The other NSA story not yet in the press

Discussion in 'Think Tank' started by The Internet, Nov 21, 2013.

  1. Rockyj Member

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  2. Kimbayah Member

    If Mericans view it as the world's biggest private library, would that make you feel better?
  3. JohnnyRUClear Member

    AGG has been doing a solid job saying pretty much what I would have, so "ditto" me to his recent comments.

    I'll take a crack at this one.

    Yes, in anarchyland, anyone can claim to be a doctor. However, everyone knows that. Thus, people regard a claim the same way they do now when seeing any ad on TV: they know it may or may not be true, and that it's a claim being made by a private party in a self-interested attempt to sway others' behavior. Grain of salt time, and dox-hunting time if there's interest in the claim. It is, of course, extremely naive to automatically accept such a claim, and doing so tends to reveal the folly (via poor results not living up to promises/expectations/market standards). So the pool of suckers self-thins automatically and continually. Also, a tricked customer becomes an angry ex-customer, and bad word of mouth drags down the quack's business. The more tricked customers, the more angry ex-customers, and the more bad word of mouth. So the pool of quacks also self-thins automatically and continually, if indirectly. Sure, new liars can always turn quack, but in the long run, quackery actually isn't a valuable market service, except perhaps in an entertainment aspect (a la horoscopes and "psychics"). When it comes to health, though, people actually want to be healthy. They don't want snake oil, and when they discover that they are getting snake oil, they stop buying it and start decrying it, leading naturally to its demise.

    What is valuable in the market is accurate information about what is snake oil and who is a quack. In the absence of a state, such information is free to circulate. Today, it has to compete against such political entities as the FDA and WHO. These entities give a false sense of security and create the opportunity for corruption via their (artificial, force-based) monopolistic positions within the market. Your comments suggest that you believe these entities keep us safe from quacks, and that everyone not approved by them is a quack, but I don't believe that is even remotely true.

    Ultimately, any valuable service which these entities can provide can also be provided by free market entities in anarchyland, without the coercion and monopolies. You want to know which doctors can actually claim to have performed operation X successfully on at least 100 patients? Well, guess what? So does everyone else seeking that operation. That is valuable information, and providing it is a valuable service, and that's what you find in a free market. People pay for what they want, and not what they don't (at least, not twice).

    The free market does offer quacks an opportunity to give it a go. Yep, it does, and sometimes they do. However, the state also allows this, only in order to access this opportunity, you'll need a lot more money for the requisite "access" to the appropriate "in crowd". But, once that's been established, the entire country gets misled by the monopoly. In the market, errors always start out localized, and have to survive the competitive process to grow more widespread. True remedies, too, start out localized, and have to survive the same competitive process, but with no monopoly to fight, they tend to survive better, since they actually work and successful results produce successful businesses.

    TL;DR: chaotic meritocracy FTW.
  4. Kimbayah Member

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  5. demarquis Member

    I find it helps, laughingstock, if you provide a quick summary or a quote from the article you link to. It encourages people to discuss it.

    From the article laughingstock linked to: "...The National Security Agency has an Achilles heel, according to some anti-surveillance activists. The key vulnerability, according to members of the OffNow coalition of advocacy groups: The electronic spy agency's reliance on local utilities. The activists would like to turn off the water to the NSA's $1.5 billion Utah Data Center in Bluffdale, Utah, and at other facilities around the country.

    Dusting off the concept of "nullification," which historically referred to state attempts to block federal law, the coalition plans to push state laws to prohibit local authorities from cooperating with the NSA.

    Draft state-level legislation called the Fourth Amendment Protection Act would – in theory – forbid local governments from providing services to federal agencies that collect electronic data from Americans without a personalized warrant."

    Sounds hilarious, but even if they could generate enough public support in a conservative state like Utah, the feds would just relocate their data-centers to a coast, where they could access their own water supply (or else use a military base). What we really need is a reliable way to protect our metadata (Tor isnt enough).
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  6. The Internet Member

    Except with respect to health claims, the market doesn't appear to work as you describe. Deregulation in the 1990s resulted in an explosion of quackery - tens of billions per year.

    I think the problem is, subjective info about one's own state of health is compelling but unreliable in many cases. Think of people having a heart attack who think their shoulder or their jaw is the problem. The brain is good at localizing sights and sounds outside the body, but the wiring for bodily perceptions is flawed.

