Latest / Words & Numbers / Episode 424: Your Body, Your Health Care

Transcript

Episode 424: Your Body, Your Health Care · Words & Numbers

0:00
Hi, I'm James and I'm Anthony. And this is words and Numbers
0:08
brought to you by the fine people at KHAKI, the Center for
0:10
American Culture and Ideas. Aunt, what's new and exciting in
0:14
your world this week? Two things to talk about.
0:16
One is the stock market, but I'll come to that in a moment.
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Of course, that's on everybody's minds now.
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Aunt, we all know that when the stock market tanks like this,
0:24
the president should be impeached.
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That's what Donald Trump told us when it happened under Joe
0:30
Biden. Yeah, I'm not touching that with
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a 10 foot pole, but I'll talk about stocks in a minute.
0:34
The thing that caught my attention this week is a Chinese
0:39
smartphone manufacturer is coming out with deep fake
0:44
detection software. So this is stuff that's going
0:48
to, according to them, determine whether a video has been altered
0:52
or the audio has been altered or picture or whatever it is.
0:56
But the thing that fascinates me is the company is using AI in an
1:02
attempt to detect AI Dee fakes. And it reminds me of I'm old
1:09
enough. To.
1:10
Recall the first computer viruses.
1:14
When I first started working with computers, there was no
1:16
such thing as antivirus software.
1:18
You didn't need it, right? And then the first virus shows
1:21
up, and so you get antivirus software, and then you get
1:23
viruses that are smarter, and then you get better antivirus
1:26
software. And the whole thing keeps going
1:27
like that to the point that you have today, I have antivirus
1:31
software. There's probably orders of
1:34
magnitude more complex than the complex video games I used to
1:37
play, right? But you end up back where you
1:40
started, which is OK. I don't have any viruses at the
1:43
end of the day. And I just see the same kind of
1:46
thing developing with AI and deepfakes, that the AIS will get
1:50
better and the deepfake detection will get better.
1:53
And a decade from now, we're going to have massive software
1:57
sitting on our computers that bring us right back to where we
2:00
are right now, which is basically no deepfakes.
2:04
Sounds right. I remember when I started as
2:06
Dean in Iraq, I ordered turnitin.com for the school and
2:11
the students very quickly found turn in turnitin.com.
2:15
Yes, it's funny you mention that.
2:17
I can recall my students being appalled when I said to them
2:24
that there's websites available to faculty that cross reference
2:28
the sites that they get papers and homework from.
2:32
It didn't even occur to me that this was a big deal.
2:34
I was saying it as if, well, of course you know this and you
2:37
should have seen the faces, Blanche in the classroom.
2:41
Yeah. You know, it's a strange thing.
2:44
You bring it up in one mil, you eye in another.
2:48
Everything does turn into an arms race sooner or later.
2:51
Yeah. You're always hoping in the end
2:53
for the same detente you started with, but due to the stupidity
2:58
of human beings, you have to go through the arms race to get
3:01
there. Well, you do.
3:03
I just went through a similar one recently and if you haven't
3:06
yet, you will be of filing your taxes.
3:10
James, I had to pay somebody $1000 to fill out forms to tell
3:15
the IRS what the IRS already knows.
3:19
Yeah. Nonetheless, let's not get
3:22
heated about that. Let me talk about the stock
3:24
market. Stock market was down 10% from
3:27
mid February. Thankfully, fewer people are
3:30
losing their minds and have lost their minds in the past.
3:33
I think because more and more Americans are realizing when the
3:36
stock market tanks, this is a great time to buy stock.
3:43
Well, we'll see about that, won't we?
3:44
Yeah. And not only does it give you a
3:45
good investment because you're buying the stock at a low price,
3:48
but that action actually helps bring the stock price back up
3:51
again. And that's all I have.
3:54
Well, OK, fair enough. I wanted to remind everybody
3:58
that our president just recently said that there is nothing from
4:03
Canada that we need. Do you remember when he said
4:05
that? I don't recall him saying that,
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but my God, that's a bold statement given that what
4:10
they're our second largest trading partner.
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Yeah, but apparently, you know, we buy more from them than they
4:17
buy from us, and this is somehow a problem and etcetera,
4:20
etcetera. But in the end, he said we don't
4:23
need anything from them. And I just want people to
4:25
remember that for only a minute because this isn't really me
4:28
swinging a stick at Donald Trump.
4:30
It's me being angry about the price of eggs because eggs Ant
4:36
there is a black market in eggs. There are contraband eggs all
4:40
over these United States and they're coming in from Canada
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and Mexico where respectively they're about $2.00 to 50 a
4:50
dozen. Yeah.
4:52
These two countries don't have a problem with the egg supply and
4:59
this is how markets work. We do, and we say, well, all
5:02
right, that's too bad, let's import a bunch from the closest
5:06
places we can find because those prices will be cheapest.
