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]

Samizdata quote of the day

We’ve a new little report, piece of scientific research, telling us that cheese and red meat are good for us. This in entire opposition to everything governments have been telling us about diet for decades now. This telling us that government is a seriously bad way of doing anything.

Sure, of course, humans are wrong, most humans are wrong a lot of the time. The problem with government being that when that wrongness gets propagated by our rulers it becomes the established fact. Meaning that we’re all affected by it, there is none of that natural variability of error which protects some and harms others. We all become subject to the error that is

Tim Worstall

Food science vs government

Terence Kealey has a policy analysis on the Cato Institute entitled Why Does the Federal Government Issue Damaging Dietary Guidelines? Lessons from Thomas Jefferson to Today. I found this from a comment by ‘Bloke in North Dorset’ from Tim Worstall’s blog.

It is a very good document. It begins with a history lesson on government food advice. In 1953 people were having heart attacks so the government had to Do Something about it. Ancel Keys said it was caused by eating too much fat. But science is never that easy.

As Yerushalmy and Hilleboe pointed out at the 1955 WHO seminar, and as they expanded in their 1957 paper, the data thus suggested the citizens of poor countries (who largely ate vegetables, including starchy vegetables such as maize/corn, rice, and potatoes) didn’t die much of heart disease (but they were vulnerable to other diseases); while the citizens of rich countries (who ate a lot of meat, which includes much fat) died largely of heart disease (but were protected from other causes of death).

The document explains how understanding gradually increased but that even today the relationships are not fully understood. Adding government to the debate was not helpful.

On being challenged on the incompleteness of the science, Senator McGovern said “Senators do not have the luxury that the research scientist does of waiting until every last shred of evidence is in,” which is the opposite of the truth: research scientists are at leisure — and are perhaps even obligated — to explore every possible hypothesis, but senators should not issue advice until every last shred of evidence is in, because they may otherwise issue misleading or even dangerous advice. As they did in 1977.

In fact the government advice was out of date for 60 years:

Although by 1955, within two years of originally proposing it, Keys had abandoned the dietary cholesterol hypothesis, for another 60 years the federal government continued to warn against consuming cholesterol-rich foods. It was only in 2015 that its Dietary Guidelines Advisory Committee classified high-cholesterol foods such as eggs, shrimp, and lobster as safe to eat: “cholesterol is not a nutrient of concern for overconsumption.”

This 60-year delay shows how asymmetrical the official science of nutrition can be: a federal agency can label a foodstuff dangerous based on a suggestion, yet demand the most rigorous proof before reversing its advice.

This is the sort of thing that comes from applying the precautionary principle. But taking precautions turns out to be risky action.

To Mark Hegsted’s question in his introductory statement to the Goals — “What are the risks associated with eating less meat, less fat, less saturated fat, less cholesterol?” — we can now reply that if, in consequence, people were to follow his advice and eat more carbohydrates and more trans fats in compensation, the risks are of precipitating early death from atherosclerosis. Irony of ironies.

The document describes multiple causes of the disconnect between the real understanding and the public policy. Scientists are not perfect:

The popular view is that scientists are falsifiers, but in practice they are generally verifiers, and they will use statistics to extract data that support their hypotheses. Keys, for example, was not a dishonest man, he was merely a typical scientist who had formulated a theory, which — by using poor statistics — he was able over the course of a long career and many publications to appear to verify.

And the government makes things worse:

Governments may be institutionally incapable of providing disinterested advice for at least four reasons. First, the scientists themselves may be divided, and by choosing one argument over another, the government may be making a mistake. Second, by abusing the precautionary principle, the government may be biasing its advice away from objectivity to risk-avoidance long before all the actual risks have been calculated. Third, because of public pressure, it may offer premature advice. And fourth, its advice will be distorted by lobbying.

I imagine that much of the story described here, at least the science history part, is well understood in retrospect and uncontroversial. Its lessons might be applied elsewhere. What currently controversial science suffers from poor statistics and is being distorted by government involvement, I wonder?

Samizdata quote of the day

That there are now more overweight humans than starving humans is one of mankind’s greatest achievements.

Damien Counsell has said it many times. Good for him.

“If a nurse didn’t like you, you were a goner”

Remember the mockery that Sarah Palin got for her prediction that state health care might result in “Death panels”?

She was wrong about a few things. There is no need for a panel of bureaucrats to decide when it is time to stop treating old people and those with Downs syndrome. That can be done more conveniently by the doctors and nurses. And while we’re at it, why confine ourselves to stopping treatment? Would it not also reduce the burden on the NHS and its employees to become a bit more proactive and actively shorten these useless lives?

