calls for lithium to be added to tap water

[Ibid]

---

Members do not see this ad.

A consultant psychiatrist last night called on Government to add lithium salts to the public water supply in a bid to lower the suicide rate and depression among the general population.

At a mental health forum on “Depression in Rural Ireland” in Ennistymon, Co Clare, Dr Moosajee Bhamjee said that “there is growing scientific evidence that adding trace amounts of the drug lithium to a water supply can lower rates of suicide and depression”.

http://www.irishtimes.com/newspaper/ireland/2011/1202/1224308474582.html

Better article

http://www.guardian.co.uk/environment/shortcuts/2011/dec/05/should-we-put-lithium-in-water

27 Counties study in Texas

http://www.ncbi.nlm.nih.gov/pubmed/1699579

I just wondered what initial impressions people had of this idea. Frankly i'm skeptical.

 

[whopper]

There is data that lithium at low amounts does work to augment mood and that in communities with lithium deposits in contact with the water supply, there are lower rates of violent crimes, depression, and suicide. Ironically, the first I heard of this data was years ago from Breggin's book Toxic Psychiatry

(In case you didn't know who he is, he's a quack antipsychiatrist and it appears his motive is to make money by shooting antipsychiatry arguments that have been proven wrong, thrown out of court when he testified, and otherwise full of holes).

The problem here is the same as the old flouride argument when it was put into water. Yes, flouride would help the population as a whole, but the real effect it would have would truly not be known until it was done. When flouride was added to tap water, yes, it did have tremendous benefits in the population as a whole but there were small numbers of people that had an adverse reaction that were not anticipated in studies where some people DID DIE. Was it worth it? Who decides?

Was it worth it for example for a town to put flouride in a water supply that resulted in less cavities but a few people dying who didn't know they were sensitive to it beforehand?

The bottom line is we really don't know what something does when given to thousands of people until it's given to thousands of people. Merely giving it to 100 people gives us a good idea, but when you give it out in the water supply---everyone's going to take it. You start encountering bad outcomes that wouldn't have been detected when it was tested on 100 people.

I do believe putting lithium in small amounts would help a population as a whole but again would it be worth it if it could potentially screw with a handful of people in potentially ominous ways? Who decides?

 

[heyjack70]

He's probably in the pocket of "Big Nephrology, or Big Endocrinology"....just trying to drum up more business.

 

[IT514]

Reminds me of The Thanatos Syndrome by Walker Percy. What the OP is referring to doesnt seem quite as nefarious...but who really knows?

 

[digitlnoize]

Tap Water?!?!

Who drinks that crap anyways? 😕 I thought everyone drank aquafina or Desani...

As someone who thinks society is only a small step away from trying to water plants with gatorade ("it's got what plants CRAVE! Electrolytes!"), I'm intrigued by the idea.

Never going to happen though. There was also talk of statins the water supply for a while...never happened.

Makes you wonder what else might have made it INTO the water supply?

 

[Ibid]

The bottom line is we really don't know what something does when given to thousands of people until it's given to thousands of people. Merely giving it to 100 people gives us a good idea, but when you give it out in the water supply---everyone's going to take it. You start encountering bad outcomes that wouldn't have been detected when it was tested on 100 people.

I do believe putting lithium in small amounts would help a population as a whole but again would it be worth it if it could potentially screw with a handful of people in potentially ominous ways? Who decides?

Now that you have made a point about unintended outcomes it make me wonder, given that Lithium is better at preventing mania wouln't this just as likely lead to less happiness?

By that I mean slightly less creativity, people having fewer exciting ideas and acting on them spontaneously. Potentially you could make whole communities very very dull and boring. Fewer people starting businesses, fewer impulse buys in the shops, everyone being dragged down by the general malaise, it could cause more problems than it solves. You would end up adding in something else to deal with it.🙂

Tap Water?!?!

Who drinks that crap anyways? 😕 I thought everyone drank aquafina or Desani...

I use highland spring in the swimming pools and shower under Perrier

Makes you wonder what else might have made it INTO the water supply?

