“They are throwing that all away and saying, `We are quite relaxed about 30 deaths and 680 injuries and $230m’.

No, Prof. Sellman, National are saying “We suspect there is a great deal of bullshit in your figures”. I have to agree with them.

Estimates of the reduction in harm achieved by lowering the legal Blood Alcohol Concentration (BAC) from 0.08 to 0.05 are usually derived from studies like the ones in the WHO graph:

Assessing the relative risk of an accident will give you a rough idea of how many fewer accidents will occur. And from that you can work out lives saved. Possibly. This work has mostly been done using simulators in very controlled circumstances. The nice smooth looking curve is not so much a measure of the real-world risk, but a measure of the decreased speed of reaction and decision-making. It is therefore unsurprising that this produces such a neat graph – after all, we know that alcohol depresses reaction times in proportion to the BAC. It does not tell us whether accidents and fatalities would be reduced so attaching crash figures to this information is merely an exercise in math rather than a real-world scenario.

Zador’s well-known study (Zador PL, Krawchuk SA, Voas RB.  Alcohol-Related Relative Risk of Driver Fatalities and Driver Involvement in Fatal Crashes in Relation to Driver Age and Gender: An Update Using 1996 Data. J Stud Alcohol2000;61:387-95.) provides us with some actual crash data from the US databases. Zador showed that people with a BAC between 0.02 and 0.049 had a 2.5 times higher likelihood of a fatal crash and those with a BAC of 0.05 to 0.079 had a 6 times higher likelihood of a fatal crash. Unfortunately, as I have pointed out before, these are very wide bands, making it seriously difficult to determine the best place to set a maximum BAC. It is highly likely that the arbitrary nature of the bands has predetermined the arbitrary nature of a 0.05% limit. Again, it does not really address the issue of a safe BAC, but at least it indicates that more alcohol produces more fatal crashes.

A recent meta-analysis has suggested that no BAC may be considered “safe” for a complex activity such as driving. Having read the paper, I have no problem with this conclusion at all. The upshot is that, despite the emotive language and the dubious figures cited in the media, the debate around a reduced BAC limit is entirely missing the point. The question should be whether we should people to drink any alcohol and then drive.

This question is not as simple as it seems. Danyl at the Dim-post baldly puts it thus:

The problem is that the 30 to 60 people that will die during the two year research period don’t know who they are so they don’t know that their freedom has been compromised, while the many thousands of people who like to have a few drinks and then drive home do know they’ll be trivially inconvenienced by a reduction in the drink-drive limits.

Sarcasm aside, this argument overlooks the fact that we already allow dangerous people on our roads. The elderly and the young both have high accident rates even when sober. A teenager with a BAC of 0.5 has an increased risk of a fatal crash up to 17 times the rate of a sober driver. An adult with a BAC of 0.8% is not statistically more dangerous than a perfectly sober 17-year-old. Should we deny the young and the old the ability to drive themselves?

There are people who routinely speed and people who routinely tail-gate. There are those who have sleeping problems and drive tired and those who drive under the influence of pain killers and cough medicines. There are those who drive while adjusting their radios and those drive with children in the car. Some drive cars that are falling apart and some drive left-hand drive imports. For one or two of these drivers we have laws that may cause one to be fined, but the vast majority of these motorists drive with impunity, despite being far more dangerous than the average driver.

We choose to allow these people on the road because we strike a balance between increasing our danger and a person’s freedom to drive. Sometimes the risk is too great (people with no license, the recidivist drunk, the drunken youth) but usually we accept an increased risk of around 2-3 times greater than normal (most of the people mentioned above). The question therefore remains as to exactly what reduction in risk we will be achieving by lowering the BAC level to 0.05%. The data is not yet conclusive. Most countries who have lowered their BAC from 0.08 to 0.05 have experienced about a 8-12% improvement in accident statistics. As the lowering of the limit has invariably been accompanied with a raft of other measures and a police blitz on alcohol, it is hard to be sure exactly what this means. Joyce is right to want to gather better data so that we know whether such a reduction is actually worthwhile.