This article by Dominic Lawson about the Gosport War Memorial Hospital scandal is one of the most powerful I have ever read.

Last week’s monstrously belated report on the Hampshire hospital’s treatment of its patients in the 1990s revealed that at least 450, and probably more than 650, had been killed — sorry, had had their lives shortened — as a result of a policy of attaching them to syringe drivers pumping diamorphine. Diamorphine is medically indicated only when the patient is either in the severest pain or terminally ill, because its notable side effect, when large doses are consistently administered, is respiratory failure. Injections of diamorphine — in 30mg doses — were Dr Harold Shipman’s chosen method of dispatching his patients. But the numbers at Gosport exceed the tally of Britain’s most prolific mass murderer.

You may be thinking, no need for that sort overblown rhetoric. Surely this is a case of misplaced mercy, of overdoing the pain relief? That is what I thought too. It is why I had not paid much attention to this story until now. More fool me. Read on:

The report, led by James Jones, the former Bishop of Liverpool, reveals that only 45% of those administered terminal quantities of diamorphine were said to be in pain. And in 29% of cases their medical notes give either no reason, or no comprehensible justification, for the lethal dose (most died within a couple of days of being attached to the pump).

(Emphasis added by me, as it is in all the excerpts I quote in this post.)

Even that is not the worst. Read on further:

The ones most likely to get the treatment appeared to be not the sickest, but the most “difficult”. As the stepson of one of the victims remarked: “If a nurse didn’t like you, you were a goner.” This was clear from the testimony of Pauline Spilka, an auxiliary nurse. After the local newspaper in 2001 reported the complaints by relatives of Gladys Richards, (whose life had been “shortened”), Spilka went to the police. In an interview with Detective Chief Inspector Ray Burt of the Hampshire constabulary, Spilka said: “It appeared to me then and more so now that euthanasia was practised by the nursing staff. I cannot offer an explanation as to why I did not challenge what I saw at that time . . . I feel incredibly guilty.”

Spilka was especially troubled by the fate of an 80-year-old patient (his name is redacted) whom she described as “mentally alert and capable of long conversations . . . able to walk . . . and to wash himself”. He was, however, “difficult”. She told the policeman that this patient was “always making demands” and that “I remember having a conversation with one of the other auxiliaries [Marion] . . . we agreed that if he wasn’t careful he would ‘talk himself onto a syringe driver’.”

So it came to pass: “One day I left work after my shift and he was his normal self. Upon returning to work the following day, I was shocked to find him on a syringe driver and unconscious. I was so shocked and angered by this that Marion and I went to confront the ward manager.” They were told to put a sock in it. Nursing auxiliaries are at the bottom of the chain, without any medical qualifications. What was their word worth, against that of the formidable (and formidably well connected) Dr Jane Barton

Whereas a word from Dr Jane Barton was literally enough to sentence a woman to death. Lawson continues:

Perhaps the most upsetting case — at least, as the father of an adult with Down’s syndrome, I found it so — was that of 78-year-old Ethel Thurston, admitted with a fractured femur. She was described in the report as having “learning difficulties [and] the mental capacity of a 10-year-old”, though she “once held down a job in a bank . . . and had been able to travel across London independently”. The nurses’ notes took a different tack: “Willing to feed herself only if she feels like it . . . her behaviour can be aggressive.”

On July 26, 1999, Dr Barton made her recommendation: “Please keep comfortable. I am happy for nursing staff to confirm death.” Happy? The following then appears in the nursing notes: “Syringe driver started diamorphine 90mg. Midazolam 20mg.” These huge doses were administered at 11.15am. At 7pm a nurse confirmed Miss Thurston’s death.

Samizdata quote of the day

Even for The Guardian managing two logical fallacies in the one editorial is pretty good going. But that’s what they achieve in this one on funding the NHS. They manage both to get the Keynesian – and by extension, modern monetary theory – idea of deficit financing wrong and also the implications of the National Health Service being the efficient manner of organising health care. Actually, this is such a misunderstanding that I suspect it’s been written by Aditya Chakrabortty

Tim Worstall

Other ways of providing health care

Whenever I have attempted to discuss health care, I am always told about how the US health system fails people. I am sure that this is some combination of untrue (my own experience of US health care was walking in unannounced, paying $100 and being seen and fixed straight away) and unfair. US health care is not wholly private or even very free-market at all, and suffers a high level of regulation. But I do not understand enough about the details.

I occasionally hear good things about other health care systems, such as Australia’s method of having people pay and then possibly having the government refund them. While I can understand that it will be hard to convince people that anarcho-capitalist health care is best, it is interesting in the UK that no changes to the structure of health care at all will be considered. Private companies must not be allowed to make a profit! Such profit can only be gained from killing patients.