Synthetic oestrogen mostly by all accounts.

All over the world fish are turning into females and staying that way meanwhile human males are less and less fertile.

He's probably in the pocket of "Big Nephrology, or Big Endocrinology"....just trying to drum up more business.

 

[whopper]

given that Lithium is better at preventing mania wouln't this just as likely lead to less happiness?

Lithium, like so many other things in psychiatry doesn't follow the theoretical model perfectly. Mood stabilizer, so shouldn't it put more people in the center?

According to the data, lithium in small amounts can have an antidepressant and anti-anger effect on a large population. The studies I've seen put it at subtherapeutic amounts in comparison with treating bipolar disorder.

So this brings up questions. For example perhaps lithium, in smal dosages, prevents mental illness in the form of depression and excessive violence, but once the illness already starts, it doesn't do much, but in larger doses acts differently and actually treats bipolar disorder.

All we got (that I know of) is the data that when it's in tap water, the entire population tends to do better with mood and anger. What could be happening, there's a heck of a lot of theories and that's it. In those populations, the tap water was already exposed to lithium deposits in the ground. To suddenly introduce it, in an attempt to improve mental health for an entire community, could cause some problems we didn't know about. Per the same studies I've read, I don't know if there's been an increased incidence in thyroid or kidney problems.

Like I said with the flouride issue, all the data pointed to it being safe, it's introduced in the tap water, and then some people ended up dying. You really never know what somethings going to do to tens of thousands of people until tens of thousands of people take it. You can only make decent approximations that'll work for most people when 100 people take it. If there's a 1 in a million chance something will kill someone, and 1 million people do it, the odds then are 50-50 1 person will die. That's the problem with this issue. If lithium is given to an entire community, I'd say it'd be fair to guestimate there will be at least some bad outcomes. What they'd be, I wouldn't have a clue, but the community would likely be happier and have less violence.

 

[loveoforganic]

I think I've previously read about a need to ween off of lithium slowly. If that's the case, at this dosage level, would moving to an area that wasn't lithium-ating the water be an issue?

 

[dozitgetchahi]

Makes you wonder what else might have made it INTO the water supply?

If I remember correctly, at one point there was a consistently detectable (surely non-therapeutic) level of fluoxetine in London tap water because so many people were taking/excreting it (or at least dumping unused portions of Prozac scripts down the drain).

 

[kugel]

I would not only vote for lithium in the water supply, I'd pay an extra $20/yr in taxes to help do it. I think it would reduce not only deaths from anger/suicide, it would also reduce the # days lost to work/school due to depression, non-fatal anger-related injuries, $ spent prosecuting and jailing perpetrators, etc. If 1 person per million dies and 3 per million are hospitalized, this sounds like a fair trade to me. To me, this sounds equivalent to taxes spent on immunizations - which can have bad outcomes for a small percentage.

But I think that an even more cost-effective measure would be to control the amt of alcohol bought, similar to that for pseudoephedrine. I know, I know...some people will always find a way to get more. I understand everyone has a right to do what they want, but not when it endangers the rest of us. This is no different than speed limits or setting off fireworks. The cost of deaths, injuries, illness related to alcohol is enormous and, unlike smoking, it is often not the one partaking who pays the price.

Hmmm....
It seems I was rant-deprived.
Now I feel better.

Starting the stopwatch to when I'll be compared to Hitler.......NOW!

 

[Ibid]

If there's a 1 in a million chance something will kill someone, and 1 million people do it, the odds then are 50-50 1 person will die.

I get what you are saying and I understand. What I love about the above is the whole gambling industry is based around your typo/mixed metaphor.

It is why people back horses that are 100-1 shots at 20-1 and chase flushes in poker.

If 1 person per million dies and 3 per million are hospitalized, this sounds like a fair trade to me.

Starting the stopwatch to when I'll be compared to Hitler.......NOW!

Stalin would be a closer fit. "When one person dies it is a tragedy, when a million die it is a statistic..."

