Apart from the fact that even voluntary sterilisation under such circumstances is a violation of what little is left of the moral and ethical framework of a civilised democracy, what would it achieve?

I fail to see how offering someone – who is clearly incapable of decent parenting in any shape or form – an incentive to have no more children, can be construed as a violation of ethics. Offering the incentive to someone because they are Maori or Poor or Jewish would be exceedingly dubious, I agree. These things have nothing to do with a person’s ability to bring up a child. But offering the incentive to a child abuser makes a great deal more sense than offering the same person DPB for having another child.

I rather think that Mr George’s extreme reaction to this suggestion is rather more to do with his take on sterilisation in general – viz.

voluntary sterilisation amounts to self-mutilation and renounces the natural law of self-preservation.

I can find no biblical basis for this remark at all and I suspect Mr. George’s take on contraception would be equally extreme. He is, of course, entitled to his beliefs on this matter but he cannot use his opinion as a valid argument  for the ethicality and morality of sterilisation. Note, we are talking about voluntary sterilisation here. There is no question that involuntary sterilisation is completely unethical and entirely distasteful.

Sterilisation is a reasonable medical procedure done when a couple have decided not to have more children. The only alternative would be to continue with various forms of contraception which may have side effects and may not be entirely effective. This risks the health of the mother (who has to take the contraception) or risks an unwanted child or, worse, an abortion.  In other words, the alternatives to sterilisation are considerably worse than any consideration for the “natural law of self-preservation” (whatever that may be).

The unfortunate thing about these remarks is they detract from Mr. George’s otherwise very reasonable argument – that voluntary sterilisation will do little or nothing to the statistics of child abuse and amounts to little more than putting a band-aid over a festering, cancerous sore. This is entirely true and an excellent point of which politicians should take note. The tendency of people, especially politicians, to hide from this nasty truth is exactly what encumbers us with myriad unwieldy laws and regulations, while doing nothing for the very real social problems that plague our society.

Daft he may be at times, but Garth George is also right.

Related posts:

1. Abortion and Child Abuse
2. Retroactive #6
3. Somebody Else’s Problem

‘Unjust’ bill means 11,000 per cent rise in prison time

is not exactly studiedly neutral. And making out that Kim Workman comes from “an independent organisation on crime” is simply a bad old-fashioned lie. It is rather like saying that Phil Goff comes from an independent organisation on Politics. Of course, the headline and the statement on Kim Workman’s “independent” status as one and the same thing. The 11,000 percent (PS Herald – percent is a single word) is a typical Kim Workman “statistic”. Invariably derived from taking the most far-fetched scenario or most bizarre comparison he can think of to make his point. In this case he is postulating that his third strike criminal will only deserve a two month sentence for his crime instead of “life” – not the most likely scenario. Mr Workman is also full of strange comparisons, quoting a bizarre Californian case (despite it not being applicable to our proposed law) and then postulating that Bruce Emery (he of tagger-murdering fame) may have received a life sentence if he had two previous strike – which he did not. Mr Workman possibly chose Emery because if he had used someone like Graeme Burton as an example, he would have disproved his point (that the three strikes law is unjust) immediately.

Which is a pity because, in this case, I am inclined to agree with Workman. The Californian version of this law does not work well because of two obvious defects. The first is that the list of offenses causing a strike is too long and contains many minor offenses. The second is that there is no way of differentiating a less severe offense from a more severe offense, making those minor offenses damning. Sadly the New Zealand version of the law contains the same two flaws.

For some reason known only to the Law and Order Committee, they have chosen to remove the clause limiting strikes to offenses with a sentence greater than 5 years or an indefinite (i.e. life) sentence. This means that they now have no way of differentiating between severe offenses worthy of a strike and fairly trivial offenses. For instance, “indecent assault” is a strike offense. So if you are a bottom-pinching chauvinist, you may well find yourself imprisoned for life after you have annoyed your third victim. Of course, you would have to be grossly stupid to gain three strikes in this fashion, but the point is that the law is not intended to have this effect, it is intended to take violent criminals out of circulation.