However the IEA have recently made an interesting strategic decision to counter-attack the knee-jerk reaction that the only alternative to the NHS is US-style health-care. What if the NHS and the US system are both weird and there are other sane and functional systems in the world? Kate Andrews has appeared on the BBC pointing this out. Guido covered it. Kate Andrews wrote a piece for the Spectator. All this is to publicise the IEA report Universal healthcare without the NHS.

One thing they keep pointing out is that the NHS ranks in the bottom third of the world’s health care systems in terms of outcomes. That will need a lot of repeating if anyone still thinks it is the envy of the world.

It is also, perhaps, a much more effective strategy than attempting to convince people of the benefits of free markets up front. “Let us try to learn something from nice country X” does not require breaking down as many mental barriers as “please abandon a lifetime of carefully cultivated opinions about the unfairness of capitalism”.

Our god requires sacrifices

Tim Worstall says that Hayek’s much-derided argument that government health care would make us serfs of the state is supported by an astonishing piece by Nick Cohen which appears to argue that so it would, and so it must. Part of me hopes that Cohen, who has often been one of the more principled voices on the British Left, is writing tongue in cheek or trying to provoke a reaction. But the commenters nearly all seem to take it quite seriously and only berate him for not going far enough.

Here’s the piece from Cohen: “Saving the NHS means forcing us to change the way we lead our lives”.

If you imagine a healthy future for Britain, or any other country that has put the hunger of millennia behind it, you see a kind of dictatorship. Not a tyranny, but a society that ruthlessly restricts free choice. It is a future that views the mass of people as base creatures jerked around by desires they cannot control. Expert authority must engineer their lives from above for their own good and the common good.

Speaking as a base creature myself, I do not believe it would be a healthy future at all to be ruled by people with such contempt for me.

Here’s my partial sketch of how Britain would have to change to limit the costs to the NHS that stunted lives and avoidable pain will bring. Pedestrians and cyclists would have priority on the roads. If the roads are too narrow to take cars, cycle lanes and a pavement wide enough to allow pedestrians to walk or run in comfort, then cars will have to go. School runs will become history as heads refuse to admit any able-bodied child who arrives at school in a car.

It will not necessarily be illegal to drive in towns and cities, just pointless. Motorists would inch along because cycle and bus lanes would take up road space and pelican crossings would be reset so pedestrians never had to wait more than a minute to cross a road. Even when they reached their destinations, drivers would search forever for a space because car parks would have been demolished and replaced with public parks.

No fast-food outlet would be allowed within a one-mile radius of a school. Agricultural subsidies for fat and sugar would be abolished. Rapeseed oil and sugar beet cultivation would stop as new subsidies for public transport began. Meanwhile, the manufacturers of processed food high in sugar, salt and fat would face advertising bans and punitive taxes. (If food manufacturers want to dump prematurely sick patients on the NHS, we will say, they can damn well pay for the privilege.)

A commenter called “erikus” put their finger on what all this was reminding me of:

Stardate 21327.5. Captain Picard & the crew of the Enterprise arrive at a world where the local inhabitants are suffering the apocalyptic consequences that fell upon them after they tried to re-engineer themselves in order to meet the expectations they believe are placed upon them by the institutions that were created by their ancestors and which they’ve come to regard as sacred & inviolate.

Picard’s final speech: ‘They killed themselves for this. They died because they believed that they had to sacrifice themselves in order to preserve in perfect form the institutions left to them by their ancestors: Institutions that were themselves originally created with one simple purpose: To preserve their lives:

We must remember that the institutions that we create exist for our well-being & that once we begin to worship them & think their well-being transcends that of our own, they lose their reason for existence.’

Samizdata quote of the day

One of the great tragedies of the NHS is that it has unnecessarily turned health into a Zero Sum Game. Because it has a limited budget, money spent on one treatment means that it cannot be spent on others. It therefore has to make life and death decisions based on what those running it perceive to be its priorities.

Madsen Pirie

Sometimes you just gotta liver little

Today’s weird Guardian story is not directly political:

Surgeon admits marking his initials on the livers of two patients

A surgeon has pleaded guilty to marking his initials on the livers of two patients while performing transplant surgery.

In a hearing at Birmingham crown court on Wednesday, Simon Bramhall admitted two counts of assault by beating relating to incidents on 9 February and 21 August 2013. He pleaded not guilty to the more serious charges of assault occasioning actual bodily harm.

