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Posted at 10:39 AM ET, 02/15/2011

How penicillin fooled us

By Ezra Klein

Perhaps it's the mark of a good book that after you read it, you begin seeing evidence for its thesis in lots of different areas. Since reading Tyler Cowen's "The Great Stagnation," I've been seeing a lot of support for a claim that I'd initially resisted: the idea that the technological advances of the 19th and early 20th centuries were far more important to both the economy and quality of life than what's come since. Take this observation from Atul Gawande's "The Checklist Manifesto":

I think we have been fooled about what we can expect from medicine -- fooled, one could say, by penicillin. Alexander Fleming's 1928 discovery held out a beguiling vision of health care and how it would treat illness and injury in the future: a simple pill or injection would be capable of curing not just one condition but perhaps many. Penicillin, after all, seemed to be effective against an astonishing variety of previously untreatable infectious diseases. So why not a similar cure-all for the different kinds of cancer? And why not something equally simple to melt away skin burns or to reverse cardiovascular disease and strokes?

Medicine didn't turn out this way, though. After a century of incredible discovery, most diseases have proved to be far more particular and difficult to treat. This is true even for the infections doctors once treated with penicillin: not all bacterial strains were susceptible and those that were soon developed resistance. Infections today require highly individualized treatment, sometimes with multiple therapies, based on a given strain's pattern of antibiotic susceptibility, the condition of the patient, and which organ systems are affected....medicine has become the art of managing extreme complexity -- and a test of whether such complexity can, in fact, be humanly mastered.

Compared with penicillin, the therapies we're developing today offer marginal improvements and carry an incredible cost. In fact, I think a lot of them are a net drag on the economy: The problem with medicine is that it's very hard to say no, and that means we often end up paying a lot for treatments that do us very little good, and that squeezes the resources available to sectors that could do us a lot of good but are easier to say no to.

By Ezra Klein  | February 15, 2011; 10:39 AM ET
Categories:  Books, Health  
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Comments

great post.

At some point we have to say we're not going to prolong life for anyone (via medicare payments) at any cost. If we spend billions to keep our 90 year olds alive (even though for many its not really living) how much do younger generations suffer? Death panels (as johnmarshall correctly suggested in Wonkbook's comments) need to return and we need to as a nation have a serious discussion on the matter. We only have so many resources.

Posted by: visionbrkr | February 15, 2011 11:07 AM | Report abuse

"In fact, I think a lot of them are a net drag on the economy: The problem with medicine is that it's very hard to say no, and that means we often end up paying a lot for treatments that do us very little good, and that squeezes the resources available to sectors that could do us a lot of good but are easier to say no to."

See Provenge as the classic example of this phenomenon.

Cost- $73,000 to $100,000 per series of treatments

Treated Class - terminal prostate cancer patients

End result - extension of life 3 to 5 months in trials.

"PROVENGE's fate lies with Center for Medicare and Medicaid Services (CMS), which will determine next month whether the drug will be covered. Note that prostate cancer mainly strikes elderly males, making Medicare the biggest likely insurer to reimburse of the drug. The majority of industry watchers believe it will receive full CMS reimbursement status, though only for prostate cancer"


Posted by: johnmarshall5446 | February 15, 2011 11:08 AM | Report abuse

Do you still think the solution to the "obesity crisis" will be pharmaceutical?

Posted by: tphilpott | February 15, 2011 11:16 AM | Report abuse

Of course, you could measure that by looking at the trendline in life expectancy at birth since 1900. If Tyler's thesis were correct, you'd see an acceleration till about 1945, then a leveling off.
I poked at OECD data for the U.S. It shows a steady linear regression, but the data only go back to 1960.

Posted by: RZ100 | February 15, 2011 11:30 AM | Report abuse

Cowen's observation is true, but unremarkable. Progress is very, very lumpy, especially when measured by quality of life. That's why history is divided into Stone Age, Bronze Age, Iron Age (and you might call this last one the Steel Age, or Electric Age). The fact that the changes in this current wave have become undramatic doesn't mean that there aren't more dramatic changes coming.

