Category Archives: Hospital

Last October we were expecting to hear a round of regulations that would determine the brave new frontier of vaping, but nothing game. It’s expected that it will come soon. Ordinarily, I’d fear the silence. In this case, though, I wonder if longer isn’t a little bit better. It all depends. At this point I believe the facts are on the side of less regulation and more thought out regulations will be more measured, though it seems a bit like the anti-vaping crusaders are gaining some traction.

Megan McArdle wrote a reasonably good piece on ecigarettes. In which she speaks to the fear:

As nothing but a replacement product for existing smokers, e-cigarettes seem like a public-health win. Widespread adoption by current smokers “could potentially reduce smoking deaths by more than 90 percent,” says Joel Nitzkin, a public-health physician who is a senior fellow at free-market think tank R Street in Washington.

But what if current smokers aren’t the only people who use them? What if e-cigarettes lure back people who used to smoke or attract new smokers? What if people who otherwise would have quit keep using nicotine? And perhaps the No. 1 argument: What if e-cigarettes make smoking normal again in public places, with the attendant annoyance of a neighbor or officemate blowing nicotine-laced steam everywhere?

What is really frustrating is that we don’t know. As important as anything, we don’t even know if there will be much wrong with people choosing to vape. Almost all of the anti-vaping sentiment is based on potential and hypothetical dangers. Well, it’s hard to argue with potential and hypothetical. It’s hard to argue with the notion that vaping may be dangerous, because it’s hard to prove a negative. Tests on propylene glycol, one of the chief ingredients of the eliquid, have been performed because that’s what they use for theatrical fog, and it was found to be safe. They have tested this stuff on animals saturated 24/7 for extended periods of time (eighteen months) and they found minimal consequences (reversible dehydration of the nasal and ocular areas). The head of the FDA himself has said that nicotine addicts you and tar kills you. Ecigarettes do not have tar.

I have previously expressed some skepticism of the health consequences of these things, taking the middle ground that while they’re not nearly as dangerous as the critics claim they’re probably not as safe as the advocates say. The more I’ve read, though, the more confident I am that the health threat is likely very minor to non-existent. The advocates’ claims are based on study after study after study, while the opponents claims are based on hypotheticals. Not even hypothetical models, but vague statements about what we don’t know.

Which brings us to the next argument, which is that it will prevent people from quitting smoking or quitting nicotine. In the case of the latter, if the health risks are so marginal, should we really care? In the case of the former, that could be bad, save that there is no real reason for it to be true. According to a UK study (STS140122) on cigarette, ecigarette, and NRT (nicotine replacement therapy – the gum or patch), “There is no evidence that electronic cigarettes are undermining motivation to quit or reduction in smoking prevalence.”

It goes on to say: “Use of e-cigarettes by never smokers or long-term ex-smokers is extremely rare.”

It does not provide any data on people starting with ecigarettes and moving to the regular kind, which is another concern (supported by hypotheticals). Speaking from a personal perspective, once you’re using ecigarettes and get the regular cigarettes out of your system, the latter becomes superfluous. I can quite honestly say that I have no desire to pick up a real cigarette at all. What I’m doing now isn’t just healthy, it’s more enjoyable. Vaping offers advantages that smoking can’t match. Including, I should add, the very flavoring that the anti-vaping advocates want to ban. Not to mention the ability to do it in more places, though right or wrong anti-smoking crusaders are going after that, too.

In other words, due to their anti-smoking zeal, they are methodically trying to reduce incentives to take advantage of an amazing new tool to help people quit. Even if they don’t quit the vaping, they’re still ahead. Arguments otherwise assume that if they can’t vape they will quit For Real. They remind me of my father who, on finding out that I had indeed quit smoking entirely and was now vaping, wondered if I could just quit without vaping. The last eight years of my life indicate otherwise. Strongly.

And on a more personal level, by god I have found something that works for me. Not just because I don’t smoke anymore, but because it allows me the ability to continue to do the things that drew me to smoking in the first place. I may quit the ecigarettes or I may not. But I have finally found myself not having to obsess over this question. Do you know how amazing that is? A world has been lifted from my shoulders. The monkey that has been on my back for years and years is gone. At worse, replaced by something by all measures benign by comparison. It makes me want to kiss the skies. And it makes me furious at those who see this as some nefarious new threat to the public health.