The decision is not as trivial as Danyl makes out. A BAC of 0.05% may put a large number of responsible citizens afoul of the law and achieve little or nothing in terms of road safety.

Related posts:

1. Pushing the Limit
2. Drinking to the Limit
3. Booze Scoop

Hi Jim,
I remember reading a while ago that you thought a medical ratings website might be a good idea. Well found this on trademe forum the other day, looks like its going to be a reality?
http://www.medrate.co.nz

Thanks
Steve

Sadly for Steve, I am generally not that much in favour of medical rating sites. In November 2008 I was mildly supportive of such a site. However, seeing how they have panned out overseas, I am now firmly of the opinion that they do not serve the purpose for which they were intended; namely, giving the public sufficient information to determine a suitable doctor to visit. I can think of four distinct reasons why these sites fail in this endeavor.

Firstly , they tend to become forums for the disaffected only. People with an axe to grind are far more likely to write on such sites than people who get good service. It is therefore uncommon for such sites to provide any worthwhile data, simply because most doctors have irritated at least SOME patients. As I pointed out in my 2008 post on this subject, most people gravitate towards the negative opinions, immediately colouring their view of the doctor. Imagine choosing a doctor despite a single negative horror story about a missed breast tumour (all the other reviews are good). After a year or so of excellent service from this doctor, you suddenly discover a breast lump. Do you suddenly start to distrust your doctor’s judgement. What is the consequence to the doctor-patient relationship of your sudden lack of trust? Can this doctor continue being your GP?

The second problem is that, while some people appear to have a genuine medical grievance, the vast majority of dissatisfied patients are unhappy because of personality clashes with the doctor or disagreements with the doctor that have nothing to do with clinical problems (like being made to wait, being charged “too much”, not being given certain drugs etc.). People are genuinely ill-equipped to judge medical expertise. A doctor may be a better clinician and say “no” to your script for antibiotics for your viral infection. You then go to another who gives you the script, inappropriately. Yet your report on the site may be that the first doctor is bad and the second good. This is not to say that people do not recognise clinical expertise, but that that assessment of expertise may be coloured by the patient’s often unrealistic expectations.

Thirdly, medicine is not an absolute science. It not only requires a degree of skill but also, to a certain extent, a degree of luck. Nobody wants to hear about the “but for the grace of God there go I” moments, but every doctor has a story of a patient that was treated completely by the book and still developed rare and terrible complications. In fact, my experience is that it is often patients for whom you go the extra mile, who do the worst. It would seem manifestly unfair to blacken a doctor’s name when the complication was both unforeseeable and unpreventable by NORMAL medical management (I stress “normal” because often some whizz-bang doctor with 20/20 hindsight will attempt to tell a patient that this could all have been prevented by this <insert non-standard, esoteric and expensive test here>).

Lastly, there is always the ugly possibility that some person may wage war against a doctor’s reputation, not for any of the reasons above, but purely for personal reasons. I have heard of an ex-wife assuming multiple internet identities and blacklisting her ex-husband into oblivion.

There are, of course ways that these problems could be addressed – including allowing a separate professionally-assessed database and logging MAC addresses to ensure no-one can duplicate entries. But, in reality, there is no particular need for such a site in New Zealand. We are a small country with a small community of doctors. If you really want to know who is a good doctor in your area you just ask around. Ask the local hospital nurses. Ask the local physio. Ask your neighbours. Chances are the nurses and physio will tell you the best clinicians and the neighbours will tell you who is the nicest. Pick one who is in both groups and you will probably be happy.

Related posts:

1. The Shame Game
2. Medical Ratings
3. Bullying Doctors

Of course, knowing Sue Bradford’s history, it is much more likely that she considers her non-arrest to be a negative, rather than a positive. After all, “Ex-MP arrested at National Conference protest” would have been a very useful headline indeed.