Posted by: GBMcM | February 15, 2011 11:31 AM | Report abuse

For all of you progressives out there who claim that health care is a "right", you need to know exactly what you are claiming. By your logic, every time some expensive health care treatment is developed, no mater how effective it is, every American has the right to receive it, even if it bankrupts our country.

Posted by: cummije5 | February 15, 2011 11:47 AM | Report abuse

"By your logic, every time some expensive health care treatment is developed, no matter how effective it is, every American has the right to receive it, even if it bankrupts our country."

No, that doesn't follow logically. People have a right to healthcare without having access to the most advanced treatments.

GBMcM's comment has it more correct, I think. The history of technology going back before the modern era (1500's) shows long periods of stasis and short bursts of invention. We really have no metaphysical reason to conclude that the scientific method has changed that. We might expect it, or hope for it, but we can't conclude it.

I remember a book back in the early 90's by an author named Paepke who argued in essence that the outer contours of modern life have become well-defined -- we live in heated and cooled houses, we get around in automobiles with wheels, and so on -- and so the next improvements would not be as physically momentous, and also a lot more technically involved.

On the other hand, in medicine, I think Ray Kurzweil is correct: it looks to me like medicine is about to take-off like a rocket.

For millennia, medical discovery has been accidental, hit or miss, but only just now do we finally have the right tools: biotech, nanotech, and most importantly, mass computation to combine it, to run "in silico" simulations for rough tests and so on, and to control it.

This has really only just started, but if you pay attention to the science pages -- Science magazine, Nature, the wonderful Science Daily, etc., you will sense a continuing acceleration in medical discovery, and you will get a strong sense that some of it is fundamental discovery. We are at the beginning.

Kurzweil is considered an outsider but he has produced a series of remarkable graphs showing that every scientific field that has combined with computation has attained a logarithmic rate of innovation, perhaps following Moore's law.

I think the greater problem is in economics: the resulting distribution of income when discovery is highly technical and needs small numbers of extremely educated researchers, which can then be mass-produced without the participation of many workers. Vonnegut's Player Piano.

Posted by: Lee_A_Arnold | February 15, 2011 12:28 PM | Report abuse

Screw you, pharma!

Posted by: Klug | February 15, 2011 12:32 PM | Report abuse

It is true that the development of antibiotics and vaccines were among the biggest advances in health care, along with sanitation, which is probably the single biggest advance in reducing everything from food and water borne GI diseases to stomach and colon cancer. However, advances in surgery since the era you describe, including open heart surgery, bypass, stents and organ replacement, have also saved many lives. The next huge advance is happening now. It's the ability to grow replacement parts from our own cells, hence no rejection.

Here's a fascinating report on that from Wired Science.

http://www.pbs.org/kcet/wiredscience/story/47-body_builders.html

Posted by: GreenDreams | February 15, 2011 12:43 PM | Report abuse

I hear this, but part of the problem is that we've got a health care system designed to develop and deliver only penicillin-like cures, in spite of the fact that it should be very obvious to us that we're at the end of the ROI curve on drug innovation.

There's a lot of stuff we're simply not doing in healthcare. Using communications and information technology is the most obvious. But we're also not doing basic research in many promising areas.

If it weren't for AIDS, we'd know nothing about immunology. Even now, we dramatically under-invest in this field; we have no idea why childhood allergies are increasing, and it's a huge source of lifestyle inconvenience, morbidity and mortality.

Here's another area: brain function. We spend 1/3 of our lives asleep, we go crazy if we don't sleep, and we have ZERO idea why. We know on a molecular level why we have to eat, but the need to sleep is as fundamental a need...and we're clueless about why. Clearly, we are missing something major in understanding human functioning, and research in this field is likely to yield breakthrough findings that would be applicable to brain diseases (Parkinson's & Alzheimer's is a leading cost driver...)

