The Vaccination Examination and Healthy Lies

Certain hot-button topics are just given and not open for examination.  Anthropogenic Climate Change, Vaccines, Chemtrails and Government Conspiracies  top the lists.  Whenever any of these subjects is broached all people who consider themselves reasonable just shut down, nothing could possibly be said to add to what they know about these subjects.

Therefore these are partisan issues.  No reason will be considered, well, unless it is to criticize the people who don’t believe reasonably.  Perhaps it all started like this: The people who don’t believe in (for example) vaccines are idiots because vaccines wiped out Small Pox.  Then all kinds of other jumped on with all the good things vaccines do and what idiots anyone who has a question about vaccines must be.

So it is difficult to be non-partisan.  You must be an idiot to even listen to any argument that doesn’t say All Vaccines Are Good.  You can just say Vaccines Save Lives and you are on the right side of the argument and never have to learn anything more about vaccines.

I can now tell you my personal experience about vaccination, but the only reason I would do that is to get you sympathy and break communications barriers to ask you to listen to an argument.  But why the fuck won’t you listen to the argument anyway?  Don’t you care about critical thinking?  Is your partisanship so strong that now you don’t care about arguments, only belittling people who don’t mindlessly believe as you do?

The misleading issue is Vaccine Effectiveness.  In fact my problem is larger, all across the health field, where people lie to you, misrepresent and change the meanings of common words, in order to help you.  Zostavax, the shingles vaccine, claims 51% effectiveness.  That would mean, if words are given their normal definition, that you have a 51% reduced risk of getting shingles if you take the vaccine.  I believe that is misleading, and intentionally so.

We all know that smoking causes lung cancer too.  And by the same token I think that statement is intentionally misleading.  If someone gets lung cancer we immediately think ***did they smoke***?

“As many as 20% of the people who die from lung cancer in the United States every year do not smoke or use any other form of tobacco” says the American Cancer Society in an article that attempts to justify the belief that smoking causes cancer.  If you search for your lifetime risk of getting lung cancer you will get all kinds of articles explaining how much MORE likely you are to get cancer if you smoke than if you don’t smoke.

So that is the issue with nearly all health care recommendations.  You cannot easily find your risk of getting cancer, but it is very easy to find your risk INCREASE with behavior or exposure. By this yardstick the primary cause of drowning is swimming.  Nearly everyone who drowns was swimming.

One’s lifetime risk overall of getting lung cancer is about 7% according to the  Lifetime Risk Chart of the American Cancer Society  whether you smoke or never smoked.  So your increased risk if you smoke is averaged over all other people.  If my math is correct 80% of that 7% chance are smokers, and 20% of them are never-smokers according to the site above.  Smoking causes cancer, therefore, in 5% of smokers.  And lung cancer kills 2% of neversmokers and has the ACS jumping through hoops to explain it.

Smoking increases your risk of dying from lung cancer in your lifetime from 2% to 5%.  I am not trying to justify smoking, it is dirty and unhealthy in many other ways besides your increased risk of lung cancer.  But what I am discussing here is the how the health care industry has brainwashed everyone by giving us statistics that mean very, very little.

Which is what happens with Zostavax.  Bringing this issue to many “skeptics” has gotten me banned from further discussions.  All a skeptic seems to care about is that vaccines are good and anyone who questions is therefore wrong.  There are huge studies, all orchestrated and quoted everywhere.  Here is a good example: Zostavax Study

The main thrust of their argument, why they recommend anyone over 60 take the vaccine, is that in a study of 38,000 people over 60, half vaccinate, half receive placebo.  The claim is 51% fewer people got shingles in the vaccinated group.  To confuse the issue a lot of time and space is devoted to how the symptoms of shingles (post herpetic neurolgia) were lessened in those who got shingles in the vaccinated group. It is not explained that one must be in the unlucky 49% in order to benefit from lesser symptoms.

So just like the smoking issue, what are the chances I would get shingles without the vaccine?  A difficult figure to find, but we can easily know it is less if I take the vaccine.  Over one’s life time one has a 33% chance of getting shingles, however the vaccine does not cover the lifetime.  It only works for a disputed amount of time.  Full strength for 3 years, then it is less effective for a few years, and whether or not one has taken the vaccine is statistically insignificant after 7 years.

