Aftermath of a choice

[RACastanet]

Steve: You have certainly impressed me. Interesting site regarding firearms.

Regards, Rich

[Bill Glasheen]

Thanks, Steve!

I do not know the extent of formal training that Bill has received regarding debate.

My dad was an extemporaneous speaking coach, and I had a brother and sister that were state champions and 3rd in the country in high school.

And me? Never touched the stuff... Proximity does not engender authority status.

On a personal note, I'm so intimidated by what I perceive to be his intellectual superiority that I babble incoherently whenever I'm in his presence - in essence giving him the power to control the interaction.

This cracks me up. To that I leave you the following quote from one of my own heros.

Whoever undertakes to set himself up as judge in the field of truth and knowledge is shipwrecked by the laughter of the Gods

- Bill

[Bill Glasheen]

A few more comments...

Thanks to GEM for the cleanup work. He knows my schedule and it's good to know somebody has my back.

It's worth noting that there are several issues being kicked around here. Part of the problem is the confusion that's created when people mix arguements.

There is...

* The "right" to bear arms.

* Women and how they are treated in life, martial arts, and the forums.

* Taking up "unpopular" points of view, or views that get a voiciferous few worked up.

* Ted's original topic (stated so long ago that I forgot...)

* Other personal stuff... We won't go there.

Sometimes its worth taking up the sidebar issues - particularly when its obvious that they are significant contributing factors. But mixing discussions often creates a Gordian knot from which few can derive benefit. Certainly ANYONE has the right to begin a new thread when an important but off topic issue rears its head.

BTW, good to hear from you, Ian. Drop me a line some time, and don't let the Blue Meanies get you down.

- Bill

[gmattson]

Bill. Did you receive my two PM messages? If not, please call me at home.

[IJ]

Ah, a favorite couple topics of mine raised in these last few posts. The debate references which brought back my days as captain of the dork squad (debate team). The colonoscopies. The discussion about effectiveness. The discussion about priorities as far as preventing bad outcomes. Re the latter 3:

--I'm not so much on the fecal occult blood tests. The cards aren't of the highest quality. There are many false positives and false negatives, given the inaccuracies of the test and other causes of bleeding and the fact it's only intermittent. That said, there is now a test where you can LOOK at the stupid colon and see the lil buggers developing as polyps and scrape 'em off before they cause trouble. Then you can catch cancers early before they spread. It's a colonoscopy, and you should get one if you're over 50, or a good while before the earliest relative got colon cancer whichever comes firsts. Younger if you've got a predisposing condition like polyposis or ulcerative colitis. There is speculation (hard to sort out) whether the proven value of the FOBT is that if you do enough of them, you'll be sending people to colonoscopy a lot because they're (+) whether coon cancer is there or not.

--one of the major points about deciding on an intervention is whether or not there's any evidence that the damn thing works. I've gotten into a habit of throwing out most of the stuff that comes my way very quickly. Here's why: according to a nifty article on the medical literature (citation by request) if one were caught up on journal reading today and read one article a day for a year, one would be behind 500 years in that year's time. So we only read a small fraction and they have to be good. Anything that doesn't change managment doesn't change outcomes. I had a patient with recurrent ischemic colitis (to stay in that area of anatomy) and we found a paper which showed such patients may have a higher rate of conditions that predispose to clots. NO DATA suggesting that treating those conditions with a blood thinner helped. So, fascinating, but withou application. Not aware of any data that suggests educating people about stool tests makes them follow through, btw.

As a doctor my approach to the therapy is to ask before considering if controlling guns is constitutional, etc, is just to ask what evidence there is that it helps reduce gun deaths. In the absence of such evidence, the rest of the schmoozing about kids killed by guns is irrelevant. If there's no evidence that handgun control saves lives, what difference does it make how many are getting killed?

--to look at both these issues in another way, where are we going to focus our efforts? If a billion people have colon cancer and far fewer got killed by guns, where ought we be focusing out efforts? A favorite topic of Bill's as well because he knows that while we get up in arms in making sure that everyone has their mild hypertension treated, if they've got no other medical problems, the likelihood therapy will change an outcome is very small because of the low rate of events. Same with paps: we've got people obsessing about making sure their patients who have one sexual partner and have had normal paps get them every year, but fact is most cervical cancer is now in the group that hasn't had any, or for a very long time. Concentrating on bringing more people into the system for SOME screening would save more lives.