5:11
And yet that's exactly what the American people, and I think
5:16
it's fair to say that, broadly speaking, the American people
5:20
are no longer interested in. You know.
5:23
I don't understand how a president got over on a bunch of
5:30
people and convinced them that the best thing to do for them
5:35
would be to pay more for everything.
5:38
That's precisely what's happened.
5:40
There's a weird psychology that goes on there.
5:42
I think largely it's because people just don't understand.
5:45
It's the same error they make when they see a billionaire with
5:49
lots of money and say, well, he's somehow ripped off the rest
5:52
of us. And we look at trade deficit and
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we say, well, somehow the world is ripping us off.
5:56
No, it's not that money comes back to the US.
6:01
Ripping us off is exactly what Trump says about every country
6:05
we have a trade deficit with. Trade deficits are so foolish as
6:09
a metric that we shouldn't even be adding those numbers.
6:12
Up. That's right.
6:14
It tells us absolutely nothing. Yeah, I found some interesting
6:18
data recently. I broke it down by state.
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If you break it down by state, it's something like a third of
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the US states actually have trade surpluses.
6:26
And oddly, there are a lot of those states or states that went
6:30
for Trump. It's going to be interesting how
6:33
this all shakes out because what's going to happen and
6:37
what's going to happen relatively soon or prices are
6:39
going to creep up again. Yeah.
6:42
I mean, that is inevitable. You'll go to the store, you will
6:46
go to buy things. Everything will cost more.
6:49
And when I say everything, I really do kind of mean
6:51
everything. Yeah, it's just a huge tax
6:54
that's being slapped on things. Well, it's a tax that we have
6:57
slept on ourselves. Go back to the eggs for a
7:00
moment. I read something from a farmer
7:03
recently who was saying that of course we have the egg shortage
7:06
because the government required the farmers to kill off the
7:10
chickens because of avian flu. And the farmer said this is
7:14
completely stupid. It's not what you do.
7:17
What you do is you let the avian flu or whatever the disease is
7:21
run its course. The chickens that survive, they
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have natural immunity. You want to breed them so that
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you now don't have this problem in the future.
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But the government's ruled that you've just got to kill off all
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the chickens are killing off the ones that have the natural
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immunity that you actually want. Ant are you telling me that
7:42
government might be doing something that's deeply
7:44
counterproductive? Well, I'm underlining once more
7:47
what happens when you have policy makers make decisions for
7:51
people who actually know the matter better than the policy
7:54
makers. Yeah, well, boy, I say this a
7:59
lot, but we're just going to have to wait and see how it all
8:01
shakes out. I I say that literally about
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everything, every day, all the time.
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Anyway, Aunt, this brings us, of course, to the foolishness of
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the week. And this week's foolishness is
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especially wonderful because it comes directly from our long
8:17
time listener, supporter and Co conspirator, W Westmoreland, who
8:23
sends us something from the great state of North Carolina.
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Did you happen to have a chance to read this nonsense over?
8:31
Aunt, I don't know that I have. Did he send it to both of us?
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I usually flag Wes's emails as something to pay attention to.
8:40
I get few of them. He, he sent it to us in the form
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of a text, and it is from the General Assembly of North
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Carolina, Session 2025, from February 27th of this year.
8:56
I'm just going to read you the title of the ACT.
8:59
Are you ready for this? A bill to be entitled An Act to
9:05
provide funds to North Carolina State University for a pilot
9:09
program in Wake County to increase diversity in the game
9:13
of pickleball. Increase diversity in the game
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of pickleball. Apparently.
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Pickleball's exclusive somehow. These dopey fools in North
9:27
Carolina's legislature think a pickleball should be the concern
9:34
of the University of North Carolina or North Carolina State
9:37
University. Let me get that right.
9:40
I can't imagine why that's the case, but given that it is that
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they need to somehow increase diversity in the playing of
9:50
pickleball at the collegiate level.
9:54
What? It's not like polo or something,
9:56
right? I mean, anybody can play
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pickleball. That's part of the attraction.
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Currently Aunt the sport is underrepresented by people of
10:08
color despite it having the capacity to be multicultural and
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socio economically inclusive since it has a low cost of
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entry, high ease of play and is offered through public
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recreational facilities. I'm just not following this is
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the underlying argument that somehow people are being
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excluded on mass from pickleball games.
10:31
Well, I don't see that. What I see is that people of
10:35
color. I've always wondered what the
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hell that's even supposed to mean.
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I have a color. I'm a person of color.
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We're all people. When you get angry, it turns
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very red. Shut up, there are no clear
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people. I'm close and my daughter's even
10:50
closer. But you know, we all have a
10:52
color, so let's just say what we mean here.
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Black people, for whatever the reason, are not playing
10:58
pickleball. It's hard for me to imagine that
11:01
the Asians care that much, although it is somewhat
11:05
reminiscent of ping pong, where the Asians utterly dominate.
