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From: B. Harris)
Subject: Re: Greedy GP's vaccine ploy
Date: 16 Feb 2000 21:10:14 GMT

In <FGwq4.798$> "Jeffrey Peter, M.D."
<> writes:
>>The mystery is why some physicians support government totalitarism in
>>their own profession, as you apparently do.  No other professional
>>tolerates the government interfering with their advice to the client
>>akin to the way the CDC interferes with individual medical judgment
>>about vaccination.  Seeing what my wife studied in college and medical
>>school, I attribute the support by some physicians (a small minority of
>>the profession) of government control to a lack of free market economic
>>education.  For example, have you ever taken an economics course?
>Actually, the CDC does not interfere with medical judgement at all. They
>make recommendations, and the rational for their recommendations is
>freely available in their recommendations and reports (available on the
>web). The reason why physicians follow them is that they are good
>recommendations. IT has nothing to do with economics.
>JEffrey Peter

  Actually, it is the FDA which controls what vaccine companies may
offer physicians, and what they may advertise.  And while physicians
are in theory permitted to use non-FCA-approved treatments, in practice
few physicians dare use any treatment which is both unusual and has any
possible negative consequences. Which means, in practice, anything very
original or new. And a lot of things which aren't new, but aren't used
in the US. Most powerful treatments for bad conditions carry their own
risks, just like surgery for appendicitis. The difference is that
treatments which are common (community standard) or which are
FDA-approved, or both, by their nature protect the doctor from loosing
a civil suit and/or his licence, if the outcome is bad.  Which it is
bound to be for any treatment, eventually, for SOMEBODY.  This is not a
matter of what the medical profession has allowed to be done to it--
we've had no choice in the matter.  It was decided by law, and those
laws are backed up with guns and jails.  The people who made the laws
weren't very smart about unintended consequences, and about what would
happen as a result of the fact that these laws meant that in due time
they no longer would have access to the latest and best medical
technology, sure as the rain falls and the sun rises.

  I've given a good example of this.  There is a thing called the
cardiopump, which is a big suction device with two handles, which
sticks to a patient's chest, and allows you to do CPR in a clever way:
not only do you get a normal downstroke, but now the suction allows you
to move blood on the upstroke as well, as you lift the chest.  And this
does your ventilation for free, too, like the old armlift method.
Instead of blood pressures of 60 or 70 that CPR generates-- pressures
which don't perfuse the brain well after 5 minutes, this thing
generates pretty normal pressures.

  So why don't we have it, while in Canada and Europe they do?  Because
the FDA here made them test it on out-of-hospital arrests, where the
difference it made was lost in the noise of people who'd been in arrest
too long for any technique difference to matter.  So it failed the
trial and the company went broke.  It has worked fine in French trials,
and I suspect will be standard of care all over the world, eventually.
Except for here in the US.  If you want to import one of these giant
toilet plungers for resuscitation use on a clinically dead person in
the US, the FDA will stop your shipment at the border.  This is to
protect dead people from wasting their money, or from having any
dangerous medical treatments used on them.  Good idea.

  This sort of problem is one of the failures of democratic decision
making, when it comes to science and medicine.  People don't want what
they've never seen.  Also, treatments that people want for only a very
short time, if at all, get lost in the wash. This is the Arkansas
Traveler problem: you can't fix the cabin leak when it's raining, and
when it's not raining, the cabin doesn't leak so what's the point?
When it comes to things like resuscitation, it's hard to see the need
coming. Resuscitation is a like a firearm: one rarely needs a weapon,
but during the few times in one's life when one does want it, one wants
it rather badly. And wants it NOW.

  People in sudden cardiac arrest have about 5-10 minutes during which
they need resuscitation devices and drugs rather badly.  During this
time they and their loved-ones aren't going to close down the Golden
Gate bridge because society isn't funding the medical research
necessary to save their lives, and the FDA isn't moving fast enough to
suit them. That kind of political pressure is left for a bunch of
unmarried men with a lot of disposable income, who are reasonably
healthy now, but doomed, for some reason, in a few years. Or in a
decade. This gives them time to write a lot of plays and get a lot of
movie stars involved.  By contrast, the families of people who need the
toilet plunger have about 5 minutes to call Liz Taylor and get her to
lobby for them.  And damn, it just doesn't happen.

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