Course, this is america, and we kill people here for political gain. Rough? Yeah. But consider our last two presidents. Bill Clinton backed off on a needle exchange program despite good evidence it reduced HIV transmission without fostering drug abuse, because handing out needles didn't look good. He caused AIDS cases for political gain. Dubya is now making every effort to dismantle any non-abstinence (that is, real world) STD prevention service, because the function of health care policy in his mind is to secure the admiration and fund-ing of the fun-dies (fundamentalists and religious conservatives) who afterall financed his run for presidency. That's going to amount to AIDS and babies. And other stuff.

Likely, even though it would make sense to look at death rates and illness rates and make decisions about which we should focus on, it's not going to happen. What determines our level of interest isn't logic but simple drama, so if 40 black kids die in gun violence over a month, no one notices, but if 5 white kids die at one school at once, it's headline stuff. If 600 kids die of cancer and 400 die of gunshot wounds, the latter story makes the papers because the gun is an awful instrument of destruction, and cancer just happens. Unless it's a chemical company's fault. Anyway, it's complicated, but it doesn't have anything to do with logic.

[student]

Course, this is america, and we kill people here for political gain. Rough? Yeah. But consider our last two presidents. Bill Clinton backed off on a needle exchange program despite good evidence it reduced HIV transmission without fostering drug abuse, because handing out needles didn't look good. He caused AIDS cases for political gain. Dubya is now making every effort to dismantle any non-abstinence (that is, real world) STD prevention service, because the function of health care policy in his mind is to secure the admiration and fund-ing of the fun-dies (fundamentalists and religious conservatives) who afterall financed his run for presidency. That's going to amount to AIDS and babies. And other stuff.

Wait a second, Ian.

First, I'm glad to see you return to the Forums.

I agree with much of what you say more often than not.

But this last paragraph was inflammatorilly phrased - whether deliberately or not, I don't know. You are anything but unintelligent, but all of us can make some unintented implications in our prose, especially via the 'Net.

I totally agree that the policy decsions by Presidents W. J. Clinton and G. W, Bush cited were/are ill conceived. I agree that they allow prevetable deaths. I agree it is reprehensibler and should be changed.

But saying that our country killed people whose behavior killed themselves is just wrong. It denies that they had any part in their own fate and their own actions.

What is the difference between these examples and the preventable lifestyle-induced diseases (from lack of exercise, poor diet, stress management, etc.) ? Have I misremembered your previous posts, lamenting the poor choices that people make daily?

Regardless of differences between us, good to have you back,

Murray/student

[Valkenar]

But saying that our country killed people whose behavior killed themselves is just wrong. It denies that they had any part in their own fate and their own actions.

I am, of course, not Ian. But I disagree with what you say here. I don't think that it utterly denies the part they play in their own destruction. I think there's something for the idea that if you allow someone to be hurt when you are able to prevent it, then you bear some responsibility for the hurt, even if they are the cause of it.

To relate it back to gun deaths, nobody blames the child who finds the gun, they typically blame the parents who allowed the gun to be found. Now this is not to say that the government should act as parents. But, if the government has some fact in hand such as "giving out clean needles will save X lives per year" and decides not to do it, I would say that it is reasonable to say that the government killed them.

Without that decision, those people would still be alive. Yes, responsibility should be placed on the people whose actions got them into trouble. But to my ear saying "we kill people for political gain" accurately reflects the fact that the government chooses to have people die.

[Bill Glasheen]

Justin, Ian, and Student

Note again the point that student brings up, and examine it closely. It's actually not quite black and white, but he brings up an interesting issue.

Let's take motorcycles and motorcycle helmets. Motorcycles themselves have such a reputation for killing people that physicians call them "donorcycles." But we allow them. Why?? Because if I drive a motorcycle as opposed to a car and I get in an accident, it's my bloody fault if I get severely injured or killed. I will cause no more damage (perhaps LESS damage) to others by getting in an accident with a bike as opposed to a car or a truck or an SUV.

We also know that helmets save lives. It's pretty clear that if your head hits the pavement at high speed, it's going to be like dropping a cantaloupe off the second story onto a sidewalk. No more brain; no more motorcycle rider. We can repair the bones, but we can't do much for scrambled brains.

Yes, Deb, somebody has to clean up the mess, but this is pretty minimal compared to towing smashed cars away.

