Monday, June 16, 2008

"Pro-life" Pharmacists

The Washington Post has a story about pharmacists who will not provide contraception. I don't think you can oppose these guys very strongly or make any serious argument that they should not be permitted to operate, while supporting abortion rights.

It’s worth keeping in mind that the underpinning theory of Roe v. Wade is that the government should not interfere in the exercise of discretion by medical professionals to determine what procedures are approriate to the individual circumstances of each patient.

If you believe that the government should not interfere in a doctor’s decision that abortion is the best treatment option for a patient, then I can’t see how you could simultaneously believe the government should compel these pharmacists to provide a treatment they object to as a matter of professional conscience, even if you disagree with their objection.

The professional freedom of a doctor to provide abortion is exactly the same as the professional freedom of a pharmacist to refuse to stock or distribute a particular treatment. You can support one use of the freedom and disagree with the other, but you can’t reasonably argue that one should be regulated and the other should be protected from regulation.

Pharmacists are professionals. These guys aren’t just desk clerks who hand out pills. The entry to the profession requires six years of higher ed and it’s considered a highly specialized job. The reason for this is, in large part, because the pharmacist faces issues of professional ethics and is expected to be able to make important decisions in the course of his business. These guys are highly-educated and well-paid to be a check on lying, drug-seeking patients and unethical doctors, and to catch medical mistakes that could endanger patients’ lives.

One common and extremely important example of a pharmacist using this discretion is if the same patient presents scrips from different doctors, and the pharmacist believes the doctors have not consulted with each other, may be unaware of the other meds, or that prescribed medications will have some dangerous interactions. In this case, the pharmacist should refuse to fill the scrips.

Similarly, if the pharmacist is getting a lot of scrips from the same doc for a powerful narcotic painkiller like Oxycontin, and he believes the doc is handing out the drug to people who don’t need it and should not be getting it, the pharmacist might refuse to fill the scrips.

Similarly, if patients who are not dangerously overweight are given a powerful prescription weight-loss drug, like the phen-fen/redux combo that was widely handed out in the 90's and turned out to be incredibly dangerous, the pharmacist might exercise his discretion and refuse to fill the scrips.

The central purpose of a pharmacist's job is the exercise of discretion, and while some may disagree with his use of it, his obligation is to his conscience and not to someone else's political agenda.

Sunday, June 15, 2008

Blogs and the truth

While blogs have been around for a while, and the internet has been in use by the public for almost two decades, there's been a lot of recent proliferation of high-speed internet in offices and homes that maybe was not as common four years ago, and there's been a real boom in user-produced content.

Blogs are doing a more sophisticated version of what chain e-mails have been doing for years; dispersing questionable information to a whole lot of eyeballs. This has been used to the detriment of both party nominees:

Barack Obama's wife Michelle has been hit with rumors that she made a derisive reference to "whitey" while participating in a Trinity church panel discussion that included divisive Nation of Islam leader Louis Farrakhan.

This rumor seems to have been a blogger named Larry Johnson who claims to have some unnamed friends who swore to have seen Michelle make these statements on videotape. But as, neither the friends nor the video have been forthcoming it's significantly likely that no such panel discussion ever occurred and that Mrs. Obama never said anything like that.

A similar accusation has dogged Republican nominee John McCain. Writer/blogger Cliff Schecter reports that he has anonymous sources who told Schechter that McCain called his wife Cindy a "cunt" in response to a joke she made about his thinning hair in 1992.

Both attacks rely on anonymous sources. If you ask Johnson or Schecter to verify their accusations, they will tell you that they are relying on the credibility of the sources, and if you ask who the sources are, then the writer is sworn to secrecy on the subject.

It's a mechanism rife for abuse, which is why newspaper and magazine editors have exacting policies on citing to unattributed sources, including independent corroboration. And a reputable newspaper will be very sure it trusts a reporter before it publishes a story by that writer containing unsourced claims. And readers generally know, within reason, which publications they trust not to intentionally promulgate lies.

Blogs have no such safeguards. Johnson and Schecter respectively could have fabricated these claims. No person alive will publicly claim to have heard John McCain call his wife a "cunt" or to have heard Michelle Obama refer to "whitey."

Barack Obama had to dedicate a whole section of his website to fighting the lies and questionable claims people keep making about him. McCain, whose out-of-context soundbites have been fodder for plenty of YouTube videos, will probably add a similar section soon (especially since his website has been redesigned to resemble Obama's).

