Good Entropy

Mark A. Hall, JD, and Robert A. Berenson, MD
Annals of Internal Medicine
1 March 1998 | Volume 128 Issue 5 | Pages 395-402

It is untenable for the medical profession to continue asserting an idealistic ethic that is contradicted so openly in daily practice. However, a satisfactory ethic appropriate to the managed care era has not yet been developed to replace the traditional ethic. Many in the profession have not come to terms with the conflicting expectations they now face and so feel caught in a moral crisis.

Over at The Covert Rationing Blog

He quotes a journal piece:

It is untenable for the medical profession to coninue asserting an idealistic ethic that is contradicted so openly in clinical practice. . .We propose that devotion to the best medical interests of each individual patient be replaced with an ethic of devotion to the best medical interests of the group [of patients] for which the physician is personally responsible.

from:Hall MA, Berenson RA. Ethical practice in managed care: a dose of realism. Ann Intern Med. 1998; 128:395-402.

This is a good example of how not having the patient paying for care allows ne forces the doctor to serve two masters in terms of ‘best medical interests’. Individuals are treated by physicians not groups.

The whole post is very worthwhile. He goes onto cite pioneering work by progressives to extend medical ethics to include

…a third ethcial precept: The Principle of Social Justice.

A high tech form of the same old ‘detoxification’ woo

Whenever I hear that term, I’m at least 90% certain that I’m dealing with seriously unscientific woo. The reason should be obvious to longtime readers of this blog or to anyone who has followed “alternative medicine” for a while, because “detoxification” is a mainstay of “alternative” treatments and quackery for such a wide variety of diseases and conditions. Of course, toxins are indeed a bad thing, and we close-minded reductionist “allopathic” physicians do indeed use detoxification when appropriate. What differentiates us from “alternative” medicine practitioners is that we have this extremely annoying tendency (annoying to alties, that is) to want to know exactly what toxins we are dealing with, to verify that they are present in concentrations that can cause problems or damage before instituting any sort of treatment for them, and then to tailor our therapies to remove the specific toxins causing symptoms and to verify that we are successful. Not so for the “detoxification” as practiced by so-called “complementary and alternative medicine” (CAM) practitioners. CAM “detoxification” most often does not specify which “toxins” are being “detoxified,” or when it does it is intentionally vague about them. Occasionally, they will get specific (mercury as a cause for autism), but the problem with specifying a “toxin” as a cause for a disease is that doing so allows for falsification; it also allows scientists who know something about the disease to assess the specific toxin as a cause for a disease for biological plausibility. Not surprisingly, rarely is the mechanism biologically plausible.

It occurs to me that just because someone is uninsured does not mean they are not getting adequate health care.