Special bonus multi-post

Yesterday I was kind of busy so this post will be enriched with extra vitamins.

First, NEJM today gives you a lot of freebies on health care policy and reform. Scroll down toward the bottom portion of the page to find it all. Arnold Relman is especially good and succinct as he explains the fundamental problem of Provider Induced Demand, which is one of the reasons why health care is not anything like the fictional "free market" they indoctrinate college kids with. We don't know any better, so doctors tell us what we need, and they are paid to do more stuff. A different approach to paying for health care is needed. I've hammered and harped on that a lot here, but Relman is a good explainer. Lots of other good stuff there, including Jacob Hacker on why "cooperatives" are no substitute for the so-called public option. It even has a poll, so go there and freep that poll!

Next, sorry to have to frost your pumpkin, but don't get too excited by the much-ballyhooed HIV vaccine "breakthrough." It's always unseemly when researchers run out and talk to the press before they've been through peer review, and under the circumstances I can't even judge the merits of the trial design. But, assuming it has no methodological flaws and the results mean what they seem to mean, they don't mean much.

The degree of efficacy shown -- reducing the incidence of infection by less than 1/3 -- is very far short of supporting actually using such a vaccine. Actually, just eyeballing it, it's probably marginally significant anyway. And the follow-up is only 3 years. The problem is, if you start giving such a vaccine to people, it will cause many of them to rationalize that they are protected so they can engage in unsafe behavior. It could even be counterproductive. Furthermore this targets strains specifically circulating in Thailand. It might not work on other strains, and even the Thai strains could evolve away from it. Whether this actually raises the likelihood of a truly useful vaccine anytime soon is unclear, but count me as doubtful.

Finally for now, another open door crashed through, this time by creeping socialism. The president of France hired Amartya Sen and Joseph Stiglitz to create a "provocative new study" finding that the widely used Gross Domestic Product is not actually a measure of economic well-being. Since Sen has spent the past 30 years saying that, it's not a big surprise that he said it again. So have a lot of other people, including everybody who isn't sitting on his or her own shoulders. I especially want to acknowledge Hazel Henderson, who gave me her book Creating Alternative Futures in 1978. She used to say that GDP stands for Gross Domestic Problem.

This is another issue I've harped and hammered on here but come on, it's obvious. GDP counts costs and ills as goods. When a hurricane wipes out south Florida, GDP goes up because people have to buy building supplies and hire carpenters. Their houses are gone, but GDP doesn't even notice that. When somebody buys cigarettes, that adds to GDP. When they get cancer, it adds even more because they pay doctors and hospitals and drug companies and ultimately morticians. When one person is paid $40 million in a year and another makes $5/hr., GDP per capita is $20 million, which sounds great, doesn't it? When you pump oil out of the ground, 100% of the price of the oil is added to GDP, but the oil is gone forever -- which GDP again doesn't notice. And on and on and on. Yet when GDP goes up, the corporate media say the economy is healthy. That has always been bullshit, always will be bullshit, and we have always known it. Repeating it doesn't seem to do any good, however. The culture gives it a nod and then forgets all about it.