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August 16th, 2008

making sense of the senseless

I was surfing through Pregnancy & Childbirth books over at Amazon, sorted by rated 4 stars and up. I kept running across these books by Glenn Doman with titles that really made me wonder if someone was joking (_How to Give Your Child Encyclopedic Knowledge_ -- how is that _not_ intended to be humorous?). After looking through some of the editorial comment/review/etc. matter, I concluded that (a) the Domans are _not_ joking, or, if so, they are keeping their laughter to themselves as they collect the cash and (b) this has been going on for a while. I wandered over to wikipedia, and came away half appalled, but still slightly amused. I mean, really? Jumped up flashcards are going to teach babies to do math? _Really_? And, _why_?

For that matter, why haven't I run across these people before? The answer, of course, is _I have_ and I laughed really hard the first time, then promptly forgot the names of the perpetrators. In Ralph Schoenstein's _My Kid's an Honor Student, Your Kid's a Loser_, which I got from BPL before T. was born (aha! This is why I forgot! Well, maybe), there is an uproariously funny profile of the Domans' operation.

Look. It's a bunch of flash cards, either home made, or purchased from the Domans or someone else. You show them to your baby. You convince yourself that this is doing something (like, say, giving your baby Encyclopedic Knowledge). Or whatever. Fairly straightforward. Hard to see _quite_ how the Domans managed to sucker a bunch of people who _should_ have known better (Linus Pauling, Buckminster Fuller) but, to be fair, these are people who have shown a well-developed history of _not_ knowing any better, despite substantial accomplishments in the past within a narrow field.

T. has been largely ignoring the pedalless bike outdoors. I'm a little bummed, but I'm sure I'll get a chance to see it in action some day.
First up: James K. Galbraith on oil speculators. Now, let's be real clear here. I _really_ want to like this guy. I've bought books by him and read them (and, at the time, believed what I read in them, altho not so much any more). But whenever people start writing about how the incredibly high price of oil is due to oil speculators, I roll my eyes.

And yes, Virginia, Galbraith _does_ mention people leaving oil in the ground as a form of "speculation". Hey, if _that_ is speculation, I have no idea what the hell we're talking about any more. And neither does he.

Galbraith also mentions Frank Veneroso, saying he believes there's 800,000 tons of copper stashed away in China waiting for the market to get high enough. Let's do a little math, shall we? (800,000 * 2000)/1,000,000,000 gives a _very_ rough estimate in pounds per Chinese person. And it's under 20 (or I screwed up by an order of magnitude; feel free to correct my math). Close your eyes and visualize: how many pounds of copper wiring in a car? A house? How much copper pipe in a house? In a factory? In a motor -- any motor? How many motors in _your_ house? In a factory? In a toy shipped somewhere else?

Wouldn't 800,000 tons of copper _disappear_ in the noise of what's getting sucked into the maw of capitalistic development of China over the last few years? In any event, the price run-up in copper has been less substantial over the last five years than, say, fossil fuels (oil, coal), steel, etc., and can probably be attributed in its entirety to a combination of increased cost of fossil fuels, increased demand (maw of capitalistic development of BRIC). Any extra could be accounted for by, say, any enforcement of environmental regulations on Rio Tinto. As a for instance.

I realize it's depressing when prices go up and get passed along to the consumer. That does not mean that there are evil speculators at work. And even if they are, I don't see that being a substantial part of the problem -- or the solution.

Ridgeway's article on Medicare Part D is really interesting in that it pointed out one thing I didn't know and made a valid analogy that had not occurred to me. I _did not_ know that if you fall into the donut hole, _you_ don't get any price break your insurer negotiates on drugs that were covered but you are now paying full price for -- BUT your insurer will still get the discount kicked back to them. This strikes me as _obscene_ if true. And I don't doubt that it's true; Ridgeway tends to be fairly careful about fact checking, in my experience. The analogy is between Part D and Obama's proposal (and most everyone's proposal for universal health care at this point). It's worth thinking really hard about.