11:11
So maybe the Asians are playing. I don't know.
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I've shot my mouth off without the proper amount of of
11:16
information, so we'll leave the Asians off to the side.
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But if the General Assembly of North Carolina is to be
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believed, black people are not playing pickleball in sufficient
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numbers, and we need to subsidize something to make sure
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they do. That's astounding.
11:30
What an astounding waste. Here I am in Washington and the
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federal government just laid off 100,000 people because they're
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not contributing to anything and North Carolina is going to fund
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this study at NC State. Oh no, not a study, a pilot
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program to increase diversity. Oh my God, so they've already
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decided. Yes, yes, a priori.
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They've decided that there's a problem.
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They're not studying anything. Take out ads for pickleball and
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Ebony or something. I don't know, dear black people,
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this is pickleball. It's a thing that old white
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people do. You might like it too.
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I don't know what the Hell's going on with anybody.
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I really don't. I think everybody in the world
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has lost their minds. Well, and this is just this
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week's evidence. People of North Carolina, this
12:21
is what your tax dollars are paying.
12:23
For congratulations to you for. One Stop shopping.
12:28
For all things James and Aunt, visit our website
12:31
wordsandnumbers.org. We give a special shout out to
12:36
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12:39
If you'd like to contribute, go to patreon.com/words and
12:43
Numbers. This week, Jeffrey Singer joins
12:47
us. Jeffrey is senior fellow at the
12:49
Cato Institute and works in the Department of Health and Policy
12:52
Studies. He's president emeritus and
12:55
founder of Valley Surgical Clinics, the largest and oldest
12:59
group of private surgical practice in Arizona, and has
13:02
been in private practice as a general surgeon for 35 years.
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Actually longer than that. That's all he'll admit to.
13:12
Jeffrey joins us this week to talk about his upcoming book,
13:15
Your Body, Your Healthcare. Well, thank you for having me
13:18
here. I'm.
13:19
I'm really happy to have you on because James and I, over the
13:23
seven years we've been doing this, have talked about all
13:25
sorts of topics, but there's one or two that we assiduously
13:29
avoid, and one of them is healthcare because it's so
13:33
complicated and we don't know anything about it.
13:35
So it's great to have you on, not only to talk about it, but
13:38
you're taking in your book, Principles of Freedom that we
13:41
apply to economic interactions and you're applying them to
13:44
healthcare interactions. Yeah, that was my purpose of the
13:48
book. In fact, obviously in order to
13:50
illustrate my points, I do get into policy.
13:54
I try to keep it not too too wonkish and technical because my
13:59
target audience is actually just an educated general readership,
14:02
not people who are health economists or doctors for that
14:05
matter. I thought would be useful is
14:08
from the perspective of a doctor.
14:10
I by the way, I'm as long as I've been an adult, I'm self
14:14
identified as a libertarian. So I probably have a different
14:21
outlook and appreciation of the healthcare system in which I'm
14:25
marinated than a lot of my colleagues who may not have
14:29
thought a lot about political philosophy or economics and
14:32
don't necessarily have the insights I have.
14:34
So I thought it would be very helpful if instead of getting
14:37
into the nitty gritty economics, green eyeshade stuff, I present
14:42
everything from the standpoint of the presumption of liberty
14:45
and the presumption of autonomy. Because at the end of the day,
14:50
and of course, in the beginning of the book, I kind of lay out
14:52
the first principles and I tell readers that I'm for the sake of
14:57
this book, we're just talking about adults here because it
14:59
gets real complicated when you're dealing with, you know,
15:02
minors or people with cognitive disabilities.
15:05
So just for the sake of this discussion, we're talking about
15:08
adults and it's important for people to realize that as
15:14
doctors, we should not be paternalistic and we should
15:19
respect the our. I don't even like the word
15:21
patience. I think a better word would be
15:24
clients. Patience is kind of a holdover
15:27
word from hundreds of years ago. And I guess people were were
15:31
being asked to be patient with these very painful and often,
15:36
you know, unsuccessful remedies. I think we should approach our
15:40
patients as clients that, you know, these are adults, they're
15:43
sovereign entities. They're asking for our expert
15:45
advice that best as we know it, We give them our advice, we tell
15:49
them what we think they should do and what treatment we think
15:51
they should undergo. But at the end of the day, this
15:54
is their decision. And we have to respect that from
15:56
that perspective, like go through all of the different
15:59
areas of healthcare, whether it has to do with what medications
16:02
people can receive, what kind of healthcare expert people can get
16:07
advice from all the way down the line, or what kind of substances
16:12
they could put into their own bodies to consume.
16:15
We need to approach every one of these questions from the
16:19
perspective of the presumption of liberty.
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Start with everyone is an autonomous adult who has
16:25
liberty. And when we start from there,
16:28
then we could look at all these other issues that way.
16:32
If there's one take away I hope readers get from this book, I
16:36
hope to think it's a consistently libertarian book.