    Another issue is free choice, which we think of as choice without duress or compulsion. When you're sick it's like you have a gun to your head. So that screws up the economic model that assumes a take-it-or-leave-it customer.
  7. JohnnyRUClear Member

    Well, since you're going into historical data, we run into a problem on my end: I'm too healthy for my doc... too healthy for my doc... so healthy I rooooock! Bad karaoke aside, my point is that I have had so little interaction with health care anything, and so little need for it, that I have paid next to no attention to any of it, my whole life. Thus, I don't have the background awareness to respond to you on that. However, you didn't clarify yet about your view of "quackery". Maybe you could go back to my previous post and answer that one.

    Your second paragraph is sensible, and your third one is somewhat sensible, but they're meaningless over time. That kind of perceptional error can indeed lead to wrong choices on the spot, but wrong choices (like all choices) lead to results, which form the basis for learning, which leads to better choices afterward (even if only for the survivors). If the concern is that sick people will make wrong choices unless they have guidance, and thus it's desirable for there to be some sort of guidance provider, then I agree with the concern, but a state-based solution is not the best answer, for the reasons I've already given. The best the state will be able to do is to try to discover what the private sector can come up with; politicians and bureaucrats don't automatically know the answers to health questions any more than you or I do. But if the state can do that, so can the market, and it can do it better, via competition, flexibility, and freedom.

    I will throw this out there: I've seen the phrase "deregulation" thrown around a lot, and it doesn't always mean "removing the state from [industry X]". A highly regulated industry which then gets some of the regulations removed is not necessarily going to then be a free-market industry. Also, "regulation" isn't a fungible commodity; every regulation has its own effects, so removing one regulation will have a different result than removing another one. A partially "deregulated" industry doth not a sound free market experiment make. The results will depend on what regulations are removed and what ones remain. Beyond that, the state's interference in all parts of the market distorts most, if not all, industries, and they interrelate, so it's a tar baby of a question to analyze the state's effect on one industry, no matter how you slice it. Still, I won't be the best person to discuss it historically, due to my ignorance.
  8. The Internet Member

    Healthcare is the big clusterfuck that I don't see following free market logic. So that's why I bring it up. If anything is an exception to the law of supply-v-demand, I think it's healthcare.

    Doctoring historically has been mostly magic and religion. A little bit of writing things down and sharing info from one generation to the next noted with the Greeks, like Hippocrates. But not much systematic study of cause and effect until the 1900s. Rather astonishing that it took so long for science to take root within that profession.

    In 1911 a man named Flexner completed a survey of medical schools within the US. His report described a chaos of cults. Sectarian medicine. Schools of thought founded upon strong personalities. But science knows no cult and humans at that time were beginning to appreciate the authority of sound, verifiable methods over sectarianism.

    As a result of the Flexner report the AMA recommended that medical schools follow an evidenced based course of study and that schools be part of university centers of basic research. But only a few schools could meet this standard. Most were closed, actually. This was hard on a lot of people, particularly black people. All the black med schools were shut down. But over the following several decades there was remarkable advancement in the human understanding of disease. So the whole science idea paid off big time.

    Each decade in the 20th century led to greater refinements in scientific techniques. Peer review and careful controls became routine by the 1980s. Then came the 1990s when America decided to go back to sectarian medicine. Really fucking stupid, from my perspective. Oh well.

    Anyway, just a little history of the craziness that is sickness and doctoring amongst the poor humans.
  9. JohnnyRUClear Member

    OK. OTOH, what little history I do know on this is that the fedgov has also gotten itself into the medical provision bloodstream by introducing subsidies, resulting in treatment costs rising and people "needing" insurance more than ever, eventually leading us to today's Obamacare debacle. So even accepting your description as fully accurate (which I have to at least for the sake of discussion ATM, due to my own ignorance), there is also a major down-side to the presence of the state re: health care.

    You still haven't specified what you think is the defining boundary between quackery and legitimate medical treatment. I'd like to know; it's difficult to continue the conversation with that still being murky.
  10. demarquis Member

    Since the OP is himself contributing to this derail of his own thread, I guess I'll contribute, even though I'm still interested in the original topic.

