This is a post in the Politics of Care Forum. It lies in the sequence of posts about What You Can Do to Save the World, and What Doctors can Do to Save the World. It will be followed by Can Politicians Save the World – it turned out there were just too many things to draw to politicians’ attention for one post.
We need to reign in Technique. That means voting for politicians who understand why.
Technologies and techniques have brought us extraordinary benefits in health and wealth domains, but they are now also driving dangerous changes in the healthcare and global climates.
The dangers techniques pose cut across traditional divides between parties of the Left and Right. See The Deep NeoLiberal State. Our problems are not now with capitalism or socialism but with techniques.
We cannot Care for Health or the Environment, unless We the People regain control of our technologies and techniques.
This is not impossible. Greta Thunberg has helped mobilize a generation to tackle climate change.
In the 1970s and 1980s, Germans forced a pause in the development of nuclear energy.
The talk is mostly about the profits they make. It shouldn’t be. It should be more about the techniques they use and whether these – like SSRI antidepressants – have the potential to cause more harm than good.
As An Ugly Truth, a recent book on Facebook quotes:
So we connect more people. That can be bad if they make it negative. Maybe it costs someone a life by exposing someone to bullies. Maybe someone dies in a terrorist attack coordinated on our tools. And still we connect people. The ugly truth is that we believe in connecting people so deeply that anything that allows us to connect more people more often is de facto good.
This skips the money made out of connecting people. But even more important is that behind Facebook and related companies are a set of operant techniques that have the power to control vast swathes of our behaviour to a greater extent than anyone has ever been able to achieve before. Even if those who increasingly control us are doing so for benign or even purposes they view as neutral, there is a problem here.
In all these areas we have made progress in grappling with the dangers of techniques but not in Health. The Guardian and New York Times for instance who have helped break many of these stories have a blind spot when it comes to health – they are pro technique and technology. There is no questioning of Progressive Health care policies, no feel for our collective Health blind spot. Life expectancy was falling before Covid, and is falling even more so now. Population Replacement Rates are also falling. No-one is asking why.
If we have fewer people isn’t that good for the environment?
If video consults reduce petrol consumption isn’t that a good thing?
A Physical Environment policy platform that does not recognize the parallel degradation within the Health Environment cannot succeed. There are many ways in which properly recognising what is going wrong in Health will add teeth to Environmental policies. Its time for Politicians concerned about Sustainability, concerned about our Future, to discover this.
There is a chance to create a message of hope and value rather than be painted as Luddite, Rationing or Anti-Progress but it needs an understanding of Health that few people – either those who complain about NeoLiberalism or those worried about Deep States – have. See the Deep NeoLiberal State.
At present Green or Sustainable HealthCare policies are aggravating the problems we have in Health. Green politicians appear to think the primary contribution they can make to Health is to clean up the environment and after that encourage innovative and evidence-based Health policies. Innovation and Evidence Based are hazard markers – See The Controlled Healthcare Opposition and The MedicoChemical and PetroChemical Twins.
Ulrich Bech’s book Risk Society helped create the modern environmental movement and cement in people’s minds the hazards of the modern world.
Neither science, nor the politics in power, nor the mass media, nor business, nor the law, nor even the military are in a position to define or control risks rationally…. We are living in a world that is beyond controllability.
Shortly before Beck appeared on the scene though, the pharmaceutical industry had discovered our risky world and the marketing of risk has enabled them to increase the amount of drugs we take by over 2000 per cent and grow from a $20 billion industry to over $1.2 trillion and rising fast.
In 1980 few of us were on 1 drug per say. Now over 40% of over 45s are on 3 drugs every day of the year and over 40% of over 65s are on 5 or more drugs every day of the year.
Within healthcare – poisons (medicines) are seen as the way to manage risks. This is sold to politicians as preventive medicine.
The Zeitgeist, or something, has helped turn what were viewed as poisons into sacraments (something that can only benefit) and an increasing number of us figure we need to take Daily Meds to handle Risks in the way we once sought out Daily Communion (Eucharist), or said prayers to Mecca.
Pharmaceuticalization and financialization are now the way we manage risks – and at the moment progressive and sustainable health policies are digging this hole deeper.
Adverts like this are directed to politicians and managers. The message – medicines like anti-hypertensives, bone thickening drugs, blood sugar reducing drugs, airway opening drugs, and drugs to reduce risky behaviours will reduce hospital admissions, making for lower costs, while at the same time being better for patients.
We now have more hospital admissions and disability caused by these drugs than we have from leaving untreated the notional risks they claim to manage.
The line in the advert here about drug prices only being 10 per cent of healthcare budgets fools policy-makers, insurers, the public and their politicians. Ten per cent of a $4 trillion budget in the United States is $400 billion. If these drugs worked, their cost would be a greater percentage of a falling budget.
We are now paying not just for the drugs, but also for the screeners whose job it is to detect risk, and the auditors and managers you need to put in place because something is going wrong with hospital admissions and escalating costs and you don’t know what. Governments and insurance premiums are paying for the salesforce for the drug – pharma don’t need to send drug reps around any more. Or even take docs out for meals.