16:39
And some of the the proposals that Ioffer might strike some
16:44
readers who have not kind of thought about these things as
16:47
kind of a little radical. And maybe that's a slap in the
16:50
face. But if I end up getting people
16:53
to realize, even if they think my proposals are a little too
16:58
much or too radical, but the next time any sort of health
17:01
policy issues brought up or discussed in the media or with
17:05
friends or whatever, I hope they will stop themselves in the
17:09
middle and say, actually, you know, we're talking about what
17:13
we're going to force other people to do, not necessarily
17:17
persuade them to do. If they get that sensitivity to
17:20
that where they realize that that's what we're talking about,
17:23
then I would think I succeeded. To me, that's, that's my goal.
17:28
If you like my policy proposals, even better.
17:30
But if I just get you to to appreciate the fact that when
17:34
you're talking about government rules and interventions into the
17:37
patient documentation or into the into a person's decision
17:40
about what they want to take into their bodies and what kind
17:42
of health care they want to access, that every time a
17:48
decision is imposed on someone, you're violating their autonomy.
17:51
Just appreciate that. As I'm reading your book I'm
17:55
getting flashbacks to when I was in Europe and I was so surprised
18:01
at how easy it is to get certain types of I'll use the term
18:05
healthcare loosely. I needed some painkillers at one
18:08
point and some what do you call it the the the anti infection
18:13
drug? Antibiotics.
18:15
Antibiotics, thank you at another point.
18:17
And so of course, in this country, you got to go see a
18:19
doctor and you have to get the prescription and take the
18:21
prescription and get it filled and all the here I just walked
18:24
into a pharmacy and interestingly, the pharmacist
18:27
there seemed as well as I could tell with the language barrier,
18:31
seemed to be an expert in this particular thing doing more than
18:34
just dispensing pills, but asking, you know, well, you
18:37
know, what's your symptom here? And have you ever had a reaction
18:40
to such and such? From my perspective, way easier
18:43
to get healthcare there than under our system.
18:46
Well, I discussed that at length, actually in Chapter 2,
18:50
but also in other parts of the book.
18:52
So first of all, we didn't used to have licenses for any of the
18:57
occupations, let alone the medical fields.
18:59
And the medical fields are probably toughest ones to get
19:02
lay people to imagine without licensing.
19:05
And I talk about in the book how in the early days of this
19:08
Republic in the early 1800s, doctors were very frustrated
19:11
because many of them were itinerant and it was difficult
19:15
to make a living. They had competition from all
19:18
sorts of other types of healers. So the American Medical
19:21
Association was founded with its mission of getting doctors
19:24
licensed. And in the early days, they
19:26
would go to state legislatures and ask them to license doctors,
19:29
and they would get rebuffed. But what do you license?
19:33
You don't need a license to earn a living.
19:35
This is a free country. Yeah, But you know, there could
19:38
be some bad doctors out there. You need to protect people from
19:41
them and their response would be, well, you know, if there are
19:44
bad doctors out there, they won't last very long.
19:46
And you? Know neither will they're
19:48
patients, neither will they. Pay right, but you won't you
19:51
won't need us to protect people from them.
19:53
It'll take care of itself after the Civil War in the late 1800s
19:57
when, you know, government got bigger and people getting more
20:01
comfortable with. Certain types of licensing laws,
20:04
there were already some occupation licensing laws.
20:06
Then the AMA started making headway.
20:08
And they also, I mean, they did everything legally.
20:11
They founded a network of state chapters who would lobby their
20:14
state legislatures. And in the early days, what they
20:16
did was they got the state's license physicians and then
20:20
they'd make the licensing board would consist of members of the
20:23
state chapter of AMA. Kind of sounds a little fishy
20:27
already, right? And by the way, our fee for
20:29
service system, if you as a physician decided to sign a
20:33
contract with, let's say a company to be the company doctor
20:35
on a, let's say a monthly fee or something to take care of all
20:40
their employees, you could be kicked out of the AMA because
20:43
that was violating their, what they considered to be a code of
20:47
ethics, which is you have to be fee for service.
20:49
So that has a lot to do with our system we have today.
20:52
And then they next came up with a council to credit medical
20:57
schools. And eventually in 1913, they
20:59
commissioned Abraham Flexner, a very prominent educator who came
21:04
up with what that was, was called the Flexner Report, which
21:08
basically recommended that you have to have a bachelor's degree
21:11
before you even go to medical school.
21:12
Up until then, that wasn't required.
21:15
And a lot of countries, like in Europe, you know, you know, you
21:17
can go on a six year track. You don't have to get a
21:20
bachelor's degree. And they made all of these
21:23
onerous requirements on medical schools, including the amount of
21:26
research that has to be done, which made it very costly.