Posted by: theorajones1 | February 15, 2011 1:10 PM | Report abuse

--*The problem with medicine is that it's very hard to say no, and that means we often end up paying a lot for treatments that do us very little good, and that squeezes the resources available to sectors that could do us a lot of good but are easier to say no to.*--

That's the zero sum game of muddled socialism trying to second guess itself.

One size does not fit all.

Leave decisions about "resources" to individuals, and hundreds of millions of individuals making their own decisions will automatically allocate between sectors efficiently, spurring innovation and growth, also automatically, leaving meddlers like Klein nothing to scribble about.

Posted by: msoja | February 15, 2011 1:30 PM | Report abuse

"Leave decisions about "resources" to individuals, and hundreds of millions of individuals making their own decisions will automatically allocate between sectors efficiently, spurring innovation and growth, also automatically, leaving meddlers like Klein nothing to scribble about."

What?

Posted by: johnmarshall5446 | February 15, 2011 1:37 PM | Report abuse

--*Cost- $73,000 to $100,000 per series of treatments
Treated Class - terminal prostate cancer patients
End result - extension of life 3 to 5 months in trials.*--

The only way that's a problem is if sick people are able to *force* others to pay for their medicine, which *is* the entire problem with Medicare etc.

Posted by: msoja | February 15, 2011 1:47 PM | Report abuse

"No, that doesn't follow logically. People have a right to healthcare without having access to the most advanced treatments."

What kind of a right is that?

I can only imagine the dialogue:

Patient: "So I have stage 4 cancer. I have a right to health care, and thankfully a new drug was just developed which can cure my condition."

Doctor: "Well, you don't have a right to all health care - just some health care. That new drug costs society $500,000. You're 80 years old - we can't go around dropping half a million bucks on every old geezer who gets cancer."

Patient: "What? How do I have a right to "some" health care? I've easily paid $500,000 in taxes during my life."

Doctor: "We have decided that if the procedure is considered advanced, you don't actually have the right to it. This advanced procedure is pretty expensive, and it's not like you've got decades to live anyway. In any case, that $500,000 wasn't your money, it was society's money."

Patient: "So what the hell does my right to health care mean?"

Doctor: "You'll have a nurse come in day by day and give you morphine and smile at you. You also get a hospital bed - expensive enough, I think."

Patient: "I don't really have a right to health care then, do I?"

Doctor: "No you don't. No one really has any rights to anything. Rights are nonsense on stilts. People say that there is a right to life, but if we think it expedient to kill you, nothing really wrong with that. You have a right to property, unless we think others need it more. You have a right to liberty, but we'll restrict it as we see fit. I mean hey, you probably got this colon cancer from eating too many hamburgers, so we'll just go ahead and ban those. Should help the younger folks out.

You see, we all felt bad about people having health insurance, so we decided to make up a right to health care and take other people's property in order to pay for it. Then, we discovered that some health care is just plain unaffordable to give to everyone, and so we just took away your right to the expensive stuff. So you have a right to health care when we can successfully take other people's money to pay for it, but we can't kill the goose that lays the golden eggs - we can't take ALL of the wealth out there, or none will be made in the first place."

Posted by: justin84 | February 15, 2011 1:58 PM | Report abuse

"On the other hand, in medicine, I think Ray Kurzweil is correct: it looks to me like medicine is about to take-off like a rocket."

I agree and hope Kurzweil is right: real health care prices will drop like a stone and we won't have to discuss this issue any longer.

Posted by: justin84 | February 15, 2011 2:07 PM | Report abuse

msoja:

Ok, I get you now. The only trouble with that idea is that a majority of those over 75 in the US today would be dead without Medicare (hyperbole of course, because the actual number is unknowable).

While I'm in favor of allowing large numbers of oldsters to shuffle off gracefully rather than after extended hospital stays, you have to also understand that there is a product development pipeline that would cease to exist without the reasonable expectation of government funded treatment.

