We are developing the social individualist meta-context for the future. From the very serious to the extremely frivolous... lets see what is on the mind of the Samizdata people.

Samizdata, derived from Samizdat /n. - a system of clandestine publication of banned literature in the USSR [Russ.,= self-publishing house]

A tale of two paradigms

Here is an interesting observation by Jo Nova of two sets of reactions in an article titled Company stops Ebola, Bureaucracy puts it on a plane:

The rubber plantation has 8,000 workers with 71,000 dependents. It is an hour north-east of Monrovia, surrounded by Ebola outbreaks. The virus arrived on the plantation in March. Knowing that the UN and the Liberian government were not going to save them, the managers sat around a rubber tree and googled “Ebola” and learned on the run instead. They turned shipping containers into isolation units, trucks into ambulances, and chemical cleaning suits into “haz-mat” gear. They trained cleaners, and teachers, they blocked visitors, and over the next five months dealt with 71 infections, but by early October were clear of the virus. There were only 17 survivors (the same 70% mortality rate as elsewhere). But without good management, there could have been so many more deaths.

In contrast, the nanny-state takes a good brain and stops it thinking. In Texas, trained health professionals were caught unprepared, following inadequate protocols they assumed were good enough, and even risking their own lives. A nurse who cared for a dying Ebola patient — and knew how bad Ebola could be — still needed to phone someone to ask if it was OK to board a plane with a slightly raised temperature (99.5F or 37.5C). The official she spoke to “didn’t Google”, they just said yes because her temperature was lower than the official threshold of 100.4F.

Read the whole thing.

A bet on Ebola

Bryan Caplan, over at the EconLog blog, has issued a sort of challenge to folk in the US getting worried about Ebola:

Mainstream scientists assure us that Ebola poses very little threat to Americans; unless you’re a health worker who cares for the infected, Ebola is almost impossible to catch in a rich, modern society.  Yet many populists and borderline conspiracy theorists are convinced that the experts are seriously understating the danger.  In their contrarian opinion, we desperately need to close the border now. Fortunately, this is an easy argument to put to a bet. My tentative offer: $100 says that less than 300 people will die of Ebola within the fifty United States by January 1, 2018.  I’m willing to switch to “Unless the U.S. changes its Ebola-related policies, $100 says that less than 300 people will die of Ebola within the fifty United States by January 1, 2018,” but then we’d have to carefully define what policy changes count.

Leaving aside what you think about the specifics of the Ebola case, this idea of economists and other commentators making hard financial bets on specific claims has the merit of injecting a certain edge to proceedings. There is nothing quite so much like a bet to make people prove they are convinced of something. And as the late Julian L Simon proved when he bet against a neo-Malthusian about commodity price trends, there is nothing more satisfying than being proven right.  (Paul Ehrlich, who lost the bet to Simon, was invited to have another go and declined the offer, despite responding to Simon with singular ill grace.)

Direct health care: register your interest

Recently I wrote about Simon Gibbs’ idea to find doctors willing to offer direct health care, providing better care at good value to customers and making a profit at it. Now his site Libertarian Home is gathering a list of people in the UK interested in such a service.

Register to express your interest in purchasing, for your own needs, a monthly subscription for GP services such as check-ups, disease management, minor treatments, obstetrics, and advice.

Simon explained to me that he wants to find a cluster of people who make a potentially viable business for someone, and put them in touch. You will be signing up to be notified of opportunities.

I hope he can help make this work. For the right price I would welcome such a service: it would be valuable to just have access to a doctor who I could chat with at leisure for general advice and not feel like I was being a nuisance.

The Ashya King story: am I missing something here?

This seems like a very odd story. Some parents remove their child from a UK hospital after they determine the NHS will not provide what they conclude is the most appropriate treatment for a brain tumour. They then go overseas where they hope to find somewhere such treatment is available. And this triggers a Europe-wide manhunt?

Is there more to this than meets the eye? Because if not, what possible justification is there for state involvement at all, let alone hunting the parents down in Spain.

Health and safety law in action

All eggs that are sold in the United States would be illegal according to European health regulations.