 

[whopper]

Your comparison Kugel to an immunization is pretty fair because in that situation everyone gets it, and some people do have a bad reaction to it.

With mental health, I think the political stigma is blurrier. I'm not saying it's truly something different but people will interpret it that way. When the gov does something to affect people's mental state through the use of a pharmacological agent--all hell can break loose with people's fears. While this is certainly a topic that should be of concern, there'll be a fear-mongering aspect that'll likely push people to react to fear instead of using their ability to reason.

Some supplement companies actually sell lithium because of it's alleged benefits at low dosages, and who can deny them this since it's a naturally occuring salt?

http://www.lef.org/Vitamins-Supplements/Item20006/Supreme-Lithium.html?source=search&key=lithium

 

[billypilgrim37]

I usually just suck on cell phone batteries. That's safe, right?

 

[Ibid]

I usually just suck on cell phone batteries. That's safe, right?

Sucking on batteries? All depends, sometimes it's a postive thing, sometimes it's negative.

 

[Ibid]

With mental health, I think the political stigma is blurrier. I'm not saying it's truly something different but people will interpret it that way. When the gov does something to affect people's mental state through the use of a pharmacological agent--all hell can break loose with people's fears.

It's harder to put it anybetter than Aldous Huxley in Brave New World where "soma" was distributed to create stable citizens who conformed to societal norms.

"My dear young friend," said Mustapha Mond, "civilization has absolutely no need of nobility or heroism. These things are symptoms of political inefficiency. In a properly organized society like ours, nobody has any opportunities for being noble or heroic. if ever, by some unlucky chance, anything unpleasant should somehow happen, why, there's always soma to give you a holiday from the facts. And there's always soma to calm your anger, to reconcile you to your enemies, to make you patient and long-suffering. In the past you could only accomplish these things by making a great effort and after years of hard moral training. Now, you swallow two or three half-gramme tablets, and there you are. Anybody can be virtuous now. You can carry at least half your morality about in a bottle. Christianity without tears–that's what soma is."

Maybe it will all come true. Western Liberal Democracies are creaking at the seams and it is the authoritarian one party states who have the upper hand now. Italy now has no elected members in it's government, only technocrats.

Democratic countries seem barely able to cope anymore. The US government struggles to pass a budget while the EU is putting off an inevitable collapse by playing oyster as much as acting like a head in the sand ostrich. Like you said in you first post "who decides?"

So regarding Li why bother to tell anyone? If all hell would break loose, just do it eh?

 

[billypilgrim37]

Sucking on batteries? All depends, sometimes it's a postive thing, sometimes it's negative.

Some posts do deserve *rimshots*.

 

[ShrunkenHeads]

What about trace amounts of MDMA?

I know Li is one of the early ones to treat bpd so there's a lot of history to go on in terms of effects, but I believe there have been some recent clinical studies of MDMA in treating depression and the like.

Maybe I can get that sprinkled on my fries instead of salt? 😀

http://www.psychiatrictimes.com/bipolar-disorder/content/article/10168/1857028

And I can't leave this thread without...
http://www.youtube.com/watch?v=3fIqq5XVFKQ

 

[Ibid]

Some posts do deserve *rimshots*.

True so true😳.....i'll go now and pump up the balls, put the jock straps in the tumble drier and maybe practice some granny shots before I turn the lights out....

 

[Apollyon]

But I think that an even more cost-effective measure would be to control the amt of alcohol bought, similar to that for pseudoephedrine. I know, I know...some people will always find a way to get more. I understand everyone has a right to do what they want, but not when it endangers the rest of us. This is no different than speed limits or setting off fireworks. The cost of deaths, injuries, illness related to alcohol is enormous and, unlike smoking, it is often not the one partaking who pays the price.

It was tried in the US almost 100 years ago - to the point of an amendment to the US Constitution (#18). That was 1919. It lasted 14 years, until the 21st amendment repealed it - the only time that that has occurred in US history.