Right now I am just waiting to find out how bad it’s going to be. Whether the thing that right now costs me twenty-five cents a milliliter will shoot up to seventy-five cents (a very real possibility). Whether the people I get my supply from will be allowed to remain in business. Whether I am going to have to throw everything out and start all over with an FDA-approved device. I’m concerned about the number of people out there who could take the same path as I did to recovery, but as much as anything I just want to keep doing the thing that has put more distance between me and cigarettes than I have had in over ten years. Or whether it will be made more complicated and disrupted with right-now unthinkable consequences. In the name of public health. In the name of my own well-being.
(more…)


Category: Hospital, Statehouse

Even the New York Times seems to have been exasperated over the New York City Council’s recent debates on vaping:

In a city where the technocratic mayor prides himself on making decisions based on the evidence, the proposed ban produced one of the most scientifically vague and emotionally charged health committee hearings in recent memory. Anyone who used the word “smoke” or “smoking” to refer to electronic cigarettes, which typically contain nicotine, was instantly corrected by audience members hissing “Vapor!” and “Vaping!”

The health commissioner, Dr. Thomas A. Farley, said electronic cigarettes were such a recent invention that he could not say whether they were hazardous to the health of those smoking them or those who might breathe in secondhand vapor. He said that they do put out fine particles and chemicals, and “I certainly can’t guarantee that that is safe.”

And what we do when we can’t “guarantee” something is safe… we here in the land of the free ban it. Of course, ecigarettes are not banned, but only because a judge said so.

To be fair, it’s hard to have a scientific discussion when the evidence, pro or con, simply isn’t in yet. I have said before that I expect we will find out this thing is more dangerous than its advocates suggest for vapers. But I also think it will prove to be fine for non-vapers, no matter how much Of course, after years and years of hearing about how smoking bans were justified because of the physical dangers of second hand smoke. That threshold – a reasonable one within limits (family restaurants, yes, entire college campuses, no) – has been lowered to “I don’t like it” and “it makes me uncomfortable.”

The other two arguments are (a) it brings “smoking” back into the public eye which will entice children and (b) “bartenders and staff can’t tell the difference between cigarettes and these things.” In the case of the former, this could be avoided by pushing smoking out of the sidewalks and into the bars. In the case of the latter, as with the discomfort, that’s a fair reason for an establishment to ban them, but not a reason for City Council to get involved.

But, of course they have to because Big Tobacco and Big Tobacco’s invincibility. Big Tobacco, which hasn’t really won a political battle since… I don’t know when. Hookah lounges are still legal in NYC, but vaping lounges are more important because… it’s harder than targeting establishments primarily operated and patronized by Middle Easterners?

Having said all of that, the people who were vaping in the council session? Bad messengers. Terrible messengers. The same applies to a lot of vapers who seem to get a thrill out of being in-your-face about it because they can. That’s a good part of the reason why they won’t be able to for much longer. While “it makes me uncomfortable” isn’t a sound basis for a law, it is more than a sound basis for common courtesy. Smokers lost the smoking ban wars in large part because of their own lack of courtesy. Vapers are positioning themselves for the same fate.

Which I fully expect to happen. This is a certain loss. At this point, the real battlefield is (a) keeping it legal, (b) keeping the flavor spectrum as wide as it is now, and (c) keeping Internet sales as open as possible.


Category: Hospital, Statehouse

Silk Spectre SmokingWhile back home, we went out to eat on the outskirts of the metro area in a town that allows smoking in restaurants (which is, of course, increasingly rare). It was an odd experience. They had a smoking and a non-smoking section, separated by nothing. Mom – who doesn’t smoke at the table anymore – made a comment about it. Which the guy smoking overheard and misinterpreted as a complaint and moved tables further away. It’s amazing how increasingly trained smokers are becoming.

It’s been a long enough time since I have had a cigarette that I stopped counting.