21:29
The AMA adopted that and would not accredit medical schools
21:33
that didn't meet those criteria. And since every licensing board,
21:36
which was made-up of the AMA affiliates said we will not
21:40
grant a license to anybody who didn't graduate from AMA
21:43
accredited medical school, This resulted in a huge reduction in
21:46
the amount of medical schools in the country, raised the costs.
21:50
So that actually at the at the beginning of the 20th century,
21:53
women made-up at least half of doctors.
21:56
But after that they disappeared. A lot of minorities disappeared.
22:00
There were 7 black medical schools, but only two remain
22:04
because the other 5 didn't meet the criteria.
22:07
They created a cartel. There are a lot of other health
22:12
related fields and particularly today in modern times where
22:15
they've had extensive training and they could do a lot of the
22:18
things that you get from a physician for which actually the
22:23
physician is overqualified. I'm not saying you don't need a
22:26
doctor, but you should take advantage of a doctor's
22:29
expertise on things that are more less than routine.
22:32
So for example, pharmacists, and I have a section in there about
22:35
this, 50% of graduates from pharmacy school these days are
22:39
doctors of pharmacy pharm D degree.
22:42
It's a five to six year program. They learn as much about
22:46
pharmacology and indications for drugs and interactions.
22:49
They've learned more than physicians do in Med school in
22:53
some countries in the UK, for example, in Australia, now now
22:57
in most of Canada, first Alberta and then Ontario, they allow
23:01
pharmacists to prescribe and test for routine things.
23:03
We learned during the COVID pandemic how you can get a
23:05
pharmacist to do a COVID test. Well, in those places, if you
23:09
have a routine thing that you kind of know what's going to
23:12
happen. Like if you think you have a
23:14
strep throat and you know there's a swab test that you
23:16
could take for the strep throat and you know, unless you're
23:19
allergic to penicillin, the penicillin's the treatment.
23:22
So, but nevertheless, you have to leave work early and sit in
23:25
the doctor's office for an hour to get seen.
23:28
And then that doctor takes that swab test.
23:30
You know exactly what the doctor's going to do, swabs your
23:32
throat and if it's positive, gives you a prescription to go
23:35
get the penicillin. Wouldn't it be great if you
23:37
could just kind of stop off on the way home from work and you
23:39
said all taken care of, you know, at the pharmacy counter?
23:42
Well, they do that. They're now Idaho and Colorado
23:46
have adopted the approach of Alberta and Ontario.
23:49
So there's an example. All of these are protectionist
23:52
policies instituted by the medical cartel.
23:56
Of course, they always say we're just looking out for the safety
23:58
of others, but they're really just protecting themselves
24:01
against competition. But more importantly, they're
24:05
assaulting our autonomy. They basically have lobbied
24:09
state lawmakers to say, let's say, you know, you wanted to
24:13
stop off at a pharmacist, take advantage of his expertise and
24:17
say, would you do a test to see if I have a strep throat and if
24:20
so, prescribe the antibiotic for me.
24:22
Well, the state will say you cannot do that because we don't
24:26
think you should be allowed to ask that pharmacist that
24:29
question and we don't think that pharmacist should be allowed to
24:32
answer. You could approach it from, you
24:34
know, an economic perspective, it's protectionism and access to
24:38
care and cost, etcetera. But in my book, I'm constantly
24:41
trying to weave in and out the moral perspective that you
24:46
realize that these people are using the power of the state to
24:50
tell we autonomous adults who we will be allowed to ask advice
24:56
from and get help from. They're deciding what's in our
24:59
best interests. We're not getting to decide
25:01
that, and there's a whole host of things like that.
25:05
Jeff, there's a couple of things I'd like to get you to weigh in
25:08
on. The first of which is, I mean,
25:11
listeners of our podcast will know that I've gone through
25:15
tremendous health issues with my back and having all kinds of
25:19
issues with pain and living in the great state of Arizona.
25:22
The legislature decided that they didn't care about that and
25:26
I wasn't going to be treated for that.
25:28
So I'd like you to address that sort of thing.
25:31
And then also people who are in much more unfortunate
25:35
circumstances. And the Dallas Buyers Club movie
25:39
comes to mind immediately, right, where people who are
25:41
dying and desperate want to try things to save their lives and
25:45
are not permitted to. Yeah, well, where's the harm in
25:50
that? So if you could maybe take on
25:52
both of these briefly. Two chapters dealing with the
25:56
FDA and one dealing with the war on some drugs cause other drugs
26:00
we don't have a war against. But let's start with the pain
26:03
medicine angle first, OK? The what you were asking about.
26:08
First of all, as I explained in my book, the overdose crisis
26:12
that's been just growing over the past several years has
26:17
nothing to do with doctors cooking their patients on
26:20
opioids and creating this population of zombies going out
26:24
and taking fentanyl and killing themselves.
26:26
I provide data from the government showing that the
26:29
overdose crisis has actually been on an exponential growth
26:32
trend since the late 1970s, as far back as we can get the data.
