I was speaking the other day with a friend who is contemplating a different type cancer treatment, one that is neither chemo, nor radiation. She has reacted badly to both, so they simply aren’t an option for her. Her doctor highly recommends this third type of treatment, which he believes will provide an optimal outcome, with the lowest level of stress to her body. The treatment has been used successfully all over the world — except in the U.S. The problem is, the FDA won’t approve it. If my friend wants this treatment, she’ll have to leave the US for Mexico or India.
I have a real problem with the FDA. As originally formed, it was intended to provide baselines for Food and Drugs, below which the consumer was imminently at risk. This was a reasonable mandate. As you may or may not know, one of the triggers for the FDA’s formation was the occasion when a pharmacist, back in the days when pharmacists made their own medicines, mixed ethylene glycol, aka antifreeze, into a children’s medicine to make the flavor more palatable. Large numbers of children sickened, with way too many dying.
Somewhere along the line, however, the FDA changed its own mandate. It went from trying to provide minimal safeguards for consumers to trying to ensure that every product placed on the market is perfect and risk free. Of course, that’s not possible, and the FDA knows it, but it keeps trying with ever greater demands. The result is that medicines and treatments that could work never make it to the consumer.
The FDA will say that these medicines and treatments carry risks, but so do all the medicines and treatments. Heck, have you ever gotten a prescription recently that didn’t have thousands of words of fine print detailing every possible side effect that could ever happen? In fact, these things are usually so chock full of information, they’re unintelligible. A nice example is the info sheet for Ambien, a quite innocuous and very helpful sleeping pill.
I bet that, if you’re having trouble sleeping, you’ll wade through all that Ambien info and decide that it’s worth trying out. If you’re unlucky, and sensitive, you’ll get the side effects. If you’re lucky, not only won’t you get side effects, but you’ll sleep well for the first time in forever. The important thing is that, armed with the information and your doctor’s recommendation, you made a choice.
The FDA not only bars drugs, it also bars treatments (especially cancer treatments) that might not work. How about allowing the treatment, but mandating that the provider clearly explain to the patient that the FDA thinks it won’t work or spelling out clearly what the risks are? This would be similar to the warnings on cigarette packages — you know, the ones that say, it’s a free society, and you can buy cigarettes if you want, but you should know that they’ll probably end up killing you. People still smoke in America, but many fewer than when I was growing up. Freely available information changed people’s behaviors.
Imagine a cancer patient who, for whatever reason, is not a candidate for either chemo or radiation because his reaction to them is so severe it’s likely to kill him before the cancer does. There is a third option available, one that has fewer side effects, but is also less likely to cure him. Because, in this hypothetical, information is readily available about the treatment, he knows it is not a miracle cure with no risks. Still, it might cure him, and he’s willing to pay the price for that chance. Unfortunately for our sufferer, the FDA won’t approve it, because it’s less effective than chemo or radiation. (I.e., it’s not perfect.) That leaves the patient with only one other option: no treatment and certain death. I’ve framed this as a hypothetical but, if you circle back to the top of this post, you’ll see that’s precisely what my friend is facing.
You see the exact same pattern — the bureaucrat’s ceaseless pursuit of perfection — when it comes to building codes. They’ve gone from minimal safety requirements to known risks (fire, earthquake, collapse from rotten wood, etc.), to dreams of glory that often make new buildings and remodels impossibly costly. We were thinking of adding a small stand-alone studio to our property, but gave it up when we learned that the building code required, among a hundred other things, that we make large parts of the studio wheelchair accessible — never mind that we don’t need wheelchair accessibility. Yes, we might later require wheelchairs, but if that need arises we can spend the extra money at that time. Or a prospective purchaser might demand wheelchair access, at which point we could, if we so desired, drop our sales price as part of closing the sale. The big question, though, is why am I being forced to include those expensive and, to me, unnecessary amenities now? Faced with the prohibitive cost, we abandoned our plan. That was too bad, since it would have improved our property, and have provided employment to a bunch of people during a recession.
This is not an aimless rant. It’s a rant that’s connected to government controlled health care. One of the things that’s been worrying all of us is the accountant’s mentality that will gradually constrict the identity of patients who are entitled to care: “It’s not cost effective for the government to pay for this cancer treatment for people over 70.” “It’s not cost effective for the government to maintain medicine for hemophiliacs.” “It’s not cost effective to provide intensive care for a newborn given a less than 50% chance of survival.” We’ve already seen this happening in other countries that have government run medicine, so we know it will happen here.
But what we haven’t thought about is that the bureaucrats’ penchant for perfection will also affect the way government care is managed from within, never mind the patients who qualify for treatment. That is, the government won’t just cut patients who might not have perfect outcomes. The government will also cut medicines and treatments that might not have perfect outcomes.
This treatment and drug cutting won’t come about with the announcement that the government is henceforth refusing to pay for Drug A or Treatment B because they’re imperfect. Nope. This will be a backdoor one. The government will promulgate more and more complex regulations, written in the abstract, regarding its expectations for drugs and treatments that will make the cut. Superficially, these regulations will make it look as if the bureaucrats in charge care deeply for us, because they want only the best, the most optimal, the most perfect drugs and treatments to touch the precious body of each American citizen. In reality, though, the bureaucratic quest for perfection, easy enough to achieve on paper, will prohibit entirely whole branches of treatment and medicine, since they will fail to meet the regulatory standards.
Voila! Death through bureaucratic perfection.
Incidentally, if you want to read more on the subject of impossible bureaucratic hurdles, I highly recommend an old, but not out-dated book, called The Death of Common Sense: How Law is Suffocating America.
One more thing: one of these days, this bureaucratic perfection is going to spread to the world of eugenics based, not on race, but on freedom from imperfections — with the imperfections being mapped out by the same bureaucrats. This isn’t going to be ugly, with mean spirited words about destroying the imperfect. It’s going to be dry legalize that carefully spells out the perfect babies the government wants to ensure its citizens have.
UPDATE: Right on time, there comes an article in my local paper about a rash of broken arms at brand new — meaning “totally up to code” — school playgrounds.