 

[OldPsychDoc]

Some posts do deserve *rimshots*.

At least he's current on the literature.

 

[kugel]

It (ban on alcohol) was tried in the US almost 100 years ago - to the point of an amendment to the US Constitution (#18). That was 1919. It lasted 14 years, until the 21st amendment repealed it - the only time that that has occurred in US history.

That's true.
And I'd say the 21st amendment was the error.
If there's another unnecessary substance of abuse that causes more death/disability/injury/harm to others, I'd be happy to hear.

But I understand that once something has become so ingrained in the culture, it becomes almost impossible to remove. The NTSB is suggesting we ban cellphone use in cars, but I doubt it will happen. If the NTSB wanted to ban something that kills people on the roadways, it'd be cars that travel more than 40 mph.

 

[Ibid]

At least he's current on the literature.

eww thats harsh....very harsh 🙂

[YOUTUBE]http://www.youtube.com/watch?v=WC25abFB3co&feature=fvwrel[/YOUTUBE]

If there's another unnecessary substance of abuse that causes more death/disability/injury/harm to others, I'd be happy to hear.

Well that is tricky because the abuse is personal and the effect is generalised. But to follow the logic on those grounds exhaust fumes from your car would win by long way.

You could argue the internal combustion engine is currently necessary but what about out and out luxury items like choclate then? The death/injury/disability caused to the child slave labour (anyone who thinks this is rare rather than the rule is deluded) who harvest the beans in West Africa? Preteens sold to farmers cutting themselves to ribbons in filthy rags so westerners can stuff their fat gobs. The link to those children seems pretty clear to me.

All for more tax on alchol btw not sure about an out and out ban but then I would decriminalise most if not all drugs.

 

[SpiritiualDuck]

how can we jump from epidemiologic evidence to saying we should treat??? Too many confouding variables. This might suggest further studies, but this should't lead us to jump to the conclusion that it's somehow causative. And then for that psychiatrist to suggest we add it to the water supply... Shoot, ice cream consumption and drowning correlate nicely too, but that's because both go up in the summer. It's a curious finding a best, but not evident of a need for mass treatment at homeopathic levels.

This could all be the result of chance alone. These areas might have better access to health care, economic difference, employment differences, rates of substance, etc, blah, blah, but to assume that the differences are the result of water lithium levels ranging from 70-170 micrograms/L is a stretch and not to mention, do we know how much water is actually consumed by the people in this area. We're assuming treatment effect when we have no evidence that they actually got the treatment.

Oh, and maybe they didn't even drink the water, they use more plastic containers, and consume more BPA, and have estrogen like effects and that's why they...

 

[OldPsychDoc]

http://www.businessweek.com/magazine/correlation-or-causation-12012011-gfx.html

 

[erg923]

How do you guys think this comes across to those not in the profession? Think they might view this as quite diff from fluoride in the tap water? I'm always struck by the patriarchal attitude in psychiatry, and actually, medicine in general.

"Just sit back and relax son...we know whats best for ya." 🙂

 

[kugel]

How do you guys think this comes across to those not in the profession? Think they might view this as quite diff from fluoride in the tap water? I'm always struck by the patriarchal attitude in psychiatry, and actually, medicine in general.

"Just sit back and relax son...we know whats best for ya." 🙂

I agree with your point in general. Medical education does not generally address these issues nearly well enough. When we tell them, "the next stage in treatment is this...." we don't tell them that "there's a 40% chance this will resolve spontaneously and a 10% chance it will result in serious impairment or death if left untreated. So, tell me again, are you sure you want the Z-pack?"

For me:
A) I don't say anything on SDN that I'm not willing to say in public
2) I don't know of any other dept. in the hospital that talks about whether or not we have the right to treat the patient - in every single case.
D) In this state, I'm required to get written consent for every psychiatric medication, including medications handed out like candy by non-psychiatrists.
1.3) I blow a gasket when the staff tell me, "Just admit him. Even if he doesn't meet the full legal criteria. You know he needs it." As it is, the laws make it way too easy for me to suspend people's constitutional rights. I'm NOT going to add to that problem.