    By govt subsidies you presumably mean Medicare/Medicaid payments? That's part of the problem, but a greater part are the monopolistic practices of hospitals. They are allowed to charge anything they want for the services and medical products they deliver to patients, and the insurance companies go along with it, since they just pass the cost on to the rest of us. Hospitals act like monopolies because once you're in one, it usually isnt practical to move to another one. Similar considerations apply to specialized outpatient clinics. The insurance companies dont like you moving around, so they discourage it, mostly through obfuscatory paperwork. The end result is that costs rise.

    One way to control costs is sharing medical performance data with the general public. RIght now its extremely difficult to determine which doctor or hospital is the best with regard to treating particular illnesses. Try it for yourself: can you figure out which hospital or clinic in the US is the best with regard to, say, chronic pulmonary disease? Damn near impossible. So how do you make an informed decision? And in the absence of good information, a market cant function properly.
  11. JohnnyRUClear Member


    Your comments following that make sense.

    True. So, what is obstructing the information gathering/flow? We live in the info age....
  12. demarquis Member

    The data isnt gathered. No one measures health delivery performance by common, comparable standards. This is a situation that, barring some radical transformation in our economy, this is going to require more government intervention. Health care delivery systems will have to be required to collect information on their own patients long-term health outcomes, and deliver that information to a centralized databank, which would make it available to the general public. But before that happens, someone will have to decide what data must be gathered and how. Probably a panel of retired doctors, medical researchers and statisticians. In other words the relavent technical experts. Then the Congress would have to pass it into law. Dont hold your breath.
  13. The Internet Member

    The boundary between quackery and legitimate medical practice is somewhere in the gray area between a community of individuals who respect Bayes' theorem and who require the respect of their peers versus people who fail to assign reasonable probability estimates to the elements of Bayes' theorem, particularly the prior probability value.

    Within the gray areas reasonable people might disagree over the merits of a particular health related claim. But some claims have no merit --e.g., homeopathy. The prior probability for homeopathy is zero, meaning that any novel information seeming to support the hypothesis that homeopathy works has to be false positive information.

    So you need two things to do science within medicine: sound mathematical methods and a community of people who get the math and who can call each other out when mistakes are made.

    Quackery is not necessarily a problem for that community provided it's happening someplace else. But what we have now is a shift in the culture of medicine away from science and more toward making customers happy, even if those customers are ill informed or nuts.

    It would be great if poor outcomes would lead to self correction. However outcomes within medicine are largely invisible to the individuals concerned. You're sick, you take a pill, you get better. But you don't know what might have happened had you not taken that pill.
  14. Anonymous Member

    In countries where local governments have taken a sensible approach to healthcare processes have been implemented that go way beyond what you describe here in terms of public access to information.

    The irony here does make me chuckle somewhat though. One of the key arguments that have been made on WWP against the US adopting the sensible healthcare practices of other countries has been to argue that the real world data isn't sufficient to allow a cross comparison – but the reason for the poor quality of data from the US side is just another part of the failing they pretend not to notice….

    Ime those with a good scientific grounding tend not to see much of a grey area, and those who struggle with understanding scientific concepts and methodology tend to be the ones in the fog. The absolute key, if Johnny really wants a fairly broad topic boiled down to a soundbite, is independent verifiability of results. If a team in the US found good results for a given treatment then, when they publish their work, other teams all over the world can independently repeat and verify the original results (or, as the case may be, disprove them). That fundamental premise of independent verifiability, where research is published in a manner that will allow all other medical teams to check and test, is the difference between medicine and bullshit.

    Interestingly, scientific understanding is not a criteria that fits into this picture. If a given shamanic practice could deliver consistent verifiable results then such a practice would become medicine – even if there is no scientific basis behind it. The only metric is "does this method outperform placebo by a statistically significant amount?". A specific example to illustrate this is physiotherapy. For years new physiotherapy techniques have been heavily researched, and efficacy repeatedly and independently demonstrated. And yet it has only been in the last 10 years that the biological basis for why physiotherapy works has been explored. Prior to that no researcher had a fucking clue, scientifically speaking, how the practice worked from a biological perspective. But because it worked, and could be demonstrated to work consistently, it became standard practice in hospitals all over the world. Only in very recent times has the underlying biological mechanisms involved become subject to our understanding. I think this is a good illustration that independent verification works pretty well and is results-based.
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  15. demarquis Member

    "One of the key arguments that have been made on WWP against the US adopting the sensible healthcare practices of other countries has been to argue that the real world data isn't sufficient to allow a cross comparison – but the reason for the poor quality of data from the US side is just another part of the failing they pretend not to notice…."