The chances of getting shingles go up with age, but the best numbers available are the numbers of this study 38,000 people over 60 meticulously documented and tested.  So what are the figures?

Overall the chance of getting shingles in that age group is 7.8 per 1000 person-years.  So any given year a person over 60 has a 0.78% chance of getting shingles.  That risk is reduced by 51% for at least three years after taking the vaccine.  To a lesser extent one is protected for an additional couple years but no protection at all after 7 years.

The numbers work out to about 3.4% will get shingles in the over 60 group without the vaccine and 1.6% with the vaccine.  Another way to put it is the $250 vaccine will help about 1.8% of the people who buy it.  For every 120 people who buy the vaccine one is prevented from getting shingles.

Please check my figures, I would love to find out I am wrong.

The numbers are worse for the HPV vaccine.

The salient point is the Number Needed to Treat (NNT) in order to prevent one case of the disease. Presumably the disease in this case is Cervical Cancer, so the number to treat is somewhere between 324 and 9080. Estimating NNT for the HPV vaccine

The series of three shots costs about $500 in the US or Canada. 324 time $500 equals $162,000, and times 9080, my calculator must be broken…That how much it costs all of the customers of Merck who bought Guardasil9 for every case of cancer prevented.

And if your insurance covers the cost you can bet the insurance company did not lose money on the deal either.

Both Sides are Partisan

The name calling and the irrational speech is on both sides. Granted one side seems much more irrational than the other, but only by acceptance of principles of logic and critical thinking will we make any progress toward a non-partisan dialog in which we can address the real underlying social concerns.
 
Hate and name calling and mis-representing the issues of those with whom you disagree are the problems. Logic and critical thinking are the solutions. Well, and getting partisan groups to understand and accept logic and critical thinking as a viable alternative to “Free Speech” as they are calling it.
 
For example, who among us wants to address the real social issue of those who do not contribute to society? Who are they? How are they identified? Who is responsible for them? Why? And who has to care for them and how will they be cared for?
 
Obviously lumping all of “them” together without specifics as the ones who are causing problems for “us” is hate, name-calling, and mis-representation of the issues.
 
But if we were to address rationally the underlying social issue in direct and logical terms we would be addressing the rational problem.
 
Affirming the problem and looking for a solution will address the problems that have brought the undercurrent of the ultra-right movement who are named “fascists” by people in this conversation.

The Fairness Doctrine Is Gone Forever

People don’t want to be educated, they want their side to win.  Only a libertarian philosophy and a critical mind cares what other people think.  But without fairness nobody really wins.

According to a Facebook-spread meme the partisanship we see today is because Reagan vetoed a Democrat sponsored bill (not named in the meme) the 100th Congress in 1987,  Senate Bill 742 introduced by Ernest Hollings (Democrat from South Carolina):

“To clarify the congressional intent concerning, and to codify, certain requirements of the Communications Act of 1934 that ensure that broadcasters afford reasonable opportunity for the discussion of conflicting views on issues of public importance.”

According to this view the reason we are more partisan today is due to Reagan vetoing this bill which would have directed the FCC to require broadcast media to provide both sides of issues of public importance.

It used to be called “Equal Time” but it never required an equal amount of time.

In a free market, Republicans presumably presume, if there is a need for something it will appear.  Like if there is a need for a rebuttal to an argument someone will provide it.

So this is an epitome issue: Dems believe “Equal Time” should be regulated and enforced, Repubs think the market will provide “Equal Time” if it is worthy.

Vetoed on June 19, 1987. The veto message was laid
before the Senate and printed as S. Doc. 100-10. (133
Gong. Rec. 16989). The Senate agreed to a motion on
June 23, 1987, by a vote of 53 yeas to 45 nays to refer
the veto message to the Committee on Commerce,
Science, and Transportation. (133 Cong. Rec. 17002).
Veto unchallenged.  Continue reading

Libertarian Awareness

Our governmental system needs help.  There are systemic problems so deep in the justice industry, law making, health care, environment….  I should just list every governmental service.