Posted by: johnmarshall5446 | February 15, 2011 2:36 PM | Report abuse

So, wait.

The failure of humans to come up with a cure for cancer in the later part of the 20th century (even though none was found earlier) is attributed to lack of innovation during that period, and the failure of penicillin to pan out as expected is *also* blamed on the second half of the century? Also, the failure of diseases to conform to early 20th-century expectations is due to lack of later innovation?

I agree with your overall point about the finite resources and the need to say no. I also can see the idea that, as we reach an optimum, we realize diminishing returns.

But, those aside, Ezra, you're not playing fair. You're acting as if the discovery of penicillin was an independent event, completely unrelated to all the research that went into finding -- and failing to find --something like penicillin. Then you're comparing that to all the research today that goes into ... take your pick of cures for today's ailments.

You seem to understand that, if a cure for cancer is found, the cost will have been all the positive *and* negative research that went into arriving at the cure, but you're not holding the discovery of penicillin to that same standard.

As for Gawande's quote, penicillin, amazing as it was, did *not* turn out to be a cure-all, especially not long term. That is an "indictment" of 20th century innovation, not later innovation.

And the fact that *some* diseases proved to be far more difficult to treat than people foresaw (and I don't necessarily believe this) is also an indictment of that time, not due to lack of innovation later.

Finally, it's ironic that he uses "melting away skin burns" as an example, because scientists are doing exactly that right now using stem cells.

I still contend that most people who decry our current level of innovation really have no clue what is actually taking place. And, for comparison, they choose only the most successful past innovations, and to top it off, they calculate the cost by ignoring all the failed attempts that led to the breakthrough.

This smacks too much of the curmudgeonly "it used to be better in my day" points of view that rarely hold up under closer scrutiny.

Posted by: dpurp | February 15, 2011 2:42 PM | Report abuse

Death panels! Death panels!

Posted by: UberMitch | February 15, 2011 3:02 PM | Report abuse

Medicine is more complex now because we can treat a lot more. Perhaps there was some brief period where folks thought penicillin was the first of a waive of cure alls, but how long could that belief really have lasted? Then it worked or it didn't. Now if it doesn't, you try something else.

Also, the examples are telling. I read recently about the testing of spray-on replacement skin made from the patient's stem cells. As for heart disease and strokes, we keep doing more, and less intrusively. For example, they can replace heart valves without surgery.

In other words, to the extent that people thought there would be a pill for everything, they are likely disappointed. But that doesn't mean the leaps are still out there.

Posted by: amiller5 | February 15, 2011 4:06 PM | Report abuse

--*there is a product development pipeline that would cease to exist without the reasonable expectation of government funded treatment.*--

That goes back to Bastiat. Positing the absence of government funded projects does not mean one has to presume a void in their place.

I do not accept that old people will die en masse without the Medicare monster. People in the forties and fifties lived to ripe old ages without Medicare.

If anything, the widespread reliance on a government program that is becoming obviously unsustainable is what threatens America's seniors. Had they not been forced to contribute all their lives to a system heading inevitably toward insolvency, they might have made other, more reliable preparations for care in their later years. One can presume that scores of millions of workers making such choices as they got older would have spurred all sorts of innovation and endeavor in meeting the demand for services and products. Instead, we've got goons like Klein performing ersatz cost/benefit exercises with other people's lives and a finite lump of stolen treasure.

Likewise, alá Bastiat, again, what we have less and less of, owing to its displacement by a rapacious government, is a vibrant free market in health care, catering to young and old, rich and poor, alike. The more government intrudes, the worse it will get.

Posted by: msoja | February 15, 2011 4:08 PM | Report abuse

Justin84: "What kind of a right is that?"

What kind of right is freedom of speech, when they won't give me a microphone on national television?

Posted by: Lee_A_Arnold | February 15, 2011 5:03 PM | Report abuse

"What kind of right is freedom of speech, when they won't give me a microphone on national television?"