I’ve been increasingly impatient with Blu brand ecigarettes, though. The batteries seem to die too fast and I seem to be spending almost as much on replacement batteries as I am on cartridges. While saving money was not the reason for my transition from analogs to digital cigarettes, it was frustrating to watch the “savings” dissipate (Like smoke! Or vaper! Haha).

The reaction among the family has been mixed. My father wants to know when I am going to quit these things. My father-in-law, who hates cigarettes far more than anybody in my family, is quite supportive. His best friend made the switch and he was comfortable with them. He even came out to talk to me while I was vaping, demonstrating how non-offensive/non-existent the odor is.

Unlike when I was smoking, I made no real effort to minimize or hide what I was doing. Which actually felt quite nice. I would simply say “Hey, I’ve going to go outside and have a puff” and would go.

eCigBountyHunterAs it happens, my wife’s cousin’s husband is in a similar boat as myself. He made the transition a couple of years ago, though. So we chatted about that. Both of us were struck by how inconvenient we hadn’t realized that smoking had become. Both of us with wives that don’t like it and now kids (a new thing for me, not for him). You smoke, you come in, you wash up, you maybe change a shirt. Multiple times a day. Smoking jackets when it’s cold, smoking shirts when it’s not. You come up with all sorts of ways to minimize the impact of your habit on those around you, which in our SES is becoming almost entirely comprised of non-smokers.

He got started the same way that I did, with Blu. We had similar complaints about Blu and that told me that I really needed to try to find something else because it wasn’t just me. Blus look like regular cigarettes, more or less, which make them ideal for replacing the habit. Extra points because they’re extremely convenient and you can deprive yourself the excuse of smoking because you ran out of cartridges (you can just go to the convenience store and get new ones).

The Halos, which he had switched to, looked nothing like cigarettes and feel, if anything, like robotic cigars but not really. Honestly, what they remind me of are the cigarette thingies from Watchmen. Except that you are using a battery instead of a lighter to get the fluid to get things going. Okay, so they don’t look all that much alike. But I think of Watchmen every time I look at the tank on the thing.

It also reminds me a bit, oddly, of the “The Second Rennaissance” from Animatrix, the animated accompaniments to Matrix. In that, they told you the story of how the humans got displaced by the robots. Early on, when humans were in charge, the robots were made to look as much like humans as possible. Over time, as they started building themselves, they became more utilitarian in less human-like.

indoorsmokerI needed to start with something that looked like a cigarette. Both as a matter of conquering my habit and to alleviate self-consciousness. Now that I can point to these things as having completely displaced my tobacco habit, though, I am beginning to care very little. No, these things don’t look like cigarettes. They look like something that works better than the ones that look like cigarettes do.

I ordered Halos as soon as I got home. They couldn’t have arrived too soon. The night before, I was scrambling about trying like heck to find some battery-cartridge combination that would give me my nicotine hit and put me at peace with the world and nothing seemed to work. With the exception of the snow day, it was the first time I found myself saying “I need a cigarette!” (because… no mechanical failures with those!). Had the Halos not been arriving the next day, it’s conceivable (though not probable) that I would have had a complete relapse.

But the Halos are thus far working great. The batteries last longer. The puff is stronger. I can see how much fluid is left in there and I can fill it myself. It will be much cheaper in medium and long term. (1ml of fluid from Blu costs roughly $2. 7ml of standard fluid from Halo costs $6. 30ml costs $20.) The only real downside is that it’s much more conspicuous and slighly less convenient… but I have little reason to care about the conspicuity and if I find myself in a jam I can go out and get a disposable. And I’ll still have my Blu stuff.


Category: Hospital, Market

Many of my liberal friends are gloating over a report by the HHS, explaining how awesome PPACA (“Obamacare”) is going to be. Lots and lots of people are going to get insurance for really cheap! Yay! This will be a success!

Meanwhile, the Weekly Standard takes issue with these numbers. They cite the American Action Forum, who claims that the data is faulty and misleading. Boo!

A few weeks ago, we were having a very similar conversation. Liberals talking about how much was going to be saved, conservatives about how that’s not the case.