We need a change in view point and philosophy.  Today we have the Conservatives who want law and order, military might, protection from foreigners, and lower taxes.  The only other side is populated by diverse groups of liberals who fear for the safety of everybody and want lower taxes.  There is a simple principle that can put these two sides together and that is this:

If a problem can be solved without taking away someone’s rights and freedoms, use that solution.

The Libertarian organizations that rate countries by how free they are (the US ranks in the top 25) and specialize in the statistical analysis of indices, statistics and issues are usually of a Libertarian bent.  Organizations listed by the Wiki

Above all Libertarians want access to information, governmental transparency, justice for everybody not just those who can afford it.  And justice does not mean free lawyers, it means a dispassionate and fair view of the problem with an eye toward finding a solution that doesn’t further abridge the rights of everyone.

The libertarian fame comes first from the Founding Fathers of the US who were nearly to a man libertarian.  Then from opposition to drug laws and the war on drugs.  In the US we spend double or triple on illegal drugs and the punishment of those who use illegal drugs, than we do on the entire beer and liquor industry combined.  Our prisons are literally filled with non-violent drug offenders and distributors who feed off that industry.

In the Philippines there is a literal drug war where thousands have been killed and over a million drug users have surrendered to the military and police. This has all happened in the last year or so of the war which started in May of 2016.

On the other hand, in Portugal all drugs are legal.  If someone is known to use drugs they are referred by law to a psychological counselor, a legal adviser and a health care professional instead of taken to prison.  Argentina’s supreme court recently held that its constitution does not support the state telling the people what they cannot put in their bodies.  That is not to say selling dangerous drugs is legal or that there should be no controls on drugs.  But it is a difficult situation to say that having something is illegal, and that is the legal situation with drugs in America.  Possession is the crime.

We all know the problem is not the drugs but rather addiction.  So the answer is not to make drugs illegal.  If that worked we should make murder illegal as well.  If we put a fraction of what we spend on legal system expenses and punishments for drug related problems and instead put it toward addiction prevention programs and education we would all know a lot more about these problems.

Everyone uses drugs, but most of us get a doctor’s approval before using them.  Many of us circumvent that approval illegally by buying on the internet, and others just over use and abuse the system that attempts to control drug use.

 

 

Learning = Playing Devil’s Advocate

We all know teenagers and youngsters who answer every statement with “I know”.  Be careful in the street “I know”.  Algebra is good for you.  Don’t eat too much.  Let’s get up extra early to tackle this job tomorrow, “I know”.

And as we get older and wiser and find that there are things we don’t know.  Well, no.  That doesn’t happen.  We learn a little and incorporate that little we have learned into the things we already know.  Vaccines are good.  Electric cars will save the environment.  Guns kill people.  Healthcare is expensive.  Trump is an asshole.  Chemtrails only exist as a false example of a conspiracy theory.

There are two or more sides to every issue.  Although we all know, to take the first example, vaccines have saved an estimated millions of people, wiped out an entire deadly disease from the planet, saved countless people from pain and suffering…  But what is the other side?

If we are fair we have to consider there is another side.  There are people who do not take vaccines.  And if we read about these people it is generally to scorn or ridicule them with the straw arguments, telling ourselves that they say there is a correlation of vaccines to autism or mercury poisoning….  We don’t even allow ourselves to investigate because it is just stupid.  Every doctor and every newspaper tells us vaccines are good, so take every vaccine your doctor says to take without investigating.

So what happens now, if I say something bad about vaccines?  Will you stop reading?  Will you investigate?  Have I already lost you. you already think you know what I am going to say?  All of the above?

I will say each vaccine is different, with different risks and you should study and understand for yourself every medicine you take.  That statement was uncontroversial and every doctor in the world would agree.  That said, let’s investigate a vaccine or two.

My favorite to investigate is  Zostavax, recommended for adults age 60 and older, whether they’ve already had shingles or not. Read the labeling and it is 51% effective in preventing shingles.  Well, I am sold.  I may as well take it, insurance pays for it ($200 or more, but nothing out of pocket).  And in three or four months I get shingles.