26:36
And the only thing that's varied over time is which particular
26:39
drugs seem to be more prevalent. And actually looking at the
26:43
government's own data, and I have actually the graph in the
26:45
book, the addiction rate to prescription pain pills for
26:49
adults 18 and above has been essentially unchanged, like a
26:52
flat line at less than 1% the since the National Survey in
26:56
Drug Use and Health began doing its survey in 2002.
26:59
So what's basically that the overdose crisis is, is the
27:02
result of prohibition. We have a growing population of
27:05
people who are non medically, shall we say, using drugs that
27:10
are not necessarily available through legal means.
27:14
And some may be self medicating because of prohibition, as I'm
27:19
sure listeners to this podcast know.
27:21
And well, first of all, it makes whatever you obtain the black
27:23
market, there's no quality control.
27:25
You can't even be sure what it is, what you're getting.
27:27
And also incentivizes the development of more potent forms
27:30
of the drug so that it could be smuggled in smaller sizes.
27:34
And then for the risks you're taking, you can get more bang
27:36
for the buck as a smuggler. So that's what's been driving up
27:39
the overdose rate. Now, as far as the prescriptions
27:42
in the FDA is concerned, many people may not know this, but
27:46
prior to 1951, the FDA, which is a government monopoly agency
27:52
dealing with which drugs can be bought and sold in the in the
27:56
legal market, they didn't make the decision as to what's
27:59
prescription only and what's over the counter.
28:01
That was a proprietary decision. You know, obviously if you're a
28:05
manufacturer and you have a drug that's complicated, you may
28:08
think, especially after consulting with the legal team,
28:11
you know, if somebody doesn't use this, as we explained, that
28:14
something bad's going to happen, we're going to get sued and our
28:16
reputation's going to be destroyed.
28:18
So they would tell pharmacists if somebody wants to purchase
28:22
this, you know, it's a contract, you could sell it to them
28:24
providing they have a prescription from a healthcare
28:27
practitioner because that basically means there's somebody
28:30
else involved who take responsibility.
28:33
And then in 1951, with Durham Humphrey amendments to the Food,
28:36
Drug and Cosmetic Act, that ended.
28:38
And it was the FDA that made the decision from then on a
28:40
government monopoly. Only one entity decides.
28:44
And prior to 1938, when the Food, Drug and Cosmetic Act was
28:47
passed, the government didn't even decide what medications can
28:53
be sold and what we as patients can consume.
28:57
It's in the book. I explain how he got there.
28:59
But but in 1938, Congress passed a law saying from this point
29:04
forward, every drug that's already on the market is
29:06
exempted. It's grandfathered.
29:08
But any new drug, you have to persuade us that it's safe to
29:12
use before we'll let you sell it to people.
29:14
They actually. And you look in the
29:16
Congressional Record when this bill is being debated.
29:19
The bill's author said nothing in this bill is meant to in any
29:22
way infringe on a person's right to self medicate.
29:26
Even back then, they still recognize that and they say,
29:30
however, we want to make sure they could self medicate safely.
29:33
That's why many people may not know this, but to this day you
29:35
can get regular and NPH insulin over the counter and it's cheap.
29:40
It's not as convenient as the more modern versions, but you
29:43
can get it. Because that was already in
29:45
existence starting around World War One.
29:47
So that was exempted with the prescription requirement when
29:50
the FDA got involved with that. Basically, the law says now that
29:55
there are certain drugs that the government decides I cannot have
29:58
access to unless I get what amounts to a permission slip
30:02
from another autonomous adult like myself who happens to be
30:06
licensed by the state to be a gatekeeper.
30:10
That's basically, if you want to boil it down to that, that's
30:12
what's happening. I, you know, if I want to take a
30:14
medicine, it's my body and I, and I've read up on it and I
30:17
want to try this. No, first I have to go convince
30:19
some other adult to give me a permission slip called the
30:22
prescription so that I can go to the pharmacist.
30:25
The pharmacist is not allowed to even sell it to me unless I
30:27
could present that prescription to the pharmacist.
30:29
So this is what what goes on now, you know, our FDA has the
30:34
incentive to be overly cautious. Milton Friedman talked about
30:38
this too. It's, you know, what's seen and
30:39
what's not seen. So all of the people who suffer
30:43
or die because the drug wasn't available to them, because there
30:46
was a delay in making it available to them, we don't
30:48
really get to see that. But we do get to see is if they
30:51
approve something and there's a bad reaction and this is the
30:54
precautionary principle, they're going to err on the side of
30:57
being overly cautious. And meanwhile, people who may be
30:59
terminally ill and want to have access, they want to try
31:02
something they they'll know going in with their eyes open,
31:05
this may not work, but I'd like to try it because nothing else
31:08
is working. Well, you can't do that because
31:11
you have to get a permission slip.
31:12
So we get into all that. Making matters just a little bit
31:17
worse here, yes, you have to get a permission slip, but then the
31:21
pharmacist can further deny the medication to.