I have at least one discussion per week with other staff that simply "getting him to take the medicine" is NOT consent, and we should not be railroading the patient into treatment. We also have discussions about whether the voluntary patients understand the potential socio-economic harms from entering treatment, including how becoming hospitalized may get used against the patient by employers, ex-spouses, etc., and whether we need to explain those potential effects more clearly before engaging in treatment.

As for Lithium in the water, I am advocating for doing the studies to determine if there is benefit and then Put It Up For A Vote.
I would be equally willing to commit sabotage (including felonious vandalism) to any effort to do this surreptitiously or against the majority will.

Did you get to vote on flouridation, or Hep B vaccination, or the ban on using lead-based paint in your own home? I would vote in favor of all those measures. And I would fight fiercely against doing it by fiat or executive order.

 

[bdrensch]

That'd be ridiculous. Why can't we just have Water in our tap? If we want to supplement with LIthium, you can do so voluntarily.

 

[kugel]

That'd be ridiculous. Why can't we just have Water in our tap? If we want to supplement with LIthium, you can do so voluntarily.

Because we live in a republic where majority (or majority of representatives) rule.
That is one option for which people can vote.

The people could vote for ...
- no pubic water supply (every building has have its own well)
- public water supply with only water (no chlorine, no flouride, no lithium, etc.)
- public water supply with supplements decided on by the local water district (local control), decided by the state health dept, or by federal standard.
- a public water supply is provided, but you can opt out if you want. But if you opt out and it goes bad, then you are entirely on your own; no rescue of any sort including healthcare for an illness from the water, and you are responsible for healthcare of others you infect.

I won't get into whether healthcare is a right (my opinion isn't fully formed),
but we all pay for the healthcare of uninsured people, and we pay through taxes or premiums when others infect us with illnesses that could have been easily prevented.

Do we want that payment to be equitable and efficient, or wait until it requires hospitalization, or let them die and only pay for funerals? When we have a way to effectively and efficiently deliver a way to keep people healthy (rather than wait for them to get sick), we can use it (immunizations, flouride) or pay more later.
Since I live in a land that has decided over generations to provide public sanitation and public healthcare, I would rather that paying for the system be equitable and efficient and effective.

You are more than welcome to have any opinion that you want.
I only ask two things:
Vote for what you want.
Accept the result of the vote.

I believe I have reached the end of the space allotted for my rant this wee

 

[bdrensch]

I won't get into whether healthcare is a right (my opinion isn't fully formed),
but we all pay for the healthcare of uninsured people, and we pay through taxes or premiums when others infect us with illnesses that could have been easily prevented.

😉 Are you sure your opinion isn't fully formed? I have a pretty strong opinion on health care. I think the current system is hurting both the people and the physicians... and being a person and a future physician (if all goes accordingly) I have a strong stake in the matter! Adding what is essentially a psychotropic to our water supply is just the start for a system where we are forced to pay for the negligence of others, and where insurance is forced to insure events that are controllable. What an absurd system in my opinion. I understand your rant though entirely and its a pleasure discussing the matter!

 

[kugel]

😉 Are you sure your opinion isn't fully formed? I have a pretty strong opinion on health care. I think the current system is hurting both the people and the physicians... and being a person and a future physician (if all goes accordingly) I have a strong stake in the matter! Adding what is essentially a psychotropic to our water supply is just the start for a system where we are forced to pay for the negligence of others, and where insurance is forced to insure events that are controllable. What an absurd system in my opinion. I understand your rant though entirely and its a pleasure discussing the matter!

That my be the most polite disagreement I've ever received.
Thank you for the civility. We could all take a lesson.
Unless you were viciously slamming me and I'm too dense to recognize it! Hmmm....

It will certainly be interesting to see where US healthcare goes over the next 10 years.
It may look nothing like what we have now, and perhaps nothing like what any of us imagine. I think perhaps our future patients have more at stake than we do. I would argue we are already forced to pay for the negligence of others.