Although I don’t expect subtle debate at such a protest, the level of responses given to interviewers can only be described as abysmal. Bradford could muster little more than that the proposed law changes were an “attack on workers”. Matt McCarten was more hyperbolic, declaring than Key was waging “a war on workers”. Neither seemed to be able to elaborate on these fantastical statements. Least you think the media were just selectively reporting soundbites, at least one interviewer tried to get something more intelligent:

Asked if the changes were necessary to stimulate job growth in a tough financial climate, Mr McCarten said that was “bullsh**”.

Such a powerful argument. But McCarten’s garbled rhetoric continues:

He said the Government’s changes were about restoring power to employers and they amounted to a return to the Feudal System.

“They want to make us slaves in our own country and they know where they can stick that,” Mr McCarten said.

Say what? A return to the Feudal System? Is he serious? Does he know anything about the feudal system and slavery? All Key is proposing is that larger firms are offfered the opportunity to take on workers at lower risk to themselves. Can he not see that this means that people can be given the chance of employment that they may not have had?Only an idiot would think that employers would use such a rule to circumvent the ERA. A 90-day turnover of staff would be massively disruptive even in the low-wage section of the service industry. Even MacDonalds would find it too disruptive.

Sadly, McCarten’s bizarre remarks are amongst the more “sensible” ones. John Minto’s contribution is to insult John Key, by comparing his face to a rat’s. Mr. Minto, of course, is not noted for rational argument. Maxine Gay had this gem:

Maxine Gay from the National Distribution Union said the issue was about “who owns the workplace”.

She said denying workers the right to choose who to invite into their workplace “amounts to slavery”.

I am unable to follow this bit of illogical nonsense at all. Adam at the Inquiring Mind has a similar problem.  The person who owns the workplace is clearly the employer and s/he has the perfect right to refuse entry to anyone s/he likes. How is this in any way slavery? It is not as if the owner of the workplace chains up his workers and has overseers whipping them. It is not even as if the business owner refuses to let their employers join a union.

Helen Kelly, National President of the Council of Trade Unions, attempts to suggest that people are being dismissed during their 90-day probation because they join a union or raise workplace safety concerns. She produces no evidence for this assertion. This seems wildly unlikely to me. After all, there is nothing to stop someone from joining a union 10 minutes after the 90-day period ends, so I can’t see any advantage to the employer in firing someone for this reason. Only a very stupid person would think that this would produce an un-unionised workplace. As for the latter – that raising workplace safety concerns might get you fired – I have the same observation. There is nothing to stop the employee raising this at day 91. I also fail to see how the workplace safety problem, so obvious that a 90-day probationer can spot it, has not been brought up by regular employees.

Ms. Kelly goes on:

she said 22 per cent of those employed under the existing 90-day scheme were dismissed and 47 per cent of those were people under the age of 23.

She fails to mention that 40% of employers who have used the 90-day probation provision would not have employed that person without that safety measure. The high rate of dismissal therefore suggests that this provision is working, especially the very high rate of dismissal of young people, a group that employers are notoriously reluctant to employ – with good reason. Ms Kelly bewails the fate of the dismissed saying:

she had seen many of these young people in her offices and the “impact was devastating”.

“They have no idea what happened.”

While I sympathise with young folk who are dismissed in this way, at least they have had an opportunity to try something. That something did not work out. Now they should try something else. And I suspect that most employers would be happy to tell people why they are being dismissed, if they ask. But then they would not be able to portray themselves as victims, as Ms. Kelly is so willing to do.

A point often overlooked about the 90-day probation is that the reason for dismissal is not recorded on a person’s work record. A young person who may initially have a bit of a problem with authority, or the concept of normal work hours, is given the opportunity to correct these behaviours without attracting a very negative work record. Of course, this is not a “get out of jail free” card, as a string of 90-day dismissals would speak just as loudly. But at least a young and inexperienced worker does not have to get things right the first time round.