So...what would you say if I wanted to ride a bike? It's my bloody business if I get hurt. Libertarians would also argue that it's no business of government to have me ride without a helmet. My body, my brains, my fault if I get smushed. Now I STILL may sue you if the accident is your fault, and so that's where it gets complicated.

In the end, all states allow motorcycles, and SOME states make helmets optional. In the end, libertarians will argue that government should not impose laws on riders to "protect" them. And some people will INSIST that riders are crazy and laws should be imposed on them to "save lives."

Given that all states allow people to ride motorcycles, can we say they are killing people? I think not. Do we say that government is killing people when they allow riders to ride without helmets? Think about it. (Note - I say no, even though I will choose to ride with a helmet). The only issue here is government paying for the medical care of motorcycle riders sans helmets if they survive an accident but are vegetables for life.

Now it gets a little trickier with disease, particularly when there is a greater good (innocent parties) served by applying certain laws. Clearly allowing a disease to reach epidemic levels so that innocent parties (babies exiting the womb that are born to HIV-infected mothers) are infected is no longer an issue of "personal freedom." If I am infected, I don't have a right to knowingly or carelessly infect others by any means. And then there is the issue of who pays for the care when the employed individual can no longer work, and/or the child or adult uses up a lifetime maximum on a health insurance policy. And don't tell me that society will just allow a person to sit and rot on the streets because it's their fault. Our system cannot help itself; we treat the sick regardless. This is where medicare/medicaid kicks in and/or hospitals and emergency departments are stuck with the bills. Thank you, taxpayers! Here is where government intervention of SOME kind makes sense.

* Abstinence and monogomy would be nice - if they "worked" (i.e. we could convince young people to abstain from sex and others to practice monogomy).

* Other methods would be nice too (like free needles or easy access to barrier methods of contraception) - if we could show they are effective programs at preventing disease.

IF in this situation people knowingly halt EFFECTIVE means of stopping the spread of a disease, then we have a problem. But there's a big "IF" on the effectiveness thing there. Intuitively we think certain things, but the evidence may or may not be there to support what we think.

Same goes for gun control, or lack thereof. Need ... more ... data ...

- Bill

[Valkenar]

Note again the point that student brings up, and examine it closely. It's actually not quite black and white, but he brings up an interesting issue.

No, certainly it isn't. I tried to convey that through the bit about partial responsibility.

I agree with what you say. I think motorcycles should be legal, and people shouldn't be forced to wear helmets, provided they sign away any claim to public funds for rehabilitation. If they can't do the latter, they shouldn't be doing the former.

But I think that the situational differences between motorcyle riding behavior and IV drug using behavior goes a long way towards explaining why there is government accountability in one and not the other (though there are other reasons as well).

For one thing, IV drug users are not as aware of the potential consequences of their behavior as motorcycle are. Second, people tend to turn to drug use because their lives are otherwise a shambles more often than they turn to motorcycle riding. And I think the addictive factor makes a difference. With other dangerous recreational activities, it's a lot easier to do it for a little while, and then decide that it wasn't a good idea, and stop. Heroin, for example, lacks this pleasing feature.

And I really don't think that the idea of irrevocable addiction is one that really sinks in for a lot of people. And this ignorance, in my mind, places some responsibility on society to help.

In summary:
Recreational activities that you go into with full awareness of the dangers: your (almost) sole responsibility. Recreational activities that you go into without knowing the dangers: your shared responsibility.

One assumption, here, that a lot of people will probably disagree with, is that society has the moral obligation to try to do something for people who are in bad situations through no fault of their own. Even if those people then bring their situations from bad to worse.

IF in this situation people knowingly halt EFFECTIVE means of stopping the spread of a disease, then we have a problem. But there's a big "IF" on the effectiveness thing there. Intuitively we think certain things, but the evidence may or may not be there to support what we think.

Same goes for gun control, or lack thereof. Need ... more ... data ...

This is absolutely right. And it's very true that I was assuming needle sharing programs would be helpful, for the sake of argument. As for whether needle sharing programs actually *are* a good idea is another story entirely. Indeed... need more data.

[Glenn]

I changed my mind. I did have a reply here, but I'm going to start another thread with it. This one has enough topics running through it already.