The best plan I've heard (whether public or private) is to pay large premiums, and then get cash BACK when we engage in pro-health behaviors: obtaining/maintaining healthy weight, getting lipid numbers good, smoking cessation, etc., etc. This would combat one of the largest problems for pro-health behavior adoption; that all the short-term gains and long-term pains are gathered on the side of vice and all the short-term pains and long-term gains are gathered on the pro-health side. This makes pro-health behavior adoption almost antithetical to human nature.

 

[whopper]

The best plan I've heard (whether public or private) is to pay large premiums, and then get cash BACK when we engage in pro-health behaviors: obtaining/maintaining healthy weight, getting lipid numbers good, smoking cessation, etc., etc

The entire system of insurance or gov-based healthcare is built on the foundations that everyone pays into a communal fund. The fact of the matter is that healthy have to pay for the sicker. While I fully support that in cases where the sicker person had no ability to avoid the problem (e.g. congenital and genetic defects), or could not reasonably avoid the problem (e.g. occupational hazards), and even several behaviors, many people voluntarily engage in antisocial behaviors that were clearly avoidable such as smoking, overeating, high-risk lifestyles etc. Yes it is antisocial because the behavior is costing society.

It's to the degree where some people are literally funelling out hundreds of thousands per year per individual for the above avoidable behaviors at the cost of healthier individuals.

If you were literally told that your roommate is costing you to pay an extra $150 a year in healthcare expenses to pay for his bad habits wouldn't you be a bit sore at him?

Anyway, I'm digressing from the OT of the thread and I've already ranted about this before.

 

[billypilgrim37]

...many people voluntarily engage in antisocial behaviors that were clearly avoidable such as smoking, overeating, high-risk lifestyles etc. Yes it is antisocial because the behavior is costing society.

The only way that this logic works is if you also advocate that we drag all the old people in nursing homes out in the street and shoot them. Otherwise, living past age 65 is the most antisocial thing you can do. DSM-5 will have to include "Dementia, Antisocial Type" for anyone who makes it to retirement.

If everybody stops smoking, drinking, and eating fast food, and starts running 3 miles a day, our country will collapse incredibly quickly. But then nobody will be able to afford cigarettes or alcohol, and people will be running 3 miles a day because they can't buy cars, and fast food will implode without the cars. So maybe that does solve our problem.

So, Whopper for President in 2016! And I'm going to buy a lot of stock in companies that run nursing homes.

 

[SpiritiualDuck]

Whopper, I'm a fan of yours. I love your posts. However, I'm so not with you when you write, 'Voluntarily engage in antisocial behaviors that were clearly avoidable such as smoking, overeating, high-risk lifestyles etc. Yes it is antisocial because the behavior is costing society." And maybe you're using hyperbole here to make a point.

I'm currently reading a book about the myth of choice. And it challenges the ideas around how freely people make choices given a host of psychological vulnerabilities, marketing influences, learning, reinforcement, etc. Maybe everything that looks like an independent choice is really quite predictable if we understood the innumerable variables that led to that moment.

Not to mention, biological vulnerabilities regarding reward pathways that are likely leading to of these choices that people make that are "antisocial"....

Sexual addition, drug addiction, we stand in moral judgement of the people that we're called to treat. So, I hope you're not being serious when you talk about "high risk" lifestyles being "antisocial." Even the dx of antisocial personality d/o has biological underpinnings that can be explained by epigentics (understanding how biologically vulnerable kids in neglectful environments, abusive homes create these folks). http://www.tamiu.edu/~CFERGUSON/evmeta.pdf

And I'm not above this judgement. I work hard not to get pissed when a frequent flier drunk shows up in the ED or a "crack" using addict is trying to get a bed for the night with SI. But when I step back, I'm able to see them as patients and not morally corrupt.

 

[whopper]

The only way that this logic works is if you also advocate that we drag all the old people in nursing homes out in the street and shoot them

Aging is not voluntary. While there are factors that can accelerate it, even the most ardent lifestyle regimens cannot stop it.