The renowned liver, spleen and pancreas surgeon used the gas argon, used to stop livers bleeding during operations and to highlight an area due to be worked on, to sign his initials into the patients’ organs. The marks left by argon are not thought to impair the organ’s function and usually disappear by themselves.

The 53-year-old was first suspended from his post as a consultant surgeon at Birmingham’s Queen Elizabeth hospital in 2013 after a colleague spotted the initials “SB” on an organ during follow-up surgery on one of Bramhall’s patients.

As one might expect, this is being treated as a crime:

Elizabeth Reid, of the Crown Prosecution Service, said Bramhall’s actions were an abuse of the trust placed in him by the patients.

“It was an intentional application of unlawful force to a patient whilst anaesthetised,” she said. “His acts in marking the livers of those patients, in a wholly unnecessary way, were deliberate and conscious acts on his part.”

But not everyone agrees.

Following reports of Bramhall’s suspension, his former patient Tracy Scriven told the Birmingham Mail that the surgeon should be immediately reinstated. “Even if he did put his initials on a transplanted liver, is it really that bad? I wouldn’t have cared if he did it to me. The man saved my life,” she said.

She has a point. As was discussed here yesterday there is a push (it’s called a “consultation” but no one is in any doubt what the desired answer is) for England to follow the example of Wales and institute a system in which unless a person objects in advance to their organs being donated after death their consent will be assumed.

Why, then, should Mr Bramhall not say that he assumed that his patients were OK with him putting his graffiti tag on their livers? They didn’t sign a form objecting, did they?

Be a trendsetter not a follower

It is always nice to be reminded that history has no direction. The Times reports,

Austria will scrap ban on smoking in restaurants, Freedom Party declares

Austria is to break with a global trend in health policy by abandoning plans to ban smoking in bars and restaurants.

Full smoking prohibition was due to come in next May but will be shelved at the insistence of the far-right Freedom Party as a condition of joining a coalition with the Austrian conservatives.

The Freedom Party (FPO), which came third in elections in October, is in talks to form a government with the Austrian People’s Party (OVP).

Heinz-Christian Strache, leader of the FPO, made overturning the ban, agreed in 2015, a top campaign pledge.

“I am proud of this excellent solution in the interests of non-smokers, smokers and restaurant owners,” Mr Strache, 48, a smoker who has tried to quit, said.

“The freedom to choose lives on. The existence of restaurants, particularly small ones, has been secured. Thousands of threatened jobs have been saved,” he said.

Some of the Times commenters say that their dislike of smoke is so strong that they will not be returning to Austria as tourists unless the ban is reinstated. That is their choice, although it does seem to me that their understandable preference for a non-smoking restaurant could be satisfied at a more local level than that of an entire nation.

This is why we can’t have nice things

To be precise this is why we can’t have politicians who try to explain concepts from economics in a relatively grown up manner. When they give the more highminded strategy a go, along comes the Daily Mirror and the “pan-disability charity” Scope – whose Wikipedia entry is graced by one of those template messages saying, “This article contains content that is written like an advertisement” – to remind them why when attempting to discuss economics with the Great British Public the wiser course is to mindlessly repeat one pre-prepared soundbite. Daring to suggest that some groups might be on average be less productive than others, even in the context of saying that their participation in the labour force is a good thing, only brings on another mass bout of indignation dysentery. All one can do then is try not to breathe in too deeply until people have got it out of their system.

Quoth the Mirror:

Philip Hammond blames Britain’s low economic productivity on working disabled people

“The consequences of high levels of unemployment, particularly youth unemployment, will be felt for many, many years to come.

“It is almost certainly the case that by increasing participation in the workforce, including far higher levels of participation by marginal groups and very high levels of engagement in the workforce, for example of disabled people – something we should be extremely proud of – may have had an impact on overall productivity measurements.”

Quoth Scope:

Anna Bird, Director of Policy and Research at disability charity Scope, said: “These comments are totally unacceptable and derogatory. They fundamentally undermine the Government’s policy to get more disabled people into work, and the ambition set out by the Prime Minister just a week ago.

“The Chancellor must urgently withdraw them and offer a full apology.”

Quoth Mirror commenter “DiAne”:

Didn’t Hitler say something similar?

Samizdata quote of the day

One claim by campaigners is that this will ‘help the poor’, who are disproportionately more likely to suffer from alcohol-induced ill-health. How making poor people poorer will improve health is a real head-scratcher. This is typical of the missionary attitude of public-health zealots – imposing policies that poor people don’t want ‘for their own good’. Neither will minimum pricing do anything to solve the problem of weekend revellers ending up in A&E – bars already charge way above the minimum price. Instead, this new policy will target those trying to relax with a cheap drink at home.

Rob Lyons