An increasing chunk of the $3.6 trillion in the US is going on healthcare staff who are selling the drugs.
Another chunk goes on the increased admissions the drugs that are supposed to be reducing costs cause and the difficulties in effectively remedying spiral fractures of the femur caused by bone-thickcning drugs, dementia caused by hypoglycemics, rhabdomylosis caused by statins, or the mental instabilities caused by psychotropics.
The amount of medicines in us is rising faster than CO2 levels are rising in the atmosphere or the amount of guns circulating in the United States.
Doctors are dishing these risk management meds out with a liberality the National Rifles Association can only envy – and they are causing more death and disability than guns are. Doctors are following a line from Donald Trump – the answer to risks is to have a good guy with a gun outside every school. They go one step further and are arming every school-child with a set of drugs.
Ask any doctor you know and medical authorities why there are no Guidelines for People, the first element of which would be a recognition that medication burdens should be contained? See What Doctors Can Do To Save the World.
If they agree Guidelines for People should take precedence over Guidelines for Diseases, which push doctors to prescribe more drugs, ask what plans there are to make this happen – or is it a matter of keeping the beaches open for the tourist season?
A little over a decade ago, Deprescribing came on the radar. A paper by Garfinkel and Mangin indicated that reducing medication burden from 10 or more drugs especially in older patients to 5 or less can reduce hospitalizations, improve quality of life, and extend life expectancy.
More important than saving money and helping people feel better, Deprescribing has the potential to bring home the role of technique.
Deprescribing exposes the Nuclear Bomb problem at the heart of all techniques.
As with armaments, drugs produce an arms race. The side with the most effective weapons wins so there is no option but to compete. And weapons get more and more effective until we get to the Nuclear Bomb which is too effective to use.
Efficacy has its limits. And just as we can have bombs too effective to use, so we cannot now use all our drugs. Effectiveness starts falling off once we go above 3 drugs per day.
Getting the maximum bang for our buck means deprescribing. This is not a matter of rationing, its a matter of sustainability. And there is no place for an algorithm in sustaining what each of us might want sustaining.
This is not just a matter of overall efficacy. Its also clear that having too many guns around and letting them leak into places they shouldn’t be in, even if we have a good guy with a gun outside every school, is not effective in the sense of achieving what we want from guns which for the most part is Safety.
Targets are a bad idea. But if we can set a target for temperature rise, lets also Target:
- Turning around current falls in Life Expectancy.
- Stabilizing our Falling Replacement Rates
Re Life Expectancy, as this graph in the Wall Street Journal shows, with Covid we now have a dramatic fall in Life Expectancy.
Look not just at the red bar for 2020 but the ten years before that when life expectancy had been falling each year compared with ten years before that. The only comparable time this happened was in the 1950s and 1960s when the falling life expectancy was also put down to drugs – in this case tobacco.
The single easiest way to turn this trend around will be to deprescribe. There are now 3 studies looking at factors linked to Covid deaths and in all three the quantity of medication the person was on before they got ill has been a factor in their deaths – Dennis the Menace gets Covid.
Re Replacement Rates:
Across the Western World, roughly 15% of us take antidepressants. These affect the way every single one of us who takes them makes love, in most cases abolishing our ability and/or desire to do so, which of course affects another 15% of the population. This is increasingly a young person’s problems – not an old folks one.
(The BMJ article here blames depression but the kind of depression they are talking about increases sexual activity rather than reduces it and just as with the issue of Drugs and increased likelihood of death on Covid, journals are not happy to link any problems to the sacraments we are taking even when the problem is as obvious as genital numbing within the first 30 minutes after taking an antidepressant).
Given the uneven distribution of these drugs, it is quite likely there are areas of most countries where 20-30% of the population are not making love. At the moment, this is more a matter for white folk than for any other ethnic group.
If a woman does conceive, while on treatment, the meds double the rate of miscarriages, increase rates of voluntary terminations, double the rate of birth defects and double the rate of children who will have behavioural problems like autistic spectrum disorders. A recent estimate suggests a looming bill of over $5 trillion.
Drug regulation was based on Safety until 1962. A 1938 Safety Act in the United States kept thalidomide off the market there.
The Thalidomide tragedy triggered a change. Companies were required to prove the Efficacy of their drugs. This was supposed to contribute to Safety but this focus has given us weaker and weaker drugs with their hazards concealed – drugs are much less Safe now than they were in 1962.
Restoring the Primacy of Safety must be something for the first 100 days of office of any incoming administration that aims at Sustainable Healthcare.
In 1962, medicine was the scene of one of the strangest twists in human history. As of 1962, only one drug had ever been through a placebo and randomized controlled trial (RCT) before being brought on the market, in which it had been shown to be efficacious and safe – the test we now have in place to stop Thalidomide happening again.
That drug was Thalidomide.