First, I agree with counter-arguments to my rant that you can't stop every single voluntary behavior. Every single behavior can cause problems, even ones that are well planned and prudent. This phenomenon exists on a spectrum. Further there are some behaviors that are detrimental to health that actually lower healthcare costs because the person dies before they get expensive treatment (not that I advocate these behaviors).

On the flip-side, 20 year old guy, getting $550 a month on SSI for bipolar disorder (and he doesn't have it), has nine children, and is happy about it because in his neighborhood that increases your street-cred and pushes his alpha-male status even higher, none of whom he's assisting in raising, goes off and buys a $200 dollar pair of sneakers that light up when he touches the ground...

My bottom line is that no, I do not want a police state where a big brother telescreen monitor demands people to wake up and start doing push-ups or else. I do however, think that some simple factors such as being overweight and not going to regular doctor's visits should affect payments into healthcare funds.

Anyways, while we're veering off the subject, this does have some connection. It's all about individual choices. In lithium in tap water, some people do not have the choice to avoid it if put into tap water. While people could argue they could buy spring water or filters (and filtering out a salt I figure would be more difficult than other pollutants), some people simply cannot afford these things and live paycheck to paycheck. In the case of lifestyle choices affecting healthcare expenses, yes it does have an impact, and the person does have some control over this.

 

[billypilgrim37]

Aging is not voluntary. While there are factors that can accelerate it, even the most ardent lifestyle regimens cannot stop it.

But dying early is voluntarily, and that is very pro-social by your argument. That aging is not voluntarily isn't relevant.

(btw, this is more or less coming from a VERY funny Christopher Buckley novel called Boomsday (William F Buckley's son, also wrote Thank You for Smoking). Jeanine Garafaolo actually reads the audiobook and makes it great. Highly recommend it. Of course my argument is a little bit absurd. But the fact that it's not ENTIRELY absurd is the important part.)

 

[whopper]

But dying early is voluntarily, and that is very pro-social by your argument.

True, in most cases, though indirectly. Most people don't voluntarily say they want to die and often face it after being in denial of several health problems.

And then IMHO this should beg questions to anyone trying to deal with the way our current system is managed. Should the system cause people who engage in expensive behaviors to pay more for treatment?

If someone wants to engage in a lifestyle that is risky, so be it. I think that should be their choice. I question, however, should I pay for it? I think they should pay for it. If I eat a cheesecake, I shouldn't ask my neighbors to pay for the risk I incur. I should pay for it.

My personal opinion is this is on a spectrum and it should be tilted, at least slightly, more towards a personal responsibility model. To go completely in that direction on an extreme would be catastrophic. E.g. people not being able to pay for treatment, who had no power over their health (e.g. genetic disease) being denied care.

Some things that were done in that back my idea were: increased taxes on cigarettes, drives to pay primary care doctors higher wages, incentives such as lower premiums or kickbacks to people who get regular cholesterol screenings, and public awareness drives to inform the public on health matters.

 

[billypilgrim37]

If someone wants to engage in a lifestyle that is risky, so be it. I think that should be their choice. I question, however, should I pay for it? I think they should pay for it. If I eat a cheesecake, I shouldn't ask my neighbors to pay for the risk I incur. I should pay for it.

Agree. You're estimating personal costs correctly, but you are not estimating public costs correctly. If you eat a cheesecake, your neighbors will have to pay for the risk that you are going to have elevated health costs sooner and die sooner. But if you DO NOT eat the cheesecake, your neighbors will have to pay for your additional social security and medicare premiums and your nursing home bills. So, speaking from a net perspective, your neighbors aren't paying significantly differently whether you eat the cheesecake or not. They are economically indifferent to it. So THIS particular line of reasoning is incorrect and not useful. They don't owe you a dime either way if they choose these behaviors. They are only hurting or helping themselves.