[IJ]

Brain sprring with Bill has always been safer than jyuyu kumite, in my opinion

First to clarify: the reason I made the paragraph inflammatory is because it OUGHT to be infuriating when our leaders do things like this. Make a decision that leads to the death of 1-2 people as a street criminal and you're an animal, the next Willie Horton, and disgust with you can get a president elected. Fine.

Launch a cruise missile at a baby formula factory and kill someone while you're in the middle of a scandal involving your buxom intern, and it's just subpar policy and people look down on you. Steal 100 million zillion dollars as a CEO or something, and it's a minimum security prison for you, if that.

People commit crimes with the tools they have in front of them. I mean, I'm real impressed Dubya hasn't resorted to selling crack, but we can all see why he doesn't need to right? Whereas the story is different for others. Not that they're not guilty, but, we have to realize the equivalent evil in making a policy decision you know will lead to the deaths of people for political gain. WWJD, as far as that goes? I don't think JC would really care about the opportunities people have to make the deaths they cause cleaner and neater on paper. I think it's about the body count. And there's something even more sinister about the cold calculating way a tobacco exec kills for money.

Hey, that's just me. Not an argument, just an opinion.

Now back to Bill's point:

Needle program X can save lives, and so can enforced helmet wearing law Y. If I say blocking X is murder, I have to support Y.

I disagree. First, heroin users are addicts by and large, and addiciton means their ability to control their actions is impaired. Sometimes, when people can't help themselves, we hve an ethical responsibility to help them.

More importantly, X is a program that's been shown to work, probably saves money (reducing expenditure on AIDS) Y is a law that limits personal freedom and has less restrictive alternatives. Clinton was weighing politically expediency against humnan life and objective data, and chose the former. That's as much a political killing as an assassination, IMNSHO. Just because an addict 100% pushes the drug into their own vein, the president 100% knew that deaths would result from the policy. Responsibility is not a nonrenewable resource, there's plenty for everyone involved.

While I think a motorcyclist hurts more than himself or herself when getting hurt (most accidents NOT fatal, and many lead to longterm state dependency as well as brutal suffering for loved ones, or if recoverable, still cost our trauma centers tons), I know that there are alternatives to forced helmets. On motorcycle purchase, we can require education on the risks, including the fact they're 21 x more likely to die on a bike than in a car, and the fact that for bikes at least, helmets reduce head injury by ~86%. Then there are public safety messages and physician counseling. And when someone does die, you can say you tried, which is more than what you can say for the guy with AIDS (and everyone he gave it to).

[Bill Glasheen]

Ian

Good points made.

I agree about the motorcycle education as a logical alternative to straight-out limiting personal freedom to achieve an end. First time I took my motorcycle written license, it was a laughable exercise. And then years later, Virginia instituted this law where folks who got too many traffic violations (like...uh...driving faster than others think you should... ) had to retake their driver's exam upon license renewal. And wouldn't you know that yours truly happened to have fallen in that category one year... (shocking as it may seem). Well even though I don't have a bike anymore, I still want to maintain my motorcycle status on the license.

Well...it took 30 seconds through the standard driver's exam manual to realize I would do fine, and I did on that part. Then I looked at the manual for riding a bike. WOW!!! Not only had they made it MUCH more difficult, but - get this - all the conventional wisdom and recommended good-riding practices had changed!! I actually had to STUDY for that exam.

Good! That's the way it should be. And frankly the road test SHOULD be a lot more than what they asked of me - riding my bike down the street, doing a U-turn w/o touching my foot, and riding back.

When a friend of mine who was a long time rider gave me advice about motorcycles (circa 1973) , he told me something interesting. He said that if you were going to get hurt on a motorcycle, it would be because either: 1) you were a weekend and/or fair weather rider, and/or 2) it was your first year of riding on the bike. My personal experience showed he was right. I observed the most number of motorcycle accidents coming through the ER on the first nice day of spring, and NOT during bad weather or in the middle of the summer. And all my own accidents on the bike (rarely my own fault, by the way) were in my first year of riding. After that, I did fine and always managed to avoid the stupidity of insensitive car/truck drivers. Moral of the story - education probably does help.

I agree with you, Ian, about crime vs. opportunity and social class. You must have been on a 96-hour shift when I was on this forum ranting about Scott Sullivan, the former CFO of WorldCom. I was almost ready to send a lynch mob down to his multimillion dollar mansion (a.k.a. money shelter) in Boca Raton, Florida. I don't think scum like this deserves a "special" prison for "nice boys."

