Saturday, June 23, 2012

You, Your Health, and the Government

How far should the arm of government extend where individual health is concerned.  There is the argument that government has a vested interest in the health and welfare of its citizenry.  That is a fact.  After all, there is money involved - your health and the maintenance of your health affects government expenditure as well as that of the private insurance sector - and more.

But The Blog is asking you to put the cost factor aside for the moment, and consider only the concept itself.

Does a government have the ethical right to regulate the health of its citizens?  Is it the function of government to monitor how we eat, what we eat, whether or not we get proper physical exams, whether or not we get appropriate blood tests, whether or not we smoke, use drugs, or drink alcohol, exercise, etc.

A government has the right and the responsibility to protect its citizenry from the behavior of those whose habits may interfere with the health of others -  but not when it affects only an individual's own health and well-being.  If smoking, drugs, etc. negatively affect the health and welfare of the non-user, then these forms of behavior should be appropriately restricted or banned.  What one eats, when one goes for a physical examination, whether one exercises, what blood tests one obtains, how one wishes to be treated or not treated for a disorder, is not in a government's realm of responsibility!  Even the wearing of seat belts or safety helmets goes against the concept of individual rights - the only one who is affected is the non-wearer - no one else.

This is not to argue that the government, or any private corporation should not invoke methods to encourage individual health and well-being.  The government can demand that seat-belts be available in all cars.  An insurance company can vary premiums depending on whether seat belts were properly applied or whether clients are smokers.  A government and an insurance company can encourage healthy life-styles by tax deductions, credits, and premium adjustments.

So consider what a government should be permitted to actively restrict or ban.  Forgetting the cost factor, shouldn't you, and you alone be responsible for your own well-being.  You may not, however, while participating in unhealthy behavior, negatively affect the health and welfare of those around you.  It is to this latter function that governments should confine their regulations.

But what to do when considering the issue of cost?   How big a factor should this be in a government's application of regulations regarding individual health maintenance?

Tuesday, June 12, 2012

"Carrots" and "Sticks" in Behavior Alteration

OK, so Mayor Bloomberg and his activist Health Commissioner have decided to improve the health of New Yorkers by prohibiting certain establishments from selling sugar-containing soft drinks of a certain size.  Good luck!  Not only do such methods almost never work, this particular prohibition really infringes on individual rights.  Shouldn't a person be permitted to engage in behavior that, though potentially self-injurious, is not harmful to others?

Look at how well we all did with our drug and cigarette laws.  Tobacco smoking continues,  as does illegal drug use, and with all the years of knowledge of  its negative health effects, it remains the largest cause of potentially preventable disease in the United States.  Yes, the number of adult smokers in the U.S. has decreased since 2005;  from 20.9% all the way down to 19.3%! (CDC statistics)

Despite all the advertising about the horrors of cancer, heart disease, COPD, obesity, diabetes, drug addiction, and more, we go on with this behavior.  As long as these desirable agents exist, we will continue to use them.  If we make their possession, or sale illegal, we will find a way around the law and purchase them illegally.

Why do we do this  Why do we participate in what is known to be "bad for one's health?"  Easy - because we are human beings - and that is how human beings behave.  Humans take chances that they feel are reasonable - and hope they come out ahead!

But Dr. Balaji Prabhakar, a Stanford University professor of computer science thinks he may have found a better way to alter human behavior - a method that is distinctly human and very persuasive.  A "carrot" approach rather than a "stick" approach.  Humans are risk-takers and love to gamble.  Actions in the face of bad behavior are, in fact, forms of gambling.  When participating in these bad habits, we are gambling that they will not impact us adversely - and its a good bet, because despite these poor habits, most of us will not be affected in a major way for most of our lives, if not forever.  Dr. Prabhakar considers the "carrot" approach rather than the "stick" approach as far more advantageous in the transformation of behavior.

In today's Science Section, The New York Times reports how he has incentivized drivers ("carrots") to alter their commuting habits when going to work.  Participants are entered into a lottery with the chance to win extra pay when they shift their driving times to off-peak hours, thereby alleviating congestion.  The program has reportedly been very effective.  He has also proposed a program akin to frequent-flyer miles (or maybe even actual frequent-flyer miles) as a possible incentive.

Animal trainers know that using "carrots" rather than "sticks" is what works best.  "Sticks" are apparently not very effective in altering human behavior either, but give a man a "carrot" and you  actually may be able to change him.   

Thursday, June 7, 2012

Recognition of Gov. Scott Walker's "Re-election" in Wisconsin

"The Message From Wisconsin" reads the headline of the lead editorial in todays New York Times.   As you probably know, the people of the State of Wisconsin had petitioned successfully for the recall-election of a duly elected sitting governor for reasons unrelated to any malfeasance in office, but because of his purported "anti-union" stand in attempting to balance Wisconsin's budget - in effect keeping a promise he had made in his campaign.