That is when I investigated.  Yes shingles is a serious side effect of the shingles vaccine.  I did not know that.  Only happens, according to the literature, in 1% of cases.  So I look into the numbers again.  51% effective, it says.  Several very large studies have confirmed a 51 to 55% drop in the incidence of shingles in the control group versus the vaccinated group.

But consider the fact that you have a 33% chance of getting shingles in your lifetime, and the drop in incidence is a drop of approximately 2.5% chance of getting shingles to a 1.3% chance of getting shingles, which is the 51% effective ratio.  And remember, you have a well established 1% change of serious side effects, including getting shingles and blindness.

So the whole truth is not the simple truth. Vaccines can be good, but read the fine print.  If you do the math, the shingles vaccines has a 1 in 174 chance of actually helping you by stopping you from getting shingles, and a 1 in 100 chance of giving you serious problems.

Shall I talk about another vaccine, say the Lyme Disease vaccine?  Or shall I move on to another controversial issue?

The point is that in place of making straw arguments to pat yourself on the back for how you found the other side to be sooooo stupid, look for real arguments.  Play the devil’s advocate.  It is the only way to learn.

Misleading the Mainstream

If smoking causes lung cancer the same logic says swimming causes drowning.  We know how much more chance we have of getting lung cancer if we smoke vs if we don’t, generally.  But no one seems to know or care how much chance we have of getting cancer regardless of smoking.

The statistics we most often hear are designed to control us rather than inform us.  It may not be intentional but it is hard to deny the scare tactics.

For example the vaccine against Shingles virus is advertised as 51% effective, but if you read the fine print you find the truth.  of 2.5% of people in the study got the disease without the vaccine, and only 1.3% of the people who got the vaccine.  So the useful statistic is that you reduce your chances of getting shingles by 1% if you take the vaccine.

You can blame the drug companies or the doctors who swallow their line, but the only defense is to read and understand the ideas yourself.  Smoking is the best example.  We all read all the time that Smoking Causes Cancer.  And at some level we all know that does NOT mean that everyone who ever smoked will get cancer.  Many of us don’t think much past that point at all.

It is good for your health to quit smoking.  Not only because of lung cancer but other diseases as well.  Controlling us to quit with lies and half truths is probably a good thing overall.  But in some of us the lies and half truths leads us to distrust all authority,  And when that happens who do we turn to?

There is no substitute for thinking for one’s self.  And it appears to me the problem is the way statistics are presented.  It is more useful to me to find my overall risk of contracting cancer than it is to find how much more or less chance I have than someone else.

Risky behavior should be identified, and smoking is definitely a health risk.  But is it more risky than driving or swimming or mountain climbing? That isn’t very helpful to know.  But we are constantly inundated with statistics that show smoking is more risky than non-smoking as if that is helpful.

In our lifetimes we have a 42% chance of getting cancer of any type and a 23% chance of dying from a cancer.  We have a 7% chance of getting lung cancer and a 6% chance of dying from lung cancer.  This is overall, without separating the data out for smokers and non-smokers or family history or any other issue.  https://tinyurl.com/y7ct546w

Then try finding data about lung cancer in non smokers and you get a mishmash of data that is hard to find meaning.  Ten to 15% of lung cancer appears in “neversmokers” and immediately we are guided to other risk factors that may have contributed to such a cancer.  It appears we are being lead to the idea that all cancer is caused by our behavior, that if we did nothing at all our whole lives but sit in a climate controlled room eating non-cancer causing foods we would not get cancer.  But does anyone believe that is true?  Perhaps we should design some sort of study to that effect.

Regardless the most useful information overall is the risk of getting cancer, which is over the entire population.  If you add risk behavior like smoking to your profile you will raise your risk of getting cancer and lower that of the rest of the population, presumably.

It would be useful to find out how my chances of getting cancer overall change if I eliminate risk behavior like smoking.  Can I find data for non smokers with no substantial family history of cancers?  Difficult to find, but that would be more helpful than knowing that I reduce my risk of lung cancer by 80% if I never smoked.  80% of what?  Of the 7% chance I have of getting lung cancer overall?  The weather man is 80% correct 7% of the time.  The statistics become meaningless and are only used to say “quit smoking”.

