Monday, April 30, 2012

54% of UK doctors are either pig-ignorant about statistics and/or meddling nanny-state fools

At some point, the incremental loss of liberty in Britain becomes such a constant depressing dripping that it's hard to maintain the incredulity. 

On the one hand, the police harassed a gallery that displayed a photograph of a sculpture that depicted a mythical scene from Greek antiquity, because they thought it might "promote bestiality". (No, really). Despite the fact that nobody had complained about the photo. That's a separate outrage post all of its own.

On the other hand, the Daily Mail cites a recent UK study where 54% of doctors agreed that the NHS should " be allowed to refuse non-emergency treatments to patients unless they lose weight or stop smoking".

Those god damn smug condescending prats.

If a doctor refused to treat the injuries of a drunk driver at a hospital and let him bleed out on the floor, we'd label him as a monster. And drunk driving has way, way bigger costs to other members of society than smoking does.

In the first place, the size of the true effect of smoking on health is hard to measure. The chances of you dying of lung cancer given you smoke seem to be only around 0.3%. More importantly, very few people seem to have any real sense of magnitudes when considering the question of exactly how harmful things like smoking are.

But let's give the doctors the benefit of the doubt, and assume they know the risks perfectly. 

What exactly is the principle at stake here? Is it:

a) You shouldn't get treatment if the actions were your fault.

b) You shouldn't get treatment if your actions cost the government too much money

c) You shouldn't get treatment if you're an unfavored group.

The first one is a ridiculous way to run a health care system. All of us take risks in things we do all the time. Driving 5 miles an hour over the limit? Increases your risk of death. Take part in an equestrian event? Increases your risk of death. Fail to eat only lentils and beans to minimize your chances of heart disease? Increases your risk of death. Go out drinking at a pub in Covent Garden on a Saturday night? Increases your risk of death, by stabbing or road accident if nothing else.

Where the hell does it end? The reality is that everyone is going to die at some point or other. Actions that you take might make it happen earlier or later, but there's no escaping it. Any test on this point is going to end up transforming into test c) - some risks are deemed politically acceptable, and others aren't.

The second test is actually a fair basis for running a healthcare system (assuming you buy the assumption that it's the government's business to be doing that in the first place, which I don't necessarily). But does it really apply here? It's pretty damn hard to tell, because it depends a lot on how much stuff you account for.

Suppose you die of heart disease that comes from smoking. Since heart disease kills a lot of non-smokers as well, it's not clear that the difference in treatment costs in nominal dollar terms are large, or even positive. It's not like this is a $10 million treatment for some rare disease - smokers die from heart disease and cancer, the same as everyone else, and treating these costs about the same as for everyone else. The cost does arrive sooner for smokers than non-smokers. This does mean that the present value of costs is higher, but it's not clear how large this difference is.

But what else happens? You don't claim the pension for thirty years, either. And based on a fair accounting for these two effects, it's not at all obvious that smokers on net cost the government more money. Absent healthcare costs, dropping dead right before the pension cheques are about to start is good news for the government budget.

So what's really going on here?

The answer is of course option c). Smokers and Fatties are today's out-of-favour social groups. Everyone loves shaming smokers, and nobody sticks up for their right to smoke, notwithstanding its bad effects on health.

Tax them! Make them stand out in the cold! Deny them medical care so they die quicker! When you see them huddled outside in the snow, tell them what a 'disgusting habit' it is, with as much condescension in your voice as you can muster! Feel smug and self-righteous about your own superior decisions!

*#$% THAT.

For some reason people's general sense of politeness in terms of not offering up gratuitous, unsolicited criticisms of people's personal choices that don't affect others seems to go out the window in the case of smoking. No level of hassling is too great. We'll badger them into health! Then when they get fat from giving up the smoking, we'll badger them into going jogging too.

Don't like smoking? Don't smoke. Otherwise, shut the hell up. They're adults. They know the risks. If they decide that they enjoy cigarettes enough that it justifies the reduction in life expectancy, that's their damn choice. 

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