Perhaps a less frivolous example is that someone can have two strikes for robbery and then get into a bar fight and find themselves in jail for life.

Clearly, there needs to be some rider that differentiates these more minor crimes from others. The five year sentence rules did exactly that, which makes it a complete mystery why the rule has been reversed. While there may be some debate around the exactly length of sentence that would spark a strike, there should be no debate about the actual rule itself. In addition, some of the non-violent offenses should be removed, as the entire thrust of this law is to remove violent offenders, not simply crims.

The three strike law could be made to work well, but there seems to be a great deal of undercover politicking going on that is threatening to produce a bizarre and unworkable law that will produce the same crazy injustices of the californian law. This will serve no-one well and it is time that the Law and Order Committee got its act together (in both senses) and produced a more sensible document.

Related posts:

1. Spam Journalism #24
2. Three Strikes and You’re In
3. Crime Statistics

Of course, one might more or less guarantee that Labour would take a contrary position (and pretty much guaranteed that NZPA would lead with it):

Hitting tertiary education providers with funding penalties for high student drop out and fail rates would put teachers under pressure to give passes even when they were not deserved, Labour tertiary education spokeswoman Maryan Street says.

Nonsense. Excessive pass rates are statistically quite easy to spot (there is a great chapter on it in the original Freakonomics book) and universities watch out for it all the time anyway. There is nothing more deadly to a university’s reputation than lowering standards. And Ms Street’s suggestion that universities will offer less challenging courses is laughable. She appears to have forgotten that it was Labour’s willingness to fund every course in creation, no matter how bizarre, that lead to the profusion of daft courses being offered by the technical colleges. But even in the midst of that the universities stayed well away from such things.

Standards are everything to a university and even the tech colleges usually maintain reasonable ones. But it is crazy to have students chalking up large student debts while not attaining any sort of qualification that would help them pay that debt off.

Related posts:

1. Cap in Hand
2. Unforgiven
3. University Access

All this is irrelevant.

The simple matter is that cervical cancer is caused by strains of HPV that Gardasil does not protect against and sometimes happens in the complete absence of HPV. Therefore the only way you can be safe from cervical cancer is to have a regular pap smear. As the cure rate for early cervical cancer caught by pap smear is close to 100%, it is arguable the Gardasil is a fairly useless, expensive addition to the vaccination schedule and that any serious adverse event is one too many, if the vaccine itself is useless (this is the same argument currently being used against cough syrups in under 6 year olds).

While it is true that a pap smear is not 100% successful in detecting an early cervical cancer and that some slip through the net, as it were, it is also true that the vast majority of women who die from cervical cancer have not had a pap smear for more than 5 years prior to their diagnosis. In other words, women would be far better off if we put all the expensive Gardasil money into an effective campaign to promote regular pap smears.

So – bad reactions to the Gardasil vaccine are not the reason why we should abandon it. The real reason is that it is a complete waste of money that should be spent elsewhere.

When Julie Smith suggests on her site that Gardasil may actually increase cervical cancers, she is accidentally right. It is perfectly possible that girls who have been immunised will be less motivated to get pap smears at regular intervals. A drop in pap smear rates may well increase the death rate from cervical cancers.

Tony Ryall would be better employed looking properly at the data available, rather than issuing bland assurances that “the Ministry of Health did not have concerns about the vaccine’s safety or effectiveness”. We have insufficient data to be sure about either.

Related posts:

1. A Sexy Needle
2. Gardasil Update
3. Dumb, Dumber and Dumbest

There is no problem with the Pharmac model when an exact generic equivalent is available. While we may desire Medsafe to be a little faster at investigating generics that appear to be non-equivalent for various reasons (as in the thyroxine debacle), and we may desire that Pharmac should not be quite so willing to take the cheapest equivalent almost without regard to the source, in general, the Pharmac way of doing business does no harm to New Zealanders and keeps our drug bills enviably low. Even here, however, you see a trace of the major flaw in the system. When a generic drug is not the exact equivalent product of the the drug it is replacing, unexpected problems arise. Hands up all those who find Dr Reddy’s Omeprazole not exactly the same stuff as Losec.