31:25
You and that's because the pharmacy if you're dealing with
31:27
something like particularly like opioids for pain.
31:32
The pharmacist is worried because they have to digress a
31:35
little bit. But back in 2016, the CDC, which
31:40
was created with a mission to fight communicable infectious
31:43
disease. It was originally called the
31:45
Communicable Disease center. It's had a huge amount of
31:48
mission creep. So it's constantly doing work,
31:50
telling people about a whole lot of personal health decisions
31:53
that they should be able to decide with, you know, their
31:57
healthcare provider. So the CDC published what they
32:00
called guidelines for how to treat pain because they bought
32:04
into this idea that the overdose crisis is just due to doctors
32:08
over liberally prescribing opioids.
32:11
And they prefaced it with, this is based on very weak data,
32:14
mostly observational studies, subject to change.
32:18
And this is meant to be suggestive, not prescriptive.
32:21
They actually put that to cover themselves.
32:23
But as is usually a case when a government agency, especially
32:27
with an imprimatur of CDC, recommends something, that's a
32:32
de facto mandate. So now 40 states took those 2016
32:36
guidelines and put them at the statute.
32:40
So that tells basically doctors are told and pharmacist these
32:45
are how many oxycodone pills a person can have did during a
32:49
given time period. Now a post surgical patient when
32:53
I sent a patient home from the hospital, I could give them up
32:55
to two weeks of pain medicine. But after that, I'm going to be
32:58
in trouble because the states under the government's
33:02
direction, set up these surveillance systems so they
33:06
keep track of every opioid prescribed and every
33:09
prescription filled. And there've been a lot of high
33:12
profile raids on doctors offices by police who are seeing, oh,
33:16
this doctor's prescribed too many opioids.
33:17
He must be a drug dealer. Lots of times it's on the
33:20
Evening News. They come in with, you know,
33:21
with, with SWAT team with bulletproof vests because, you
33:24
know, most of us doctors pack heat in our office.
33:27
We are dangerous. I usually use a machine gun.
33:30
So if the cops come in, I could gun them down.
33:32
But they would never do that, by the way, if I was a cartel
33:35
member because they can get hurt.
33:38
They'll only do it with somebody who knows who's unarmed and and
33:41
afraid. More often than not, they don't
33:44
even press charges. They get the doctor to surrender
33:46
his DEAI know a couple of doctors, they surrender their
33:48
DEA license, which is licensed to prescribe narcotics.
33:51
And then they got it back a year later.
33:54
So it was just, you know, performance art.
33:57
And they do that to pharmacies as well.
33:59
So that's what's happened is so that the pharmacist when he's
34:02
filling an opioid prescription, he has to look through that
34:05
database just like the doctor has to by state law.
34:09
And the pharmacist is also thinking, well, if I fill this
34:12
prescription for that doctor, looks like this patient's
34:14
already had, you know, X amount of pills.
34:17
And and it's kind of pushing up against the quota that the state
34:19
lawmakers recommend because they're not doctors, they're
34:22
lawmakers. I don't want them to raid my
34:25
pharmacy and me get carted off in handcuffs and be on the
34:28
Evening News. So they'll sometimes deny it to
34:31
write a pain prescription for my post op patient And the
34:33
pharmacist will tell the patient I'm not going to fill it.
34:36
And I can't necessarily blame them because we're all being
34:39
terrorized by the system. And of course, think about this.
34:43
Imagine if we put into statute, you know, how much insulin to
34:48
give for diabetes, How much blood pressure medicine you
34:52
should give for a, a blood pressure of 140 systolic versus
34:55
160. I mean, first of all, if there's
34:58
anything people, all people should have learned during the
35:00
COVID pandemic is that Medical Sciences, it's a work in
35:03
progress. It's very individualized.
35:05
What works for one person may not work for another.
35:08
The dose required for one person may not be the same As for
35:10
another. And a lot of things we thought
35:12
we knew today we throw out the window two weeks from now
35:15
because we were wrong. So when you put these things in
35:18
statute, then it's concretized. So in 2016 is when those
35:23
guidelines came out. And after they received a lot of
35:25
criticism from pharmacologists and pain specialists, the CDC
35:29
revised the guidelines in 2022. It it, it still needs a lot of
35:34
work. They're still wrong, but they
35:35
revised them. But it doesn't matter because in
35:39
my state and in most of the 40 states that passed this, I'm
35:43
trapped in the year 2016 because it was the 2016 guidelines that
35:47
were put into effect. So any, any modification is
35:51
going to require another act of the state legislature.
35:54
You know, it's ridiculous. That was my long winded way of
35:58
answering your question. But I go into this kind of thing
36:01
and that's chapter 6 actually of the book.
36:06
So you said, Jeff, that your goal to the extent that you have
36:10
a reachable goal, right? And most goals here are not
36:14
going to be reachable, at least not in the short term.