However,

My personal opinion is this is on a spectrum and it should be tilted, at least slightly, more towards a personal responsibility model. To go completely in that direction on an extreme would be catastrophic... Some things that were done in that back my idea were: increased taxes on cigarettes, drives to pay primary care doctors higher wages, incentives such as lower premiums or kickbacks to people who get regular cholesterol screenings, and public awareness drives to inform the public on health matters.

This is where we pretty much entirely agree. The reason I agree with you (and I think is restating what Kugel said above to some degree) is because better health and longer healthy lives are things as a society (and as medical professionals) have decided are RELATIVELY more valuable than an individual's right to engage in self-destructive (and potentially destructive to others in the cases of drunk driving and second-hand smoke) behaviors. That's our value judgment. This is a somewhat anti-libertarian position we are taking here, but we are okay with that. We make decisions like this all the time. It's the same reason we pay for firemen. This is not socialism.

So we should encourage healthy behaviors BECAUSE THEY ARE GOOD FOR PEOPLE and are generally consistent with the values of most people. People discount long-term benefits of health for short-term benefits of eating poorly, not working out, smoking, etc. That process of discounting actually creates an inefficiency. So by encouraging health behaviors with the incentives you mention, we would speculate that we are more efficiently helping people get what they want. (Note: this is wildly in conflict with the theory of revealed preferences--but that's okay. Screw the neoclassical economists. The behavioral economists are much cooler.).

When somebody smokes, eats a cheesecake, etc., they aren't costing you a dime (now, heroin use that leads to increased crime--different story, but that's not what we're really talking about). They might be saving you money. They pay a lot of taxes on cigarettes, probably more than they consume lifetime in additional resources for health care and entitlements. So you can't argue they shouldn't do these things because you are paying for it, because YOU AREN'T. It's not true. But you can certainly argue they shouldn't do these things because they aren't good for them. But recognize that's an argument tilted towards beneficence, not autonomy. And autonomy is simply not the supreme ethical virtue that some would argue it is. There are other important ones as well, even if autonomy is pretty darn important.

That was the most fun I've had on a rant in a while. You're the best, Whopper. Seriously. It's fun kicking stuff around with you because you're smart in all the right ways. And when I disagree with you, I feel like we can really tear into something and enjoy it, and you tolerate my hyperboles lovingly. Happy holidays!

 

[whopper]

That was the most fun I've had on a rant in a while. You're the best, Whopper.

Sure. Agree with the former. Politely while passionately discussing intellectual topics is fun. Just wish we had some over a glass of brandy, a fire, dressed in cigar jackets, and a good Cohiba, not being sarcastic

I'm the best? Hope not. This particular post was written during a break at work, but the past few were on the crapper wearing the birthday suit, dodging my wife's valid requests for me to read a child-attachment book.

 

[F0nzie]

On the flip-side, 20 year old guy, getting $550 a month on SSI for bipolar disorder (and he doesn't have it), has nine children, and is happy about it because in his neighborhood that increases your street-cred and pushes his alpha-male status even higher, none of whom he's assisting in raising, goes off and buys a $200 dollar pair of sneakers that light up when he touches the ground....

LMFAO...laughed so freaking hard reading this!

 

[baxter1973]

I thought it was bad enough that everyone wants to live on SSRI - lets add some lithium to the water for the people who can't afford bottled water. That's the society I want to live in

 

[toothless rufus]

The only way that this logic works is if you also advocate that we drag all the old people in nursing homes out in the street and shoot them. Otherwise, living past age 65 is the most antisocial thing you can do. DSM-5 will have to include "Dementia, Antisocial Type" for anyone who makes it to retirement..

Overall, but specifically the bolded.

 

[Lokhtar]

Who drinks that crap anyways? 😕 I thought everyone drank aquafina or Desani...

You realize both of those come from tap water?

 

[julgar]

Sure. Agree with the former. Politely while passionately discussing intellectual topics is fun. Just wish we had some over a glass of brandy, a fire, dressed in cigar jackets, and a good Cohiba, not being sarcastic
.

hahaha...agree with you 👍