Rights are limited in the sense that they cannot contradict each other. The right to speech does not entail the right to a microphone as that requires the right to another's property, and hence violates the microphone's owner's right to property. In any case, the right to speech is not the right to heard, it's the right not to be thrown in prison, tortured or killed because other people don't like what you are saying.

Posted by: justin84 | February 15, 2011 6:15 PM | Report abuse

msoja:

"That goes back to Bastiat. Positing the absence of government funded projects does not mean one has to presume a void in their place."

Yes, it does in terms of drug development with long lead times and no certainty of market at the end. You might still have some work on major drugs like heart disease, but for a thousand problems like MS, or Parkinsons, eveything would simply stop.

"I do not accept that old people will die en masse without the Medicare monster. People in the forties and fifties lived to ripe old ages without Medicare."

Absolutely correct. Human life expectancy on an individual basis has not increased a day in thousands of years. About 120 seems to be the max, period. However the quantity of people living to old age without Medicare treatment would vastly decline back to the numbers of 100 years or more. Not indidivduals, but raw numbers within the population.

"Had they not been forced to contribute all their lives to a system heading inevitably toward insolvency, they might have made other, more reliable preparations for care in their later years."

Except that's not even in the slightest bit true. There's nothing that seniors could have saved that would prevent them from being wiped out financially by any long term illness, or even the cost of your average bypass operation.

"Likewise, alá Bastiat, again, what we have less and less of, owing to its displacement by a rapacious government, is a vibrant free market in health care"

Except that such a thing has never existed in this country, even before the advent of employment based health insurance during WWII. My 90 year old father is only too happy to regale me with tales of the old days, when you either lived or died without much assistance from the medical profession.

Posted by: johnmarshall5446 | February 15, 2011 6:19 PM | Report abuse

But Ezra, as I said before when you posted on Cowen's technology writing, keep in mind he appears to be a pretty, or very, strong libertarian and willing to mislead for the cause (strong libertarians are usually forced to mislead for the cause, as if people really understood the implications, almost all would oppose their philosophy, so they'd have no chance in a democracy.)

Cowen wants to make science and technology look less fruitful so there will be less government spending and other actions on it – Remember, an extreme libertarian would rather have tremendous suffering and loss, and little, no, or even greatly negative advancement in science, medicine, and wealth, rather than give up even small bits of economic freedom.

It is true that practical applied advancement in science and medicine in some ways seems slower than in the early 20th century, but largely we've been in a phase of laying the foundation for the next breakthroughs, with basic understanding and development of computers, DNA, nanotechnology and more. But make no mistake, tremendous real applied advances, that will greatly improve our lives and our wealth are coming – And will come far sooner if the government invests heavily in them – the private sector will grossly underinvest, and inefficiently invest in these things due to long established in economics market problems, like externalities, massive economies of scale the zero marginal cost of ideas, etc., etc.

Ray Kurzweil is a highly esteemed scientist and inventor, winner of the $500,000, 2001 Lemelson-MIT Prize. Here are some things he forecasts in his 2009 book, "Transcend":

In the 2030's:

"...nanobots that act as artificial white blood cells, except they're a lot smarter than our natural white blood cells. These robotic "microbivores" can detect and destroy virtually any dangerous pathogen, including viruses, bacteria, cancer cells, as well as cancer stem cells. So tumors are stopped when they are just a handful of cells, long before they become a tumor. And we can download new software into these microbes when we discover new pathogens." (page 143)

"...in the rare even that you do have a heart attack, you'll be glad you have these little robots (nanobot red blood cells). They'll keep your heart and brain and all your vital organs supplied with oxygen for at least 4 hours. You can walk into your doctor's office calmly and explain you're having a heart attack. She'll inject you with more respirocytes and then deal with removing the clot and fixing the problem." (page 48)

And there's much more, just as amazing.