The recall was successfully rebuffed - Gov. Scott Walker remains the governor of Wisconsin.  Why?  Two reasons, says the Times in this editorial - 1)Democrats nominated "the wrong candidate," and 2)Contributions in "excess of $45.6 million" to Gov. Walker's campaign.

Nowhere in the editorial is it even remotely suggested that perhaps the majority of the people of Wisconsin actually agreed with Gov. Walker's policies, or that the concept of recalling a sitting governor, in office only two years, fulfilling his campaign promises and with no evidence of wrongdoing, is just counter to the way democracy works.

That is not to imply that the causative factors cited by the Times are not to be taken into account.  But to totally ignore other reasonable possibilities is not fair.

It should be clear that Gov. Walker's efforts to restrict or eliminate collective bargaining did not affect private unions at all.  It applied only to unions in the public sector.  It was not intended to eliminate unions, but to only eliminate collective bargaining rights regarding wages and benefits.  Many states and localities do not permit public employees to bargain or strike.  As President Franklin Roosevelt said:

 "All Government employees should realize that the process of collective bargaining, as usually understood, cannot be transplanted into the public service. It has its distinct and insurmountable limitations when applied to public personnel management. The very nature and purposes of Government make it impossible for administrative officials to represent fully or to bind the employer in mutual discussions with Government employee organizations. The employer is the whole people, who speak by means of laws enacted by their representatives in Congress. Accordingly, administrative officials and employees alike are governed and guided, and in many instances restricted, by laws which establish policies, procedures, or rules in personnel matters."

Courts have held that public employees hold a "property interest" in their jobs giving them an advantage in that they have a constitutional protection against any arbitrary and unjust actions beyond that of employees in the private sector.  The argument continues that public employees cannot bargain or strike against the "public," namely themselves.  Government is not business - it represents taxpayers, not shareholders.  The public can sell shares of a company with which they disagree but cannot "sell shares" in a government organization.  The government provides certain necessary welfare and safety services (e.g. police, fire, army, navy, etc.) which, if a strike were to occur, could not be replaced by "outside workers."

Sure, money and personality affect all elections, but perspective and fairness are important.  Gov. Walker is still Gov. Walker.  He deserves the recognition that his "re-election" may very well be the result of support for his policies, and not that of complementary factors.

Wednesday, June 6, 2012

Sam Harris and Free Will

The philosopher, neuroscientist and renowned atheist Sam Harris has recently expounded his philosophy of "free will," or to put it more clearly, the lack thereof.   In his latest book "Free Will" he states his viewpoint that the "belief in free will has given us both the religious conception of 'sin' and our commitment to retributive justice."  Harris maintains that it is the total biological makeup of the brain and mind, not a metaphysical cause that is responsible for actions.  He cites evidence that advanced brain imaging and recording have shown predicted activity before an individual is even aware of an action which he is about to perform.

He gives the following example to ponder:

1.  A 25-year-old man, raised by wonderful parents and never abused, intentionally shot and killed a young woman he had never met "just for the fun of it."
2.  A 25-yeard-old man with an absolutely identical background performed exactly the same act for exactly the same reason, but an MRI shows a brain tumor in the region considered responsible for behavior and emotion control.

Both acts are controlled by the brain, but, though the outcome was the same, the outrage we feel is mitigated by the tumor in case No. 2.  Even though the action in case No. 1 is in all likelihood also secondary to some brain malfunction, we have a different moral reaction towards it.  It is also quite possible that the tumor in case No. 2 was not the primary etiology for man's actions, but was merely a "bystander," and the malfunction is, in fact, identical to that in case No. 1.  And, finally, before technology gave us MRI's and PET scans, the tumor may have easily gone undiscovered and the Case No. 2 perpetrator considered in a manner identical to that of Case No. 1.

Cerebral malfunction can be considered as a cause of the "conscious intention" in both cases, with the causative disorder in Case No. 1 yet to be fully explained. But, recognizing that a future physical etiology may be discovered to explain the actions of Case No. 1, should not our compassion be extended equally to both of the individuals?  Shouldn't the "psychopath" be considered in the same light as the brain tumor victim?

This is not intended to argue that  individuals may not be a danger to society and may require separation from the general public, free will or no free will! As sympathetic as we may be towards the man with the brain tumor, if he were incurable and untreatable, incarceration would still be required.

Incarceration, or separation from society, is quite different from punishment.  One cannot punish an individual whose "physical disorder" was responsible for his negative actions.  We need to separate the  "treatable" by punishment from those "untreatable" by punishment.  Like any other known physical disorder - some are treatable and curable, and some are not.

"Free will" and "morality" may be terms presently needed to describe behavior on a metaphysical basis, though what may be the true "physical" explanations are yet to be neurologically mapped and determined.