You also have to wonder what the deal is with blogs who will excoriate one of these unsubstantiated viral smears while promulgating the other. Shame on the authors who publish these attacks and the bloggers who spread them.

Being better and being right means you don't have to lie about the other guy or misrepresent his positions.

Friday, June 13, 2008

This isn't that complicated

Obama wants to implement payroll taxes above $250,000 in income. He says it's unfair for lower-income earners to pay payroll taxes on every dime they make, while wealthier earners do not pay them on the majority of their income.

The thing is, it's not intended to be progressive. The idea is that you fund your own benefits. This is why people who earned more (and paid more into the system) get a larger benefit even though they are more likely to have retirement savings, investment income and other means of support than lower income workers. Social Security is a mechanism for protecting workers from becoming destitute in retirement or disability due to poor financial judgment or catastrophic events, not a mechanism for wealth redistribution.

If not for Social Security, a lot of people would spend all their money on lottery tickets, and wind up destitute in their old age, or if they became disabled.

What Obama is really proposing is that problem that will occur when the system begins paying out more in benefits than it takes in in taxes should be solved by a special tax on the wealthy.

Monday, June 2, 2008

The $175 hamburger

The Wall Street Burger Shoppe is hawking a $175 hamburger. Shock and horror has ensued.

First of all, this is clearly a publicity stunt. You can tell because it generates publicity. There are a number of restaurants in major cities where $200 a plate is pretty standard. In general, an expensive meal comprised of Kobe beef, foies gras and truffles would not raise a whole lot of notice.

But if you put it on a brioche bun and call it a burger, the obscenity and excess of extravagant dining is somehow magnified. Of course, that might just be the attraction for the people who will order this thing.

In New York, there is a high concentration of lawyers, consultants and bankers making hundreds of thousands per year, and a fair number of hedge fund and private equity managers who make millions, tens of millions, or even billions at the high end.

And many of the people eating these meals don’t end up carrying the tab, because there are lots of financial transactions that take place over ritzy expense-account lunches and dinners.

Job interviews, deal-closing dinners, performance incentives, deal pitches, celebrations of quarterly earnings, and various other events all trigger expensive restaurant trips on corporate accounts.

Blowing $1500 on dinner for four or five people seems a lot less excessive if it's part of a pitch that wins your company a deal worth millions. Networking in the financial industry can mean big bucks, and rich entertainment budgets for Kobe steaks and $300 bottles of wine are part of how deals get made in the financial industry.

There are also plenty of tourists who are willing to spend money to experience high-end restaurants, plenty of people who want to celebrate major life events or rich bonuses in high style, and people who are just so rich that their wealth will earn more than the cost of the $175 burger while they sit there eating it.

Incidentally, my favorite excessive NYC burger is the ribeye burger at Rare. A comparative bargain at $21.

The Dumbest Generation

Apparently, my generation is too addled by internet pornography and XBox games to read books, so it's surprising how much attention this one seems to be getting.

A number of recent articles discuss author Mark Bauerlein's central premise, which is that internet social networking tools, the internet generally, movies, television and games are addling young people and making us dumber.

This premise is supported by odd statistics, such as a claim, cited in Newsweek, that only 31% of Americans had "adult literacy" in 2003, down from 40% in 1992. That seemed bizarre, and I googled it.

I assume the citation was to The National Association of Adult Literacy assessment, which was conducted in 1992 and in 2003, and found no significant changes in literacy rates, despite a rapid rise in that period of immigrants who are not native speakers of English, a group that makes up 44% of those lacking basic prose literacy according to the survey.

20% of those failing to meet basic literacy standards suffer from multiple disabilities. About 85% of adults have at least basic literacy in reading tasks and in navigating forms such as job applications, while around 75% can handle quantitative tasks like balancing a checkbook at a basic level or better.

It seems pretty unlikely that that MySpace and Grand Theft Auto cannibalized the time people previously spent reading the newspaper, studying history and contemplating the classics. Not much thought seems to be given to the possibility that the under-30's who are constantly online and the under 30's who can't tell you who the Axis were in World War II are largely exclusive groups.

The real story seems to be the growth of an information elite, and a widening information gap. As AP and college credit options expand for top students, the difference between the education the elite students are getting and the No Child Left Behind, test focused education the bottom half we provide to the bottom half creates a massive gulf in educational accomplishment.

The cultural ignorance that Bauerlein decries is likely less a result of the complacency of an always-connected middle class than a symptom of the increasingly disconnected underclass, who, in many cases do not have computers or internet at home and are being left behind by new technology and the opportunities it creates.