In a way, you’d almost think that it would be the other way around. Because, within a year’s time, we’re going to find out whether PPACA raises or lowers consumer costs. And if people believe the liberals now, they’re going to be really disappointed to when the rates that were supposed to go down end up going up or staying about the same. But if they believe the conservatives, they’ll be thrilled when rates don’t end up going up after all.

So what’s going on here? There are three possibilities: One good, one middle, one bad.

It’s possible that this isn’t framing at all. Rather, liberals genuinely believe that Obama’s law is a good one. They believe it – or want to believe it – so much that they’re latching on to any indication that it is the case. And on the other side, conservatives genuinely see disaster. So when Avik Roy releases numbers suggesting that consumer costs will go up, that is vindicating.

The middle is that everyone is itching to be right and nobody wants to admit that they’re wrong. This isn’t ideal, because the truth doesn’t care what we think and this represents a blind spot. But neither is it all bad. Everyone is more or less lining up behind what they believe.

The depressing possibility is that since nobody knows for sure what’s going to happen, everyone still is actually trying to frame the narrative. While the dangers above are real (each side setting expectations where a middling result will make people feel the opposite of how each side wants them to feel), in all likelihood the results are going to be muddled. Some people will save money in even the most pessimistic scenario. Some people will have to spend more even in the most optimistic scenario.

So then it’s ultimately about thwarting the truth, whatever it is. Laying the groundwork so that if costs go down and people save money, conservatives will be vindicated by whatever minority of people finds themselves in a worse spot and suggesting that said minority is actually the typical case. Likewise, if almost everybody ends up having to spend more, the liberals will have laid the groundwork to argue that we shouldn’t believe our lying eyes and bank accounts.

I offer no hard prediction on what is going to happen. I am preparing for the worst. Perhaps because in the end I couldn’t get on board with PPACA and so want to be vindicated. But mostly, I think, so that I will be pleasantly surprised if I am wrong and won’t be too disappointed if I am right.


Category: Hospital, Newsroom

At least, not for ex-smokers and quit-smoking weight gain:

Here’s an article on the subject.


Category: Hospital, Kitchen

Hospital Room

A couple weeks ago, I linked to an article talking about the PPACA’s Exchanges – the mechanism by which those with pre-existing conditions will be insurable. Rick Ungar said:

Upon reviewing the data, I was indeed shocked by the proposed premium rates—but not in the way you might expect. The jolt that I was experiencing was not the result of the predicted out-of-control premium costs but the shock of rates far lower than what I expected—even at the lowest end of the age scale.

Not just that. Claims were being made that rates would be lowered. And for some, they might. Mike Schilling commented:

My company just had our annual health-care enrollment meeting, and it was the usual: less coverage at a higher cost. But with a possible silver lining: since we’re demographically unfortunate (a small company with a high proportion of older employees), moving over to the exchanges might help us a lot.

This all left me feeling great. Even though I came down against PPACA, it was a relatively close call and the exchanges were one of the aspects that I had hope for. I wasn’t stunned to read that costs were coming in below expectations (though I wouldn’t have been stunned the other way, either).

Why do the exchanges matter so much? Because if the exchanges work, it’s game over for the health care debate as far as I am concerned. We have our health care system, and it’s only a matter of figuring out how to transition from employer-subsidy to government-subsidy. Then, bam! We’re done.

So it was a real let-down to read Avik Roy’s piece, pointing out that the numbers suggesting savings were based on faulty comparisons:

[F]or the typical 25-year-old male non-smoking Californian, Obamacare will drive premiums up by between 100 and 123 percent.

Under Obamacare, only people under the age of 30 can participate in the slightly cheaper catastrophic plan. So if you’re 40, your cheapest option is the bronze plan. In California, the median price of a bronze plan for a 40-year-old male non-smoker will be $261.

But on eHealthInsurance, the median cost of the five cheapest plans was $121. That is, Obamacare will increase individual-market premiums by an average of 116 percent.

For both 25-year-olds and 40-year-olds, then, Californians under Obamacare who buy insurance for themselves will see their insurance premiums double.