 

 

Illegal? Isn’t Everything Illegal?

The fourth of July brings to Connecticut police reminders that all fireworks are illegal, even the ones you just bought in Connecticut.  I shouldn’t name names, but big stores in my town sell lots of fireworks that the police say are illegal to set off in Connecticut.

Most of us don’t think this is strange, but I do, I think we have a strange system that allows us to do just about anything, but the police say we can’t do that thing.  And they call this a free country.

My town has a two lane divided highway running through it and at any given moment every single car on it is driving faster than the speed limit unless they are slowing down to take an exit.  This is normal in the United States.

Nearly twice as much money is spent on illegal recreational drugs in the US than on legal alcohol.  This is normal.  None of us question this, and most of us defend the idea that those in prison are just the unlucky ones who got caught, that all of us do things that are illegal.

If questioned about the illegal things we do, well, those things are so bad as the illegal things others do.  This is normal in the United States.  The ones who are in prison must have done something much worse than the things we did, but we don’t have any evidence of this.  Or the evidence is that they are in prison and we aren’t.

Nearly 80% of our state budget in Connecticut is related to payroll and benefits for state employees.  And nearly 80% of all the state employees are related to public safety, law enforcement, prisons, judicial, law making and such.

Imagine how much money we could save and how much better our surroundings if we educated people on the dangers of addiction instead of punishing them for drug use,  Or if our laws were structured for unsafe driving at the discretion of the officer instead of picking a speed and saying that in this area this is the maximum, in this area the maximum is different and so on.

Let Us Buy Medicaid!

The simplest solution to the Health Insurance disaster is right in front of our noses.  Sell Medicaid to those who can’t get insurance elsewhere.  Offer a version of Medicaid as an optional insurance carrier.

There are already several versions of Medicaid and Medicare that can be used as a model for coverage.  We know it costs the taxpayer about $6500 per person who is on Medicaid.

The only reasons I can think of for NOT offering the option of selling Medicaid is protection for the insurance industry.  If you have another reason please let me know!

The old system was uninsured go to the hospital who helps them, gives them a huge bill that they never pay, and the hospital increases the charges on everyone else to cover the unpaid bills.

This led to inflation on health care services so that today we can fly to Costa Rica and stay on the beach for three days, get a colonoscopy by more modern equipment and probably US trained doctors, and return to the US with a tan and cost $1000 less than the cost of a colonoscopy alone in the US. It is a 20 minute procedure and you feel nothing.

I was charged $3500 for a colonoscopy, not including the doctor.  I had insurance, so I suppose I shouldn’t complain.  It didn’t cost me anything, but it costs us all, and it boils down to the un-insureds who cannot pay their bills.

Here’s an example: A child is born with a heart problem. The cost of pediatric heart surgery without insurance in the US is $92k, and a lot of such surgery (below the top 10%) can be over $220k.

Without going into how people can make that much money in a day or why hospitals in the US sometimes charge ten times for an overnight than hospitals in other countries, let’s talk about what happens if the family of the baby doesn’t pay the bill.  Obviously the baby doesn’t die, and there are charities and Medicaid programs that might help.  And again, without going into who pays for the charities and government programs that might help let’s move on.

Health Insurance is not health care.  We pay double or more for health care not only because our insurance system is damaged.  Our whole system is based on adversarial rules which only benefit government employees and lawyers… Well and lawmakers and insurance companies.  And because of that our doctors benefit but have to hire teams of administrators to take advantage of our system.

If someone doesn’t pay a large bill, like a $300,000 bill, like a medical bill for a child’s surgery, they have to go to court.  There is no defense, the bill is theirs.  So they pay weekly, often as little as $35 a week to the hospital which means they would pay  for 167 years by court order.  Or they go bankrupt and the only person who benefits is the lawyer… and the prosecutors and the judge, and the administrators. It keeps the government employees busy on the tax payers dime minus filing fees of  probably under $300.  And the family doesn’t have to pay the hospital, but instead the courts and the lawyers.