As for the needles, well I have this to say. If I was president, or czar, or big cheese, or an otherwise influential person (and I am not...), I could give a rip about political expediency. Heck...if Clinton got away with boinging interns and exposing himself in front of secretaries, he could have spent some of those political assets on actually doing something good. (I had choice words about brother Ronnie too, but I no longer pick on him...). Frankly I would take great delight in p*i*s*s*ing off certain self-anointed religions "leaders" by doing that. To me, having Pat Robertson and Jerry Falwell badmouthing me in the media would be a Red Badge of Courage.

But... I think people need to think through things like this VERY carefully. So we stop some AIDs cases by giving out free needles, but are we not enabling another problem in the process? Is that action just another type of political expediency? Have we given up on the heroin addicts? I dunno... Just have to think that one through very, very carefully. What really IS the long term, big picture consequence of giving free needles away to heroine addicts?

Need data! Need to study other experiences, such as in Switzerland and Denmark. Perhaps we take a bold step and just TRY something without having the evidence but... it should be done small scale to study and perhaps limit the impact.

This reminds me just a little bit of some of these anti-tobacco programs that propose taxing tobacco products at a very high rate. That may help limit use but...then you put the government in the position of depending on revenue from tobacco. Sorry, that solution bothers me - even if it means I get more roads and hospitals built. What happens if tobacco goes away? Do I put the government in the position of protecting this revenue?

I'm not saying no; I just think we should proceed with caution.

- Bill

[IJ]

I'll admit that I didn't read it myself and can look for the reference and see if the data is good, but had heard there was a well designed study showing benefit in reduction of HIV transmission and no increase in use. I mean, there's a shortage of clean needles, not needles in general. I remain, however, all about the data and followup.

Is government getting involved with something dirty? Well, yeah, but it's not benefiting from iv drug use as it is from tobacco. It seems most $ from the tobacco taxes are going wherever, whereas if they were limited to anti tobacco efforts there would be less of a conflict of interest.

The government is involved in abortion now, too, and that's a good thing, even though abortion is a fairly sketchy activity (debate DEFERRED). Brought it out of the back alley; gov't hands dirtier, medical care cleaner. Probably worth it.

[Panther]

Ian, I really like the fact that you objectively put dubya and billy-jeff into the same murderous category. One legisTraitor is just as bad as another when it comes to political expediency.

The whole "needle control" issue has bothered me for a long time. (it's not about needles, it's about control!! )

Before "needle control" one could purchase hypodermic needles OTC for ~$0.01 each... After "needle control", people must obtain a prescription from a physician (who will be scrutinized if {s}he writes too much of the "wrong" script ) and pay (depending on the hypo-type and company) 5-25 times as much per needle! (I used to have a diabetic kitty-cat that I kept alive for years with insulin and glipizide)

Before "needle control", we had IV drug users... After "needle control" we have IV drug users... But now (when there is a demonstrated need for them to obtain new, clean needles) it is made nearly impossible for them to even make the decision to get a new, clean needle... rather than share that dirty one and "O-my-gawd-I-need-my-fix-damn-it-Ill-take-the-chance-that-no-one-here-is-HIV+...givemethedamnneedle!"

I guess I just don't understand the reasoning behind not providing needle exchange programs.

Take care and be good to yourself...

[IJ]

Here's the reasoning: if anyone DOES anything that might be POSSIBLY vulnerable to being CONSTRUED as supporting or encouraging drug use even if the DATA doesn't support it and it's only about saving LIVES, the image will win out in the end. Think that pot is safer than alcohol and that the government shouldn't be able to deny people the right to use it? Well, I'm sure you're right, but we don't want a letter going out to the American Conservative Nitwits Society raising money for your opponent explaining how you WANT TO GET CHILDREN STONED, probably at SCHOOL, ad doncha want to just have them outright KILLED or soemthing, you're so evil. Think those lowas forbidding consenting adults to have sex in their bedrooms are unjust? Well they're there now, so if you try to change them, you might as well be SODOMIZING the schoolkids and the knitting groups, that's what the ads will say.

It's kinda sad how that, with so much emphasis placed on getting in and staying in office, those people who worked so hard to get there stop being interested in doing anything worthwhile while they're there. Makes ME want to send them back OUT. Too bad there's nothing worthwhile to replace them with. You'd think someone could interest people in a plan to restore some personal freedoms during their stay in office--you'd think....