Now, Roy’s comparisons themselves are imperfect. Twenty-five year old, non-smoking men, are not the best basis from which to judge. And for the 40 year old, he’s not clear but it appears he is comparing the cheapest available plan and not comparable plans. On the one hand, the sudden unavailability of inexpensive plans is significant, but on the other it’s not a true apples-to-apples comparison (if I am reading Roy correctly).

But it was enough to convince me that, except for various cases of PECs and cases like Mr. Schilling’s, rates will go up for most people. This was confirmed by the many responses to Roy, which despite their criticisms (and in some cases calling him names) did not contest his central point.

Ezra Klein argued that stated rates were misleading because some people paid more and some couldn’t get coverage, and that people will get subsidies. He seemed to concede the point that rates will go up for most people, but that this is a necessary sacrifice. Whether that’s true or not is a value judgment. There’s nothing at all wrong, in my view, taking the view that higher premiums are worth it for more consistent coverage.

But that wasn’t what we were hoping for, that wasn’t what was sold to us, and that wasn’t what the initial reports had lead me to believe. So I remain disappointed.

Roy responded, pointing out that the subsidies won’t take care of it. He further argues, along with Will Wilkinson, that the rates for the young and the healthy actually matter a great deal. Because if it’s not considered affordable, they won’t sign up. And if they don’t sign up, we don’t avoid the death spiral that the mandate was put in place to prevent.

Now, that the exchanges didn’t work as well as I had hoped is not really an indictment of PPACA. It may negatively affect my opinion of the law, but I wasn’t a supporter anyway. And that the exchanges didn’t work in this context doesn’t actually mean that we couldn’t try to run a system off a similarly market-based idea. It’s possible that if we put all the healthy working people that are currently on employer plans into the general market, that rates could go down.

Unfortunately, the confirmation of that I was hoping for did not materialize.


Category: Hospital, Statehouse

I turned in a pretty lackluster day today substitute teaching. The class itself wasn’t the issue. They weren’t perfect – what second grade class has perfection – but on the whole they were better than expected as students of the school in question and given a gender imbalance (2/3 boy) that always makes me nervous.

But I was exhausted. I have been for several days now. I’ve been getting less than six hours of sleep a night for almost a week not. My days over the last couple have included some exhausting chores (driving a lot of miles in uncomfortable conditions). It was hard to keep moving around the room (and second grade demands it). I had a lot of difficulty retaining any sort of focus.

On the drive home, I was reminded of the things that my wife, and doctors like her, are expected to do on a lot less cumulative rest than I’ve had.

It’s a rather good thing that she is taking the maternity leave she is in light of the newborn coming our way later this month. I hear newborns sometimes cut down on quality rest.


Category: Hospital, School

We were pretty late in filling out our 2010 taxes, because the student loan people couldn’t get us the information that we needed. But we are supposed to be getting a refund in the ballpark of $12,500 dollars. I’m beginning to wonder if that money isn’t fictitious. When I filled it out, I requested Direct Deposit. Apparently, if you’re post-deadline, they can’t do that. So I sent it in by mail. A month or so later, we got a letter saying that they couldn’t do direct deposit and that they would be sending it to us by mail. Contact them if it hasn’t arrived in 3-4 weeks. 5-6 weeks later, and it still hasn’t arrived. So I call the IRS. They tell me that they’ve sent it before they even sent the letter saying that they were going to send it. So now I have to fill out a form to inquire where the check is. They will then investigate and get back to me. That’s going to be another 6-8 weeks. The only problem is that I didn’t write down the information on which day they sent the check, which the form needs. So now I am going to have to call the IRS again.

I’ve also been having to make calls to various banks, cancelling the credit/debit cards on my lost wallet and requesting replacements. Three cheers for Discover, who had a new one out to me in two days. By two days, I thought they meant three. I thought that if I called on Sunday, they’d mail it out on Monday and it would arrive on Wednesday. It arrived early Tuesday. The Bank of the Northern Hemisphere was less responsive, giving me what I had expected from everybody: either five to seven (for debit) or five to 10 days (for credit). The cards are coming from Lakota, which is in our mailing unit, so I’m hoping it’ll be close to the former. This is important because I will be heading to Vegas on Wednesday and it would be helpful to have more plastic rather than less (though never again will I have all my plastic in a single wallet. Back to Discover, the only annoying thing about that process was that, when it came to activating my card, they made me talk to a live person who had a script about asking me what I loved about my Discover Card. I truthfully answered: “You got me a new card in two days.”