    I'm inclined to agree. It would be much easier to manage all this with a single payer system. Aint going to happen, though, so we have to think about what is doable. Actually, that may be one reason gathering the data is resisted, now that I think about it- it would be widely seen as a step toward gov't funded health insurance...
  16. JohnnyRUClear Member

    I'm all for gathering data, provided nobody's rights are violated in the process. Data is good.

    Can you describe a "single payer system" which respects everyone's rights, including the right to not participate in it?
  17. demarquis Member

    Of course not. That's not how a tax-funded insurance program works. The whole point of using a government-funded system is to ensure that everyone participates, so that costs can be spread around more evenly between the healthy and the sick (and between the well off and the poor). If you dont enforce that, there's no point in doing it.

    The same principle applies to anything we use taxes to support: roads, the military, federal mortgage guarantees. Everyone pays, because (in theory at least) everyone benefits.
  18. Anonymous Member

    Glad to see that you are talking to the internet. He knows his stuff. He is black too.
  19. Anonymous Member

    Health hasn't been 'free market' since the early 1900s. Limits on teaching hospitals, the certificati0on of need requirement and other regulations took medicine out of the market a long time ago. It got worse in WWII when health insurance was tied to your job, a response to government regulations. It got worse again in 1965 with Medicare. Everything since 1900 has been an overlay, trying to fix the problems the regulations caused.

    Unfortunately, the one possible solution, letting the market work, is never considered, except by us 'radicals' who see the market working in all areas where it is allowed, and wonder why no one else will even give it a glance.One easy way to check that is Lasik surgery, a free market process where the price has come down quite dramatically. Cosmetic surgery is also highly competitive, with prices that reflect that.

    Quacks are with us, and some of them are board certified with lots of proper credentials. But as long as we think the government is looking out for us, then we relax our guard. So if the government falls down on the job, then all of us fall with them.

    But if there are a dozen competing regulating agencies then we have competition to keep the game honest.
  20. Anonymous Member

    So move to Somalia!

    That's the nation with the most laissez-faire approach to the regulation of capitalism (i.e. everything is totally unregulated because there's barely a government).

    And that's a paradise on earth!

    No wait, of course it isn't. Unless you're a warlord I suppose.
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  21. The Internet Member

    People keep saying this but doctors used to call out quacks all the time before the 1990s. We could look at the laws that were changed then and roll the clock back to clean up a lot of problems.

    Also, time is not a trivial variable. If it's going to take a year or so to get up to speed with some corner of the medical literature, I'd prefer to rely instead upon signifiers of expertise.

    It sucked before doctors established scientific standards as a basic requirement in medical education. It's starting to suck again now that the culture of science is being corrupted by the butthurt who can't prove their cultish claims.

    There's a cold war against science going on in this country funded by ridiculously wealthy people, like the Kochs and the Templeton Foundation, the Moonies, and the religious right. They are right up front with their belief that society is going into the crapper because people aren't taking religion seriously enough. They recognize that people take science seriously and they figure that having people in white coats saying, "by golly, ghosts are real!" the public will be impressed. Then people will fear God and stop doing crimes. Or something.

    Imagine a government filled with politicians entitled to speak for God. That should worry the people who oppose big government. But the Birchers and others on the far right who use lots of small government words are in favor of making religion super sciency real.
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  22. The Internet Member

    Not always. You don't want noisy data.
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  23. JohnnyRUClear Member

    "...In essay who?"
  24. The Internet Member

    Lol, but I hope you understand what I mean by noisy data. Example:

    Dodgy labs that have sprung up since the Doctor of Naturopathy degree won state licensures a few years ago will run reams of blood tests that invariably find a few abnormal values. This fools patients into unnecessary and expensive treatment courses. The labs will print something about the FDA not having evaluated the tests to avoid prosecution.

    Another example is thermography for detecting breast cancer, something promoted by Dr. Mercola. Thermography is noisy data. Women will die due to this noisy data.

    Maybe the free market will correct the excesses of the quacks in due time. But how long will it take? And how exactly does that correction happen?
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  25. demarquis Member

    That's why I mentioned the necessity of gov't intervention. Someone has to ensure the quality of the data as well as enforce it's collection.

    Oh- and I didnt mean medical data collected from individual patients. It's outcome data after discharge that matters.

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