And you may have seen how good computer vehicle drivers are getting. We might have that commercially in 20 years or less. Not only would this plunge auto deaths, it would have a big effect on quality and way of life. Parents today spend huge time driving kids around – suddenly they have much more time, and add on household cleaning robots saving huge time.

Posted by: RichardHSerlin | February 15, 2011 6:25 PM | Report abuse

Remember household technology advances freed up the time for women to enter the workforce. And if cities cost a fortune to live in for a job, people could live an hour away and work, shave, have breakfast, etc., in a car with the windows tinting for privacy and the computer driving.

And if you've been following solar, you know it could be cheaper than fossil fuels in a generation or less. See, for example, this Scientific American article:

http://www.scientificamerican.com/article.cfm?id=a-solar-grand-plan

And I could go on with amazing advances that could happen over the next generation, or sooner, and are far more likely to with heavy government investment.

Posted by: RichardHSerlin | February 15, 2011 6:26 PM | Report abuse

Rights cannot contradict each other? Justin, do yourself a favor and put a little placard next to your computer that says two things : (1) I will not trap myself into using absolutist definitions, and (2) Economics is a toolkit of ideas, not a normative theory to which the world must conform.

Posted by: Lee_A_Arnold | February 15, 2011 6:44 PM | Report abuse

And if Kurzweil’s projections sound unrealistic, remember that those advances involve computer technology and miniaturization, things which have been advancing exponentially relentlessly for two generations. As Kurzweil wrote in a 2008 Washington Post Op-Ed:

M IT was so advanced in 1965 (the year I entered as a freshman) that it actually had a computer. Housed in its own building, it cost $11 million (in today's dollars) and was shared by all students and faculty. Four decades later, the computer in your cellphone is a million times smaller, a million times less expensive and a thousand times more powerful. That's a billion-fold increase in the amount of computation you can buy per dollar.

Yet as powerful as information technology is today, we will make another billion-fold increase in capability (for the same cost) over the next 25 years. That's because information technology builds on itself -- we are continually using the latest tools to create the next so they grow in capability at an exponential rate. This doesn't just mean snazzier cellphones. It means that change will rock every aspect of our world. The exponential growth in computing speed will unlock a solution to global warming, unmask the secret to longer life and solve myriad other worldly conundrums.

At: http://www.washingtonpost.com/wp-dyn/content/article/2008/04/11/AR2008041103326.html

Posted by: RichardHSerlin | February 15, 2011 7:03 PM | Report abuse

"Remember, an extreme libertarian would rather have tremendous suffering and loss, and little, no, or even greatly negative advancement in science, medicine, and wealth, rather than give up even small bits of economic freedom."

Thankfully, there would be no need to worry about that scenario, since economic freedom doesn't turn everyone into Ebenezer Scrooges or Luddites.

Note that if greatly negative advancement in science, medicine and wealth occurred in a free society, it would be because the vast majority of individuals in such a society did not value those things.

"And you may have seen how good computer vehicle drivers are getting. We might have that commercially in 20 years or less. Not only would this plunge auto deaths, it would have a big effect on quality and way of life."

Automated cars more or less give you Aramis. Why spend billions on rail?

"And I could go on with amazing advances that could happen over the next generation, or sooner, and are far more likely to with heavy government investment."

Why would "amazing advances" require government funding? No positive human action occurs unless a central planner organizes it?

The government is also investing heavily in global empire, fossil fuelds, nuclear weapons, a war on drugs which is having tragic consequences here and abroad, subsidies for agribusiness which many argue make unhealthy food cheaper and increases consumption, the mortgage market, foreign military aid, etc. We're easily talking $10 - $15 trillion over the next decade going towards these activities, especially if one includes interest on the debt financing.

Even much of the marginal funding going towards liberal approved purposes (education, for example) is more or less a waste - national education spending soars, yet the results seem at best unchanged, and the inner city schools as a whole are perennial disasters.

Posted by: justin84 | February 15, 2011 7:14 PM | Report abuse

"Rights cannot contradict each other?"