Also, all eggs that are sold in Europe would be illegal according to US health regulations.

Simon Gibbs on direct health care

Last Friday Simon Gibbs spoke at Brian Micklethwait’s. He explained that libertarians are very good at talking, which is important and useful, but that he wanted to see them doing more, and that inspiring such action is what his Libertarian Home project is really about.

He had many ideas of things that libertarians could do. Some were simple and obvious, such as attending demonstrations so that the media is forced to explain who this strange new breed of demonstrator is, or handing out leaflets at events such as Occupy demonstrations where some of the attendees might not be fully sold on all of the ideas of their movement and might be amenable to persuasion. But what he really wants to see is demonstrations of things that would be everyday in a libertarian society actually working.

An example of this is direct health care. In the USA, Dr Josh Umbehr runs AtlasMD. You pay $50 per month for access to a general practitioner. You get better service, email and phone advice, and out of hours appointments. And someone who sees you as a customer rather than a nuisance, and spends time with you and helps you to find the right consultant or to try different medicines instead of rushing you out in time for the next appointment. Simon found one doctor in the UK who offers such a service for £125 per month for a couple.

I would like to see more of this. Simon explains:

It would not need to be the dominant form of healthcare, but merely to be available for about the price of a gym membership to 10% of the population. We can then start to use this kind of care as a counter example to the sainted NHS. To get there, we need to stimulate demand. We need to talk about this idea with friends and talk about the various ways in which this would be more pleasant and more convenient than the GP service we get from the NHS. We would then be able to talk about the NHS as something like a safety net for very serious medical catastrophes, not something we rely on every day for every kind of medical assistance.

The British Medical Association – auf den Tag!

Teresa May, I could learn to like even you. Just deal with the BMA as you have dealt with the Police Federation.

Soon, soon, oh let the day be soon!

Doctors vote for ban on UK cigarette sales to those born after 2000.

Samizdata quote of the day

The only serious black mark against the NHS was its poor record on keeping people alive

– This was written in all seriousness in a Guardian (No! Really?) article praising the NHS. Seriously. Not joking.

Speaking of Krugman misspeaking…

In the United States, we’re in the midst of a giant scandal about just how bad the Veterans Administration hospital system is.

For those unfamiliar with it, the US maintains a mini-NHS just for former soldiers, and it appears that it has both been undergoing a systematic meltdown and systematically falsifying records that would have allowed outsiders to learn of the situation.

As it happens, Paul Krugman, everyone’s favorite economist, effusively praised the VA hospital network as a model for future American health care in 2006, claiming it demonstrated that state operation of the health system was to be wished for rather than feared. Quoting his New York Times Column:

I know about a health care system that has been highly successful in containing costs, yet provides excellent care. And the story of this system’s success provides a helpful corrective to anti-government ideology. For the government doesn’t just pay the bills in this system–it runs the hospitals and clinics.

No, I’m not talking about some faraway country. The system in question is our very own Veterans Health Administration, whose success story is one of the best-kept secrets in the American policy debate.

The discovery of a column or speech by Professor Krugman that seems embarrassing in the light of later discoveries has become quite routine. (see, for example, his effusive praise for the quality of Thomas Piketty’s data and the inability of opponents to refute it at a point where “Capital in the 21st Century” had been in public hands for mere days. There are numerous other examples to be had.)

What is not routine, sadly, is for Professor Krugman to ever acknowledge such a mistake. I am unaware of an instance of his admitting to an error.

Samizdata quote of the day

We have to break people away from the choice habit that everyone has

Marcus Merz

Truly there is are few things more valuable than an honest enemy, for by their own words they are revealed.

The state has been astonishingly successful at “breaking people away from the choice habit” in the UK, where arguing for choice in medical care results in people looking as you incredulously as if space monkeys are flying our of your mouth.