I don’t expect that any of my points above will carry much weight with the persons who took part in this violent protest today. Unions have proven time and again that they prefer disinformation and disruption to discussion and debate.

Related posts:

1. Another ACC Myth
2. Yes, Baas
3. Big Bullies

“For you will have the poor with you always”
Jesus Christ  (Matt 26:11, NKJV)

The MacDoctor has already blogged on the book The Spirit Level, the book that contends that inequality is the cause of all social evils. As Jesus Himself points out, the poor are not going away any time soon, which means this could be a bit of a problem, if it were true. Fortunately it is not.

In a National Bureau of Economic Research working paper, Michael Haines ably demonstrates that relative inequality has remained virtually unchanged over the whole of the 20th Century in the US, and yet infant mortality has dropped markedly. Of course, this is in agreement with most of the epidemiological evidence on infant mortality, that is is heavily tied to standards of living and nutritional status. A simple comparison of low-income stats with those in upper-income brackets will always show that poorer people do worse than the wealthy.

However, it is clear from Haines’ work that inequality of income is not a good marker for a nation’s overall well-being (the main contention in The Spirit Level).  At most, inequality of income has only a slight influence on health and well-being indices, far less than economic growth and technological progress. Because of this disparity of influence, it is by no means certain that this small influence is sustainable. If reducing inequality of income also causes slow-down of economic growth, it may well be that the reduction in economic growth may eventually swallow the benefits of reduced inequality.

In the previous post I cite above, I have argued that inequality of income is merely the inevitable result of an adequate rewards system for success. If success is not rewarded, it follows that fewer will strive for it. It therefore seems logical to me that a social system that actively seeks to reduce inequality by transferring the rewards of the successful to the unsuccessful, must eventually cease to be as productive both in terms of wealth and in terms of innovation as a system that does not. Therefore, in the long term, democratic societies that are unequal will fare better than democratic societies that are not, regardless of their level of technological expertise. A truly equal society (in terms of income) would have zero reason to strive and would rapidly stagnate.

Humans do not survive very well as ant colonies.

Hat Tip: Freakonomics

Related posts:

1. Equal Blights
2. Unequal Data
3. Illness System

Exams and a recalcitrant internet connection have kept me away from blogging until today. Not sure if I have missed much. Perhaps the best summary of the last 10 days is: “politicians lie”. Not exactly earth-shaking stuff.

Exhibit A: The Thrilling One denies that his daughter has ever taken drugs, despite her confession to the contrary in court. How silly. Only the Australians have any real interest in the drug Ecstasy. I suspect most New Zealanders don’t give a rip if Phil Goff’s daughter was in possession of a couple of tablets of just about anything, let alone Ecstasy. This was simply not a newsworthy event until Goff’s knee-jerk denial. Now everyone must draw the conclusion that Goff is either delusional or lying like a flatfish. I would have preferred the former, as most parents (including me) are a bit delusional about their kids. Unfortunately, the fact that Goff is a career politician and made his denial at a news conference specifically for this gives me to believe the latter is the more likely of the two possibilities.

Exhibit B: and talking about politicians who should learn to shut up when faced with unfavorable media, Len Brown seems in serious need of some help here. While I don’t think the man was seriously trying to equate himself with Jesus, he should have realised that his statement was easily misconstrued. Regardless of Brown’s messianic aspirations, it is clear from the rest of the interview that he views transparency in local government spending with a decidedly ambivalent eye. Not that his main rival, John Banks , is any better. Banks, bizarrely, would like to host the olympics. Earth to Banksie – we can barely cope with the relatively minor expenditure of the Rugby World Cup. How would we do with the massive commitment of the olympics? In fairness to Banks, he was clearly only kite-flying, but that is a dangerous sport for a politician.

And still on the theme of lying political prats, the MacDoctor wishes to register his disappointment that it is now the middle of the week and still we have not heard this week’s fake apology from Chris Carter. This is simply not good enough.

Related posts:

1. The Thrill Fades
2. Diversion
3. Trivial Pursuit