The problem is much more obvious when there is actually no equivalent and Pharmac moves into “substitute mode”. Here the decision-making process moves from simple cost-comparisons and attempts to generate clinical protocols. Pharmac starts to dictate not merely the brand that is available but the actual chemical substance, and even the category. Choice is purposefully restrained to ensure that only the cheapest products are used. The flaw is now obvious. It is the attempt to cost the incremental benefits of one drug over another, without reference to appropriate use in real patients.

Let’s use an example. There are two blood pressure tablets A and B that treat blood pressure well but can cause coughing. There is a third product available tablet C that does not, but it is also the weakest (and cheapest) in its category and does not treat blood pressure as well as the other two. Pharmac forces you to be on both A then B (despite the fact that if one causes coughing the other almost certainly will do the same) before it allows you to use C. While you had good blood pressure control on A and B, you are battling with C (but at least you are not coughing. There is a product D on the market which is more powerful AND does not cause coughing, but Pharmac won’t fund that on the basis that 95% of people will be controlled on A, B or C and that the other 5% can use another funded product E – which is another type of drug entirely, with its own special set of side effects.

But wait, there’s more…

Shortly after you get your patient nicely controlled on product C with a little bit of product E, Pharmac decides to purchase a newer cheaper version of C. This version does not work as well in your patient, so you increase E, which causes some side effects. Then Pharmac decides that E will no longer be available (because it has too many side effects) but they will fund a drug F which is a cousin of E (but not the same thing). The patients blood pressure is now uncontrolled so you send him to a physician who used products G and H, stops F and doubles C. After a while you add some product I which Pharmac then changes to a new generic…

Now you know why GPs hate Pharmac.

The problem is that Pharmac’s decisions are based on averages. On average this product is like this one. Unfortunately, people are unique individuals who rarely obey the laws of averages. When measuring the incremental cost of a benefit of a drug, it is not the average benefit that is important, but the benefit in that particular patient. This is not to advocate therapeutic nihilism, but to advocate a freeing of the series of choices that Pharmac provides so that better fits can be made as to what works for a particular person.

In particular, Pharmac needs to set a level of funding for it few chosen drugs but allow people to choose drugs outside of that range but still get the same level of subsidy. It is manifestly unfair that a patient must pay the full price for a drug when another (for who the Pharmac choice works well) gets his drug for free. Pharmac allows doctors to substitute for some generics (usually reluctantly), taking the amount of Pharmac funding for the generic of the brand’s price so that the patient only pays a part charge. This should be the normal model.

In addition, Pharmac should beware of costing an apparently marginal benefit too cheaply. There are often many factors that they do not take into account, simply because it is a complex matter and economists and accountant tend to oversimplify.

This is why we should be careful about using the Pharmac model for purchasing equipment. There is no generic equivalent here; only old, outdated stock. While it is not always necessary to have the latest and greatest technology, obsolescence is extremely rapid in medicine and obsolete equipment can be a massive disadvantage in often unpredictable ways. Only 5 years ago defibrillators were mostly monophasic (delivered a shock in one direction) at that time a massive purchase of monophasic defibrillators would have been sensible, considering the cost of the newer biphasic ones. Large number of studies have shown that resuscitation results are significantly better with biphasic ones. We would have been left with technology that would have disadvantaged thousands of New Zealanders a year, killing hundreds of people (or failing to resuscitate them)

Cost comparisons are dangerous when you do not know exactly what you are comparing, be it an individual patient response or a new technology. The Pharmac Model is not an extensible one and should remain as a costing mechanism for generic equivalents only.

Related posts:

1. Made in India
2. The Pen is Mightier Than the Jab
3. Three Thyroxine Monkeys