will, sooner or later, be outrun by the unforeseeable complexities and irreducible detail of your medical care. If nothing else, someone will have to interpret your written instructions and apply them to the messy clinical realities. At the end of the day, if you are not "decisional" you will have a surrogate decision-maker. That decision-maker will either be a private individual or the state.

The current system very rarely results in the state directly taking custody of a medical patient who is not decisional, and is very heavily biased toward leaving health care decisions in private hands, with a fairly limited "reserved" power in the state to hear disputes about who the private decision-maker should be. So far, so good.

Although reasonable people can disagree on whether, for example, Michael Schiavo should be Terri Schiavo's surrogate or one of her parents should be, this dispute is over the proper issue of which private party should make decisions. It is very difficult, I think, to argue that this issue hasn't been fairly and adequately processed by the courts.

However, we are seeing increasing pressure to restrict the decisions that the surrogate can make. This is where it gets tricky, because legal restrictions on the decisions that a private decision-maker can make mean that the state is making that decision. If there is a law on the books that prohibits your surrogate from consenting to experimental treatments, then the state is making the decision that you will not receive that treatment. If there is a law on the books that prohibits your surrogate from withdrawing a feeding tube, then the state is making the decision that you will be fed through a feeding tube.

The current mantra that "if there is any doubt, err on the side of life" is a TV-friendly sound-bite in the service of expanding the control that the state has over your medical care, because this "principle" removes from your surrogate the ability to make health care decisions, and is functionally equivalent to the state ordering that medical care be provided regardless of your wishes. For your own good, of course.

Similarly, the endless agitation for more appeals amounts to agitation for more state review and oversight of a nominally private decision. For your own good, naturally.

In short, to the extent any coherent public policy is being advanced by the people who want the feeding tube re-inserted into Ms. Schiavo, it is a public policy that shrinks the decision-making powers of private decision-makers, and necessarily transfers those decisions from private hands to those of the state.

The over-riding principle that is cited in favor of this transfer of power to the state is the protection of life. However, the protection of life is not an absolute trump card; indeed, when it comes to medical care, personal autonomy overrides protection of life; otherwise, the law would require that life-saving health care be provided to you over your objections.

Nobody is willing to take that step, so advocates for the transfer of power to the state are left in the position of arguing that some decisions that you can make for yourself should never be made by your surrogate, but should be made by the state instead. Those are the only two choices on offer - either the state makes decisions about your end-of-life medical care by prohibiting your surrogate from deciding, or your surrogate decision-maker does.

I think you know where my instincts are when faced with a choice between preserving the private sphere and expanding state control.

On The Voice of Reason (slogan: "A penny saved is a government oversight"), there is a pretty clear headed little essay of what I think is most the reasonable position on this absurdly emotive case.

For an excellent overview of the Schiavo case, written by someone with a better work ethic than me (she links to her sources, I just kind of remember their gist), go to Majikthise.

Out of the morass of purely case-specific issues in this case, perhaps the most legitimate policy argument raised by the Schiavo trainwreck has to do with the withdrawal of food and water.

Let's be clear on Schiavo's condition and treatment here: she is being fed and hydrated through a tube in her stomach. She is not feeding herself, and is presumably not capable of taking food and water orally, or the tube would never have been inserted. This kind of feeding and hydration is just as much a medical treatment as having a glucose or saline IV inserted into your arm.

No one attempts to deny that Terri (or anyone else) would be permitted to refuse this treatment for themselves; a law mandating that you receive a given medical treatment against your will would be widely regarded as an abomination.

Similarly, no one seems to be seriously arguing that if Terri were on a ventilator or some other form of artificial "life support", that her guardian should be permitted to withdraw the life support, even though there is no written evidence of what Terri's wishes were in that regard.

This leaves many of the folks who are now arguing for federal intervention into Terri Schiavo's medical treatment in the rather uncomfortable position admitting that (a) she could refuse to consent to being fed through a tube in her stomach, and (b) that her guardian could withdraw other forms of life support, but nonetheless that (c) her guardian cannot refuse consent to her being fed through a tube in her stomach.

Thus, the policy question being posed by this case seems to be whether a surrogate decisionmaker should be compelled by law to "consent" to their ward being fed through a tube in her stomach, unless he can produce written evidence that is what the patient would have wanted.

The case against such a legal mandate boils down to the argument that denying the right to consent or refuse consent to the surrogate is the same as denying it to the patient herself. Of course, the surrogate is not, in fact, the patient, and there may be legitimate boundaries placed on the decisions the guardian can make on behalf of their ward. The question is whether withdrawal of nutrition and hydration is outside of those boundaries, and if so why.

The case for a legal mandate that nutrition and hydration be given over the objections of the legal guardian rests comes down to the argument that, where there is any doubt as to what the patient would want, we should err on the side of keeping them alive. This argument, however, founders on a couple of points. Logically, it cannot be limited to nutrition and hydration, and thus requires that we keep all life support, no matter how extraordinary, in place. Further, it begs the question of how much certainty is enough. Even where a written living will exists, the question can be raised about whether the patient changed her mind.

Because we cold-hearted libertarians care about such things, Terri Schiavo's care is being paid for by taxpayer money through the Medicaid program. Even though her parents have noisily pledged to take all financial responsibility for her care, they have not yet done so, even though the trust fund established out of the proceeds of her malpractice case to pay for her care is nearly exhausted. The annual cost is probably around $80,000 per year.

Various precincts of the US body politic are obsessed with Terri Schiavo, a young woman who has been at the center of an ongoing familial, legal, and now, sadly, political dogfight.

In very broad terms, Terri Schiavo is unable to make decisions for herself. She is apparently brain damaged, and has been in some degree of coma or "persistent vegetative state" for years. Her husband wants to withdraw artificial life support and let nature take its course. Her parents want her kept on life support indefinitely in the hopes that some day she will make some degree of recovery. As ever, you can find a medical expert to present just about any side of this that you want. This situation is, sadly, all too common.

The uproar around Terri Schiavo illustrates rather nicely the key distinction between libertarians and, well, everyone else. For libertarians, the critical question is "who decides?", based on their belief that you should be able to make your own decisions in life. Most other folks, it seems, don't care "who decides" nearly as much as they care about "what decision is made," and particularly, "whatever decision is made, it damn will better be one I approve of."

In Terri's case, this means that all sorts of folks who you think would know better than to invite the state to participate in medical decision-making are doing exactly that, because Terri's husband has made a decision that they do not approve of.

So, not only have we been treated the spectacle of the Governor of Florida, Jeb Bush, trying to elbow his way to Terri's bedside so he can dictate what care she will receive, we also have various Florida legislators trying to insert the State of Florida into the mix. Now the US Congress, apparently not satisfied with embarrassing itself* in its ongoing investigation into steroid use in major league baseball, is preparing to abuse its subpoena power to block the decision made by Terri's husband.

A fundamental principle of health care law, and one dear to the hearts of libertarians, is that you must give informed consent to any treatment before it is administered to you (with an exception in cases of emergency when you are unable to communicate, in which case the caregivers are allowed to assume you want life-saving treatment). A doctor who treats you without your consent has committed assault and battery. It is your right to refuse any treatment at all, even if it will mean your death, and so long as you are a competent adult no court or legislature can intervene to force treatment on you.

When the patient is not a decisional adult, someone who will make decisions on their behalf must be located. You can appoint your own surrogate decision-maker, via a health care power of attorney (which I strongly recommend). Some states have lists of "deemed" surrogate decision-makers on the statute books, such as spouses, parents, siblings, etc., in rank order so everyone knows w