Mike Burr - log

[FDA] An open DM to all the Medical People at all layers of Medical

Every time I have had a serious medical issue, it has gotten fixed "like new" and my experience, at least on the human-interaction level, has always been 95% positive. And a good pro-human, pro-life (but not in the coopted sense) kind of "positive".

I like "healthcare folks". I've said that to someone slaving away over my body, trying to help out, on many occasions. It's not forced. Many or most of these people are a certain "type": nice. And it's not because they're going to stick needles in me. I am not sucking up. I am surprised by this observation. I suppose I bring my own "aura" when I show up to the doctor/ER. Maybe it's a Heisenberg thing.

In any case, this isn't a "hate" about any one person or any demographic. There really isn't a direction in which to focus one's frustration. Maybe that is an emergent property of too much regulation. Or maybe it isn't.

The problem is, there are nothing but barriers. That's the short, simple summary. If my goal is to go to the store and buy drug X about which I've heard good things, I am met with a whole TSA of things that I must or mustn't do. I'm hindered by what others must or mustn't do. My goal is to get drug X.

With that goal in mind, do you disagree that there are are an enormous number of barriers and complications when compared with, say, buying an apple?

Gasp you say. These are not apples. And what are you going to do with all those drugs?

I appreciate that there are noble goals to save people from themselves. But that does not mean that what's being done right now is optimal, or in the direction of optimal, if we're considering any "improvements", or even if the goals are met, ever. There is no measuring these things.

The results of the great experiment where we design just the right arrangement of laws and certificates as a way to "solve problems" can only be compared with the "results" from a world where we never did any of that.

This is an experiment with a sample size of one.

And confidence that you're doing the right thing is no substitute for the truth. You do not know that law L is a net improvement upon the world. You cannot know. And if, to make matters worse, we have an environment where criticism about the status quo is met with something on the spectrum between dismissal and outright ad hominem attack, we are not going to approve. Do you disagree? Unless we have a perfect system, shouldn't clear, reasoned criticism be considered? Who's job is it to do the soul searching on that, the appointed tzar whose proxy-elected appointer retired 10 years ago?

And there are people who devote their whole lives to thinking of ever-cleverer ways of arguing that these things just have to be; years of debate club finally paying off!

There's nothing "science" about an 80 year old sleepy judge (or panel of 80 sleepy judges) and some overly-confidient, law ninja pleading for all his partnership that we just must keep this going. Oh, and it looks like the defense doesn't have much money, and their lawyer's toupee is just a bit off-kilter and his suit doesn't fit quite right.

It doesn't sound like science to me, and yet this is how we decide:

  • What is the definition of a "dangerous drug"?
  • How do we categorize drugs as "addictive" or not?
  • Should we just outright now forbid this up-til-now perfectly legal drug?
  • At what point has an unlicensed doctor received compensation for medical services and how should he be punished if he does so?
  • Do we have maybe too-few doctors? Could there maybe be a cause-of and solution-of this?
  • This lots of voters are clamoring for the approval of something that we would otherwise not approve. Do we just, like, approve it anyways?
  • This drug instantly makes tumors go away in apes but hasn't been tried on humans. Can this guy who is going to die next week be allowed to have it? What if it's one month, six months, two years...? How, and how much do we punish someone if the current rules are broken? And who?
  • Someone just set up a strip mall "medical" place with absolutely no kind of communication or permission from the FDA? What do we do? They refuse to stop, now what do we do?

Note that many questions are not being asked too. Don't forget the unknown unknowns.

Why are medical things 200x regular things, even if they appear identical?

Plastic bags... needles... syringes... sticky tape... beds... power systems... all of the medication...

These things, all of them, have their analogs in the "real world" (which is what I'll say from now on instead of "amazon.com"). An IV bag has its perfectly-sterile, leak-proof, even stenciled writing or accurate little Ml ticks. There are lots of hollow needles out there. Why do some cost X and others cost 9000X? Do we know if the difference in cost is money well spent? Always? No matter how fine the needle? The only difference is a mountain of paperwork!

Beds? Is there a good reason why 98% of the beds in a hospital cannot just be top-notch Honest Rob's mail-a-mattress? Has anyone's cancer ever gotten worse from sleeping on the wrong bed? There is no lee-way here? Some patients need this in order to maximize their healthcare; I get that. If you go to the hospital you must sit upon a magical million dollar bed? Must? Has anyone tried to break this rule? I don't think I've ever seen it tried. I don't understand why there aren't more just...regular beds in a hospital. Is it a practical matter? ...one that happens to multiply the price by some absurd number? I could go on (clearly, whether I make sense or not). How is the zillion-percent markup justified? Just the way of the world? Is it Chinatown? Is it?

If I pay someone in cash to reset my broken leg, and I am confident that that person is competent enough, for my purposes, what crime has either of us committed? Can you point to the law? Is the law up for discussion?

I have my own set of cynical theories about why only FDA-certified practitioners are permitted to perform certain practices, or why only FDA-certified manufacturers are allowed to produce a simple piece of plastic (that for some reason costs $800).

Multigenerational, destructive, pestilent drug addiction has made its way through all different parts of the world for literally thousands of years. We may have more on the menu and better access, but there have been places in space and time where it was pretty much "all you can eat opium for pretty much everyone". The potential to drive yourself into the gutter is basically the same as its been before, somewhere. And yet, this particular series of ever-more terrible "drug epidemics" happen to correspond pretty much exactly with "the war on drugs".

Anyone else pick up on that?

Anyone want to "steelman" the "drug regulation good" position?

In terms of forward progress, there doesn't seem to be any correlation with the "war on drugs" vs "how is drug abuse going?" then: more war equals more drugs. That seems to be the trend. Should we only accept this to be the case when we have a big enough Appomattox or Gettysburg for both "sides" to say, ok, no more. we're done. war bad.

Remember when you could just go to the local pharmacy as a five year old and buy a whole armload of laudnum without a wink from the proprieter? Pepridge Farm remembers.

Why are there so many drug use epidemics missing from history, despite wide access, at least somewhere at some time, to whatever was available to tickle your fancy at the time.

Hows about US alcohol prohibition? How about it indeed. It's not a literal carbon copy of the pointless misery we have now, but it rhymes quite well.

Even leaving all that aside, I feel that I can make the moral argument that: It is really none of your business.

How that can be so shocking and mind-bending of a position to people is genuinely perplexing to me. But consistently, I get fierce blowback from what I think is a pretty innocuous position. I sometimes think oh, this person is not aware that it's immoral to impinge upon my freedom or wait, they think that only morons would choose other-than-fda-approved.

I wonder, are people filling in the blanks incorrectly? He doesn't want these particular laws because he hates the homeless and destitute.

This is confused motte-and-bailey reasoning. Shake it out. Walk it off. Please. Actual, real relief of actual, real human misery is at stake here.

The reason healthcare sucks is not because we have not yet chucked the whole thing over the fence and let the government, like, take care of it.

We have fucked up healthcare because innovation is largely against the law, and if you try to make that point, in all your honest sincerity, you are assumed to be one of them: a coal-rollin', trump-votin', anti-science luddite.

To the extent that's happening, it's a real conversation-ender.

- 1 toast