Could we have designed a worse system?  Never underestimate the power of bad design, but keep your eyes on the cost of health care (not the cost of health insurance).  You cannot negotiate the $3500 plus doctor fees for a 20 minute colonoscopy or $200k for a half-day’s team effort because your insurance will pay it.  And the economics of why they will pay it are sicker than colonoscopy patients, possibly as sick as the child’s heart defect.

The roots of the system are adversarial judicial systems and the economic advantages of several layers of administrative charges for simple, routine and nearly universally received medical procedures like colonoscopies.

Look at the cost of a flu shot or a vaccine.  Doctors will perform these procedures for precisely what the insurance company will pay.  No one can blame the doctors.  Why would I choose to do the same work as someone else but for less pay?  And if a doctor doesn’t want to make at least as much money as other doctors I might get suspicious.  I have good insurance, I would rather get the best doctor because my insurance will pay.  So if the doctor charges my insurance more money he might very well be a better doctor.

Suppose there was a set fee for giving a shot (there is) set by insurance companies (there is) but the government sets up a system (medicaid/medicare) where the cost of giving that shot is a lot less (life as we know it).  Health care professionals still give the shots, but complain about how little money they get for giving the shot.  They will look for examples of procedures that should be paid a lot higher and lobby congress to raise the cost of giving shots and other medical procedures to tax-payer supported patients.  Again, I have just explained our life in the USA.

Insurance companies don’t want the government to take away their customers by offering insurance to people who might be able to pay big premiums to them and not the government.  So they continue to pay more to doctors than the government does.  Lots more. Now they have the support of doctors who want big bucks for giving shots, as is human nature.

So there is no way cut the crap and change the system  Well, unless we are allowed to buy a version of Medicaid….

Revision:  Based on feedback from people who point out that people look at health care as a freebie, that since they don’t pay (their insurance does, or they go bankrupt) the solution to that problem is simple as well:  Larger co-pays.

Buy Medicaid with a $50 co-pay for all doctor visits and $300 co-pay for the ER or Ambulance…

Copyright 2017 Kent Johnson

 

 

State Budgets in the US

Now is the time we hear on the news that, for example, Illinois has not had a budget in three years, the finger pointing, the observation that congress is responsible but not accomplished in many states.

So I looked why.  I hypothesize it has to do with the numbers of state employees per capita.  For example Indiana has 46 state employees per 10,000 people, or .46 % of the population is paid by the state.  But Connecticut has 115 or 1.15% more than double. https://tinyurl.com/pbgngn8

The most interesting to me is 80% of the Connecticut budget is personnel (including pensions), grants (towns and benefits like medicaid), and debt service. https://tinyurl.com/yctuht55

Indiana approved a 2 year state budget in February, Connecticut still doesn’t have a budget and will now go to budget by executive order.

Not that it would be easy to cut more than half of the state employees.  Indiana has a higher incarceration rate than Connecticut.  We have 1 full time teacher per 12 pupils through all grade levels, and Indiana has 17, which is probably not a good thing but does save the taxpayers some money.  In Indiana and Connecticut a little more than 40% of the education staff are teachers.

Indiana has 6.6 million people compared with 3.6 for Connecticut, and Indiana’s budget is $32 billion and the budget CT cannot pass is $21 billion.  On surprise I ran across was more than double in CT for judicial Indigent Services, public defenders, than in Indiana.  So I went through out budget and this is where it gets complicated to compare with Indiana.  Connecticut spends money on lots of employee salaries related to the Judicial Industry.  Below is a list I made from this web site http://transparency.ct.gov/html/searchpayroll.asp

Attorney General $42.6 million

Department of Correction $605.7 million

Department of Public Safety $218.8 million

Criminal Justice $65.4 million

Judicial Department $468 million

Public Defender Services $56 million

Nearly 1.5 billion dollars is spent in Connecticut, 25% of the total budget, directly on crime and punishment.

It would certainly be easier and cheaper and better for everyone if we focused on education and tolerance of others, and of course, removing violence instead of all the other things we prohibit.

Libertarians say Don’t Tread On Anyone.