The article, however, frustrated me. Ridgeway uses his own medicine cabinet as an example of how coverage works (or doesn't work). While I would not argue with him taking Prilosec (or its generic, OTC equivalent) because (a) acid reflux is real and uncomfortable and (b) that's a pretty plausible, symptom management approach, I have a whole series of issues with the rest of what he's taking and why he (and his doctors) think he should be taking them. He doesn't go into any detail on the eye drops question, but I would point out that this is what the US Preventive Services Task Force had to say on the subject in 2005:

http://www.ahrq.gov/clinic/uspstf/uspsglau.htm

I will further add that I was completely startled at how regionally variable practice for prescribing eye drops was (according to Eddy) some years ago; I haven't seen anything in googling to indicate that matters have significantly improved. Given that Ridgeway would "rather starve" than give up his eye drops, I suspect he's been sold a bill of goods in terms of how much benefit he's deriving from this particular treatment but again, he supplied _no_ details and equally obviously, I am not a doctor.

Ridgeway describes the wonderful care he received in France when he had a TIA (stroke) and then the medications he's on for high blood pressure (I'd guess one of the thiazide diuretics) and high cholesterol (which, incidentally, diuretics aggravate; my money is on a cheap statin). Given that the current state of the research indicates that statin therapy to reduce cholesterol doesn't help overall unless you are (a) male (which Ridgeway seems to be) and (b) have heart disease (which Ridgeway gives no indication he's been diagnosed with), I question the cholesterol med (I always do, tho, so just think broken record here).

I would sincerely hope that someone, somewhere mentioned to Ridgeway that some lifestyle adjustments might also help with the high blood pressure (regular, low-to-moderate intensity exercise, for example). But I suspect not. Which is a pity, because he also mentions he cycled through a bunch of anti-depressants before settling on the generic form of Wellbutrin, which he indicates would be one of the first of his meds he'd willingly give up. His description of his psychiatrist is uninspiring to me, and, one can safely say, Ridgeway. Regular, low-to-moderate intensity exercise is also well-documented as helping with mild-moderate depression, which is what it sounds like the range Ridgeway falls into. [ETA: To clarify, the _description_ as a piece of writing was inspired and brilliant; the impression conveyed of the psychiatrist was uninspiring.]

R. is totally unconvinced that any of the standard lifestyle recommendations for reducing acid reflux are at all effective. He's got it; I only have reflux when pregnant (or when extremely out-of-shape and overweight, but that was a long while ago now) so I can't have an opinion, other than to point out that this may be the fault of broad-spectrum antibiotics for eradicating all forms of H. pylori, including the ones that probably help with this. But with the exception of that and _possibly_ those diuretics, if I were Ridgeway, I'd be looking to get off everything else he's taking _independent of cost and who was footing the bill_.

And that's the other thing that's wrong with Part D and any universal health care plan and so forth: we _really_ need to start with the popular, massively prescribed drugs (the kind we go, why don't we just stick it in the water) and document the hell out of the benefits/harms of taking them. If recent history is any guide, if it's the most widely prescribed drug in the US, taking it is probably a terrible idea. One would _hope_ that in a reasonable regulatory environment, that would _not_ be the case.

Finally, given Ridgeway's observation about who gets the discount when you fall into the donut hole, and his stated costs for various drugs, it seems to me that if you _know_ you're going to wind up in the hole 8 months in, you should pay for the OTC version of stuff like Prilosec yourself from Jan 1. You can get at least that one cheaper than his cost through Part D -- never mind what he wound up paying for it once he fell in the hole -- and since that doesn't add to the amount before he tips into the hole, it might buy him another month on the more expensive stuff. Hard to say how it would work out without hauling out a spreadsheet, and Ridgeway is absolutely right that having to haul out a spreadsheet is a pretty good indication that something is Horribly Wrong With Health Care In America.

One last word: I have a lot of respect for Ridgeway, and Ridgeway (in conjunction with whoever he chooses to involve in the process) is the person who decides what the right care for Ridgeway is. He offered himself up in the article as a sort of case study in how Medicare Part D interacts with a relatively typical person taking relatively common medications. My comments are in _no way_ intended as medical advice for him or anyone else OR as a judgment of him as a person for continuing to take these common medications. I'm doing this in the same spirit in which I make remarks when R. is watching an episode of _What Not to Wear_ -- with the added zing of this being a huge, collective economic and financial nightmare, and not just aesthetic judgments manifested on someone's body.