36:16
But the goal of the book is to get people to ask a very
36:20
fundamental question. Is this right?
36:23
Exactly what about my autonomy? What do you think the most
36:29
effective thing in your book to get people to ask that question
36:33
is? The opening to my book, the
36:37
introduction, I thought was illustrative, and I closed the
36:41
book on the same note. So there was a very famous case
36:47
in the early 20th century, nineteen O 8, a woman named Mary
36:50
Sloendorf, who in those days, of course, we didn't have imaging
36:54
studies like we have today. So it was very common to examine
36:57
someone under anesthesia. That way they were not in pain
37:00
and get a better exam. So her doctor wanted to do an
37:03
exam under anesthesia 'cause he suspected that she had a uterine
37:05
tumor. And she agreed.
37:07
But she said specifically, but after the exam, I don't want you
37:10
to do anything. I want you to wake me up and
37:12
discuss what you proposed to me. Not any more than that.
37:17
So the doctor took her to the OR, examined her on an
37:20
anesthesia, appreciated uterine fibroid tumor, and went ahead
37:24
and did a hysterectomy. And she had all sorts of
37:27
complications. She survived, but she was
37:29
understandably angry, so she sued.
37:33
She won and then went on appeal. And the appeals court, a very
37:36
famous, you know, secular statement was made in the
37:40
opinion by then New York appeals court Judge Benjamin Cardozo,
37:45
who later became a Supreme Court Justice.
37:47
And he, I'm paraphrasing now, I have it, it's precise in the
37:50
book, But he basically said that everyone owns their own body and
37:54
to do something to someone without their consent
37:57
constitutes an assault. That didn't change everything.
38:00
There were several other similar kind of lawsuits over the next
38:04
several years. And it wasn't really until this
38:07
notion that all of us doctors have drilled into us from the
38:10
day we start medical school that you, you need to respect your
38:13
patient's autonomy. You can't do anything without
38:15
their informed consent. And if they refuse, even if
38:17
you're very upset that they're making a big mistake, you just
38:19
have to respect that. But that's actually relatively
38:22
modern. As recently as the 1970s,
38:26
surveys of oncologists found that a lot of them were
38:29
withholding the prognosis and the seriousness of the disease
38:32
from their patients because they felt that they told them that
38:35
they may not want to cooperate in what they thought was the
38:38
best treatment for them. And of course, going back, we
38:40
had the Tuskegee experiment where where a whole bunch of
38:45
African American males in Tuskegee, Alabama were being
38:48
followed to so they could track the course from beginning to end
38:52
of syphilis. And even when a treatment came
38:56
out, when we learned that you could cure syphilis, that was
38:59
withheld from them because they wanted to see how this thing
39:01
plays out. They needed the information.
39:03
Now, of course, President Clinton apologized retroactively
39:06
in in the 1990s for that. And of course, the the newer war
39:10
crimes trials, you know, brought to everybody's attention live
39:15
human experiments and those kind of things.
39:16
We were sterilizing people who we thought, you know, were
39:21
sexual assailants, all those kind of things.
39:24
So this is a relatively recent development.
39:27
And what I point out in my book is, well, now we doctors, we get
39:31
it as you can wake us up in the middle of night and we won't
39:33
even be fully conscious. And we'll spout out you got to
39:35
respect the patient's economy. But the government doesn't.
39:39
The government does to all of us everyday what Mary Sloendorf's
39:43
doctors did to her. That's how I start the book.
39:46
You know, they tell you what medications you can have, what
39:49
substances you can ingest for whatever reason you want to,
39:52
what kind of healthcare experts you're allowed to consult or
39:57
have treat you and on and on and on.
40:00
And even if you if you decide to use a substance that is risky,
40:04
if it's a not a substance approved by the government,
40:06
then. They even step in the way of you
40:10
availing yourselves of ways to make it less risky, so-called
40:14
harm reduction, by making it illegal.
40:16
So you can't even take steps to make your decision less risky.
40:21
And I close the book by saying that we doctors should actually,
40:25
since with a supposedly now we get it, we should be taking the
40:29
lead on this. We should be arguing for our
40:31
patients, for the government to get out of the way and respect
40:34
their autonomy. Jeff Singer, your body, your
40:39
healthcare available essentially.
40:42
Now go ahead and order it. And Jeff, thanks for coming on.
40:46
As aunt said at the opening, we assiduously avoid talking about
40:50
medical things because we're just not competent to do so.
40:54
And now that we know someone who is, you're probably going to pay
40:57
the price for this for the foreseeable future.
40:59
We'll be in touch real soon. Thanks for coming.
41:01
On Thank you for having me. And that's all the time we've
41:05
got this week on words and numbers until.
41:07
Next time, send us e-mail wordsandnumberspodcast@gmail.com.
41:12
Try to be nice to one person who doesn't deserve it till next
41:15
week. Can't take it easy.
41:16
See you next week, James.