On Sep 3, 2009, at 9:09 AM, Dan M wrote:
-----Original Message-----
From: [email protected] [mailto:brin-l-
[email protected]] On
Behalf Of Andrew Crystall
Sent: Monday, August 31, 2009 4:25 PM
To: Killer Bs DDavid Brin et al Discussion
Subject: Re: Ben Bernanke, fearless leader
On 30 Aug 2009 at 12:22, John Williams wrote:
One of a doctor's fundamental guidelines is "do no harm". A
responsible doctor would never operate on a patient to remove the
appendix simply because the patient complains of a stomach ache.
More
information about the state of the patient is needed before an
operation is justified.
An excellent example.
Doctors are expected to remove a certain percentage of healthy
appendixes. I can't remember the exact percentage, but it's
significant. Why? Because the effects of an acute burst appendix are
so nasty. If a doctor isn't removing enough healthy ones, then he is
actually not serving his patents properly.
You may wish to reflect on this as regards your stance.
There is one other point that clearly falsifies the "first do no
harm" taken
as an absolute rule for medicine. Take, for example, the fact that
there
are always unknown factors and low probability events in medicine.
For
example, even with the most common surgeries, there is a chance the
patient
will die in surgery. Thus, if we first do no harm, we never do
surgery.
I think "First, do no harm" is intended to be like something like the
law of the Iroquois Confederacy: "In our every deliberation, we must
consider the impact of our decisions on the next seven generations." It
acknowledges that there will be times when it is unclear whether the
decision to act now or to delay in performing a procedure on a patient
is going to "do harm".
It's an injunction against acting rashly rather than an absolute rule
against taking any action with a non-zero probability of causing harm
down the road.
This is all well and good in the theoretical, but it's not always
theoretical: may you never be in the position that we were, fourteen
years ago, with our first and only son, where we had to make exactly
these kinds of decisions over and over again, week after week, often
with agonizing consequences no matter what we decided. Should we subject
him to whole- brain radiation treatments, knowing that it might extend
his life at the risk of reducing his IQ, permanently, to double digits?
And that was just the relatively easy, obvious one.
The only direct experience I have with what some insist on calling
"government interference" with the health-care system is COBRA. Without
it, I'd have been financially ruined, twice over, by medical disasters.
First, Kevin's brain cancer, which was covered by COBRA extension of my
extraordinarily fine coverage from Apple in the mid '90s. Second, my own
brain cancer, which was covered by COBRA extension of my also- darn-fine
coverage from Sun in the early 2000s. Thus, unlike a little more than
50% of Americans, I favor some form of "government interference" with
the so-called "free market" for health care.
Dave
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