The last round of phone involved medical bills. Evidently, our insurance company carries nothing when it comes to pregnancy. I’ve never seen so many “Insurance payments: $0” in my life. In the first case, they simply didn’t have our insurance information. So I played phone tag for four days while we tried to get that situated. After looking at all of the other bills, I am expecting that insurance won’t pay for anything anyway. There are arguments against insurance covering pregnancy, though it brings up one of my constant irritations with our health care system, which is that you never know if something will be paid for until after you do it.


Category: Hospital, Market

As Physicians’ Jobs Change, So Do Their Politics

They are abandoning their own practices and taking salaried jobs in hospitals, particularly in the North, but increasingly in the South as well. Half of all younger doctors are women, and that share is likely to grow.

There are no national surveys that track doctors’ political leanings, but as more doctors move from business owner to shift worker, their historic alliance with the Republican Party is weakening from Maine as well as South Dakota, Arizona and Oregon, according to doctors’ advocates in those and other states. {…}

Because so many doctors are no longer in business for themselves, many of the issues that were once priorities for doctors’ groups, like insurance reimbursement, have been displaced by public health and safety concerns, including mandatory seat belt use and chemicals in baby products.

Even the issue of liability, while still important to the A.M.A. and many of its state affiliates, is losing some of its unifying power because malpractice insurance is generally provided when doctors join hospital staffs.

Because doctors are, apparently, completely unaware that the medmal liability insurance that their employer has to pay on their behalf comes at the expense of the value that they add (and therefore the compensation they can demand) to the overall organization. Oh, and the reimbursements they make are completely unrelated to how much of a salary that they can expect. I can buy that these things are not as much on the forefront of their minds as they previously were since they are negotiated or paid by their employer, but there’s something in the air in Maine if doctors up there no longer think medical malpractice doesn’t matter to them. Or more likely, it’s not an issue there because the issue isn’t pressing because Maine has remarkably low malpractice insurance rates despite the lack of traditional tort reform.

It also entirely contradicts my experience. Even in tort-unfriendly states, frivolous lawsuits weigh very heavily on doctors minds. It weighs on my wife’s, despite the fact that her medmal is paid for. It matters above and beyond dollars and cents. It’s partly a matter of pride, wherein a doctor doesn’t want to have to explain to a jury of 12 people who know little of medicine while the baby didn’t have a chance while John Edwards is on the other side talking to the dead baby’s spirit. Maybe this is impossibly arrogant. Maybe this is foolish. But in the years I have been surrounded by doctors – some liberal, some conservative – I have never once heard that it’s not a big deal. If anything, I think that they are too obsessive over it. But then, that’s easy for me to say because it’s not my ass – and career – on the line.

Unfortunately, this “see, they’re coming around!” tone taints my view of the rest of the article. But really, I think that there is something to the article in its totality. Particularly in family medicine, which is disproportionately populated with women and less entrepreneurial men. But I wouldn’t be surprised if it’s happening more generally. Doctors are, I think, caught between two realities. The first is that they have lived in a very Republican world. They worked hard, they were smart, they got ahead. Others that worked hard and were smart got ahead, too. It’s a very meritocratic atmosphere. Then, when they’re out of their education and residencies and/or fellowships, they are thrust into a world where they have mountains of debt but are getting taxed like they’re rich. Further, they’re taking care of people who have often broken their own bodies through ignorance or gross misjudgment and expect someone else to put them back together (almost always having worked in charity hospitals, where the expectation is that you will do so on someone else’s dime). This all lends itself to a more conservative worldview. Even the liberal docs I know have suspicious attitudes towards those below the working class.