Longer pub opening hours and fewer car accidents in the UK

Assuming this data is accurate and sustained (a big assumption, and the usual caveats must apply), this sort of item is going to make the nanny statists out there feel very uncomfortable:

In recent history, the UK has liberalized its rules concerning the hours that pubs can operate. For example, the Licensing Act of 1988 expanded Sunday hours and no longer required pubs to close for two and a half hours in the afternoon. In 2005, the law in England and Wales was further liberalized such that pubs could remain open until 5 am instead of closing at 11 pm. An article in the latest issue of the Journal of Health Economics claims that the 2005 liberalization of pub hours actually decreased the number of traffic accidents.

So writes James Schneider, over at the Econlog economics group blog.

Here is another excerpt:

The reduction in traffic accidents for England and Wales are plausibly related to the change in pub hours because the largest reductions occurred during weekend nights and early mornings. The impact on young drinkers was particularly strong. Accidents involving young people on Friday and Saturday nights decreased by an estimated 32.5 percent.

So there is evidence, perhaps, to confirm a general, common-sense sort of view that if you treat adults like adults, they behave accordingly. It is interesting that the message of this article is as troubling for the paternalist Right as it is for the Fabians on the left. I remember reading some time ago the author Theodore Dalrymple, who has made something of a name by lamenting the alleged ghastliness of modern life in the UK, reticent past, having a pop at liberalised pub hours. The Daily Mail, for example, regularly has a go and rarely fails to write stories about how we Brits are living in a sea of booze.

And yet it turns out that there has been a coincident sharp fall in road accidents on one hand, and looser licensing laws, on the other. It should be borne in mind, though, that recent years have seen a continued strong enforcement of drink-drive laws; police are pretty tough on speeding in general; there may be, for demographic reasons, just fewer tearaways on the roads in general. On the other hand, our island is more crowded than it used to be and our roads are busier, so you might think there would be more risk of accidents, not less. And yet the number of accidents, including fatal ones, has fallen.

Correlation is not causation. It is, however, worth noting that had the number of road accidents risen significantly at around the same time as our drinking laws had changed, I think I can imagine how organisations such the British Medical Association, The Lancet, and other campaigners would have used such sets of data.

You gotta hand it to him…

…Mark Goddard of Newton Abbot in Devon is not a man afraid to take his medical destiny into his own hands hand.

Man builds home-made guillotine and chops off hand after doctors refuse to amputate

Mark Goddard has been in constant pain since he was involved in a motorbike crash 16 years ago.

But after an unsuccessful two-year campaign to have his nerve shattered hand surgically removed, he decided to do it himself.

He rigged up a home-made guillotine using an axe with a weight strapped to it, to ensure it would have enough power to amputate his hand.

The first blow sliced though the bone but didn’t sever all the tendons, leaving his hand hanging off a bloodied stump.

He then used a surgeon’s scalpel to cut through the remaining tissues before dropping the remains into a bin, which he later filled with charcoal and set alight – in order to prevent his hand being re-attached.

That was the Express. The Mirror adds some more details:

Dad refused NHS operation builds GUILLOTINE to amputate his own hand – but it still hurts

Mark spent two weeks designing the guillotine and ensured his wife and son were out before he severed his hand.

He tied two tourniquets above his forearm to reduce blood flow and had a first aid kit nearby.

Mark wants a device called a spinal stimulator implanted into his back to ease the nerve pain.

He said he was “reasonably hopeful” his wish would be granted after receiving a more sympathetic hearing from doctors and psychiatrists in the wake of his dramatic protest two weeks ago.

A Devon and Cornwall police spokesman said: “Police received a call from the ambulance service to say a man had cut his hand off.

“We were concerned he might have a knife and be a risk to himself or others.

“Units attended and upon arrival a 44-year-old man had indeed cut his hand off. He was otherwise rational.

While it is not the place of the police to criticise the behaviour of citizens who have remained within the law, it would be a harsh judge who held it against the police spokesman quoted that the placement of his penultimate word did imbue his observations with a slightly ironical tone.

I totally support Mr Goddard’s right to do as he pleases with his own body, sympathise with the suffering that led him to take such a desperate measure, applaud the practical and rational way he went about it, and very much hope that the NHS will be persuaded to take his pain seriously in future, but I am not sure I would recommend his method. Hands up who thinks it was a good idea? (Er, not you, Mark.)