Of course they cannot! What does the word "right" even mean to you - whatever you decide sounds good at a particular time?

I don't know how to make this clearer.

Person A: "I have the right to life."
Person B: "I have the right to kill person A"

Can both of these rights simulatenously exist? Does Person A have the right to his life, or does Person B have the right person A's life?

Do you really not get this?!

"Justin, do yourself a favor and put a little placard next to your computer that says two things : (1) I will not trap myself into using absolutist definitions"

You really have no idea what you are talking about. Words mean things. What does it mean to talk about rights when one person has the right to violate another person's rights? Nothing.

"Economics is a toolkit of ideas, not a normative theory to which the world must conform."

We are not discussing economics. The level of confusion displayed here is mindboggling.

Posted by: justin84 | February 15, 2011 7:57 PM | Report abuse

I added the part about economics to save time, I felt something was brewing, alas I was too late:

"it would be because the vast majority of individuals in such a society did not value those things"

No, it could just be due to market failure.

Posted by: Lee_A_Arnold | February 15, 2011 9:30 PM | Report abuse

True, but give science some credit. HIV/AIDS was a death sentence within our lifetime and now, someone compliant on anti-retrovirals has a life expectancy the same as someone without HIV/AIDS.

And, you know, we treat ulcers with pills insteads of surgery. Good stuff is still happening.

Posted by: ThomasEN | February 15, 2011 9:30 PM | Report abuse

--*Justin, do yourself a favor and [...]*--

Justin84 soundly refuted your nonsense about free speech and microphones and all you can come back with is ad hom? Tch tch.

Posted by: msoja | February 15, 2011 9:53 PM | Report abuse

--*You might still have some work on major drugs like heart disease, but for a thousand problems like MS, or Parkinsons, eveything would simply stop.*--

For all you know, had all the money stolen by the government and diverted to the endeavors you name been left in the hands of private individuals, there might be cures for MS or Parkinson's by now.

How many billions have been spent for how many decades in the fruitless search by government bureaucracies renowned for incompetence? Any idea?

Posted by: msoja | February 15, 2011 10:23 PM | Report abuse

msoja:

You simply want to make statements of opinion unconnected to any actual facts. That's ok, it's fun to debate, as long as we're clear on where we're headed. Let's do this again sometime. Thanks for the replies.

Posted by: johnmarshall5446 | February 15, 2011 10:38 PM | Report abuse

soggy's such a manly man, he wills away cancer with only a copy of Atlas Shrugged.

Posted by: pseudonymousinnc | February 16, 2011 1:11 AM | Report abuse


Many existing laws and regulations apply specifically to pregnant women. Several provisions of the Affordable Care Act offer new benefits for expecting mothers. Search online for "Wise Health Insurance" if you need affordable insurance for yourself or your wife.

Posted by: kinglaura16 | February 16, 2011 1:30 AM | Report abuse

--*You simply want to make statements of opinion unconnected to any actual facts.*--

Yeah, like, "eveything would simply stop".

It's ludicrous to suppose that no one but government scientists are interested in finding a cure for Multiple Sclerosis. It's equally ludicrous to suppose that absent all the endeavor usurped by the government that new endeavor wouldn't spring up in its place.

If Amtrak shut down, we'd have no trains?
If the Post Office was abolished, we'd have no mail?
If the government school system were closed we'd have no education?

It's nonsense.

Posted by: msoja | February 16, 2011 8:29 AM | Report abuse

"The problem with medicine is that it's very hard to say no, and that means we often end up paying a lot for treatments that do us very little good, and that squeezes the resources available to sectors that could do us a lot of good but are easier to say no to."

That is an invalid conclusion. In cancer therapies, small incremental advances have led to more striking advances. AIDS is another example. Initially, the diagnosis of AIDS was a fatal diagnosis. Now, it is a chronic disease. But, neither cancer nor AIDS treatments arrived at their present states in one fell swoop.

Posted by: RickCaird | February 19, 2011 4:41 PM | Report abuse

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