But on the other hand, there’s this: they’re educated, high-earning individuals. This group has been trending Democratic for a while now. Regardless of the merits of conservatism and the Republican Party, the peer pressure is leaning against it. The Republican Party has become increasingly embarrassing, on a social level. The party that went from embracing George H. Bush to embracing his son to embracing Sarah Palin. Yes, yes, conservatives can argue that George W. Bush wasn’t actually conservative or was a RINO, but among the friends and colleagues of educated individuals, that is not the perception. Medicine and engineering seem to be the last two strongholds of educated, white collar (or white coat, anyway) Republicanism. So, especially when considering the demographic shifts (women into medicine, foreign imports into engineering), it’s not surprising to see the movement.

Obama, whether by benign policy or crude politics, is making the transition particularly easy for primary care physicians. Regardless of our resistence to his health care plan, there is at least the sense that Obama “has our back” in a way that previous presidents did not. By “has our back” I mean the backside of primary care docs and their families. He named a primary care doc as surgeon general. His reimbursement restructuring favors primary care over specialists. At least rhetorically, he “gets it”. He also defines “rich” as income above what most primary care physicians will make (and those who do make that much are more likely to have been doing it a while and less anxious about it). If it’s all rhetorical or political posturing, it’s really quite shrewd. Driving a wedge between primary care docs and specialists isn’t particularly hard and primary care docs are more likely to be supportive anyway, for a variety of reasons (more likely to be female, less likely to be money-driven).

I don’t know how this would translate to specialists, though, and the extent to which the Democrats may be making gains there. Obama hasn’t been as kind to them, though he might not need to be. Since they earn a lot more than their primary care counterparts, they might feel less stingy when it comes to taxes as they can pay off their student loans and such a lot faster than primary care docs can.

Or it’s possible that the NYT is drawing a trend from nothing but some weirdness in Maine.


Category: Hospital, Statehouse

Britain is looking at eradicating labeling from cigarettes:

“The government accepts that packaging and tobacco displays influence young people, so there is no time to waste. It may take years to pass a new law on plain packs but the law on tobacco displays is already on the statute books and comes into force next year.”

Dr Alan Maryon-Davis, professor of public health at Kings College London, said: “It’s a very welcome statement from the health secretary and a good example of how the government can help people choose a healthier way of life by ‘nudging’ rather than nagging.”

But Simon Clark, director of Forest, a lobbying group that opposes smoking bans, described the move as a “cheap publicity stunt”.

He said: “There is no evidence that plain packaging will have any influence whatsoever on smoking rates. Also, the policy is designed to discriminate against smoking and stigmatise the consumer, which is totally wrong.”

Good.is does a mock-up. Truth be told, I wouldn’t mind that one bit. In fact, I consider it far preferable to the Australian method of putting graphic imagery on packs. I’ve thought to myself if the government ever does the latter, I will probably throw out the box upon purchase and put the cigarettes in something else. That probably means that it’s effective on some level. The Good.is mockups, though, wouldn’t phase me a bit.

More effective than that (though less effective than gangrene) would be to make them less rather than more plain. I don’t want to carry around a box that’s hot orange. Of course, part of the idea is for young people and they might be more likely to respond favorably to wild coloring. Of course, the boys will probably respond positively to gangrene as well. I was vociferously anti-smoking when I was 12, but I might have fished empty boxes out of the trashcan to see how many of the disease-boxes I could collect. Boys are like that.

Does packaging lure smokers? Well, there’s two questions. The first question is whether it entices people to smoke. That I’m not sure about, though it probably does have an effect on the margins. I’m not sure it has enough of an effect to justify the time it takes to enact this law, but maybe so. The second question is whether it entices people to choose a particular brand. It does. There are a lot of brands out there and two of the main brands I smoke, Maverick and USA Gold, got my attention with their box. Mavericks had, at the time, a really sleek black and gold box that was hard to miss. USA Gold had an interesting logo. However, while the packaging got me in the door, it was the taste that kept me there. With other off-brands, I never made it through the pack.

I am sure that the tobacco companies have some research on this. I wonder what it says. Given how opposed they are to the idea, maybe I am deeply underestimating the effects of packaging to youngsters. You might think that they’d be looking at this as a way out of paying marketers money without losing marketshare to the ones paying the marketers. But they don’t, either because it is effective or because they think their marketers are better than the other guys’.


Category: Hospital, Statehouse