Bad public health decisions are rampant in this country right now. With the wide variance in how state governors are reacting to the Covid pandemic, you don’t have to be a rocket scientist to realize some of them are making bad decisions.

Many states passed new laws to legalize recreational marijuana recently, including Arizona, Montana, New Jersey and South Dakota. They join other states who earlier made the same decision including Colorado, California, Oregon, Washington, Minnesota, Massachusetts and Alaska. Many of those states are already having buyer’s remorse about their decision.

But the state of Oregon may have a lock on the worst new public health policy decision of all. I’m referring to their recent legalization of small amounts of harder drugs including cocaine, heroin and methamphetamines. None of these drugs have any therapeutic applications in these forms. There seems to be no end to the madness sweeping our country.

Naturally, the New York Times considered this good news. They write, “Drugs once thought to be the scourge of a healthy society, are getting public recognition as a part of American life.” Considering the source, this is hardly an endorsement by rational minds.

Naomi Schaefer Riley and John Walters, writing in The Wall Street Journal had more cogent and informed views. They write, “In reality, drugs are very much a scourge, particularly in the lives of young children. In 2019 parental substance abuse was listed as a cause for a child’s removal to foster care 38% of the time, a share that has risen steadily in the past decade. Experts suggest this is an underestimate and the real number may be up to 80%.”

They report that interviews with foster parents suggest that there are very few cases of children in the system that don’t involve substance abuse. Moreover, there are hundreds of thousands of children who are in the care of a single parent or other guardian because of a mother or father’s drug use. In a recent paper from the National Bureau of Economic Research, three professors from Notre Dame University estimates that “if drug abuse had remained at 1996 levels, 1.5 million fewer children aged 0-16 would have lived away from a parent in 2015.” In other words, this is a problem getting worse, not better. There is little doubt that legalizing these drugs will lead to even greater abuse of children.

If you’re a drug dealer, right now you’re celebrating. Your previously illegal business has just come out of the closet. You can stop worrying about law enforcement. The price of your drugs may go down as supply increases, but the number of customers is sure to rise and the costs of doing business just got cheaper. Adults may consider this progress but the children will surely suffer.

Riley and Walters go on: “More dug availability means more drug use, which increases interpersonal violence, including abuse and neglect of children. Babies exposed to drugs in utero can experience severe withdrawal in the near term and developmental delays in the long term. Children going through withdrawal are extraordinarily difficult to care for, and already overwhelmed parents may respond violently.”

But the greatest problem is that drug abuse leads to maltreatment of children. The Children’s Bureau of the Department of Health and Human Services reported in 2018, “Nationally, more than one quarter (28.7%) of victims are younger than 3 years old. Victims younger than 1 year are 15.3% of all victims.” Children under 3 made up more than three-quarters of child-maltreatment fatalities in fiscal 2018.

The breakdown of the family has been identified as the largest influence on rising crime rates in poor communities and this change in drug policy is sure to make the situation worse. It’s a bad time to be a child in America, especially in the State of Oregon.

Most Americans, about 180 million strong, get their healthcare insurance from their employer. Most like it that way and aren’t looking for a change.

Democrats support single-payer healthcare, or socialized medicine, which means government control of all healthcare. To get to that end they have proposed Medicare for All, which promises universal access to healthcare. About two thirds of Americans support this idea – until they realize it means eliminating their private health insurance.

Joe Biden doesn’t support Medicare for All because he realizes this won’t be supported when people understand they will lose their private insurance. Instead, he has proposed a “Public Option” be added to the current ObamaCare system. Polls show about two-thirds of Americans support this idea – because they don’t understand this will also eliminate their private insurance – just more gradually over time. In other words, it is a better marketing tool for the eventual government takeover of healthcare.

Republicans have been slow to offer an alternative. They ran hard on repealing and replacing ObamaCare in 2016. They might have succeeded if not for a few renegade senators like the late John McCain of Arizona and Senators Susan Collins of Maine and Lisa Murkowski of Alaska. This failure led to mid-term losses in 2018 and may have contributed to losing the White House in 2020.

There is no lack of good ideas from conservative healthcare analysts. There is only a lack of unity on the part of Republican lawmakers.

The Wall Street Journal  editorial board says what Americans really want is protection from the risk that they or someone they love needs help paying for cancer immunotherapy or surgery. There is a political opening for a healthcare policy that covers costs for the sick without compromising medical innovation or prompt access to care, and favors choice and competition over mandates and political control.

What’s wrong with ObamaCare?

Most Americans are satisfied with their healthcare now – but they shouldn’t be. Those who are satisfied are mostly the 180 million on employer-provided plans. Since their employer pays the premiums, they don’t realize how expensive they are. What they don’t realize is that the rising costs of these plans negatively impacts their own paychecks. When employers must pay more for health insurance benefits, there is less money available for wage increases.

ObamaCare costs more than necessary to provide good healthcare coverage. The law requires every qualified plan to provide “essential benefits” to every individual, regardless of their need for these benefits. In practice, this means men pay for mammogram screening and women pay for prostate exams. There is no allowance for variations in healthcare needs. It is a “one size fits all” system.

A better system would make allowances for specialized plans for, say, diabetics or cancer patients. Women beyond child-bearing age could eliminate obstetrical services. Tailor-made healthcare policies would lower costs and improve healthcare outcomes.

ObamaCare also unnecessarily raises Medicaid costs. The federal government pays states more to enroll prime-aged men above the poverty line than to cover the truly needy – even as Democrats claim to be the party of compassion. When state budgets are strained to pick up these higher Medicaid costs, other budget items, particularly education, suffer and children are the losers.

Medical costs could be lowered by enhancing Health Savings Accounts (HSAs). When I got my healthcare insurance through my business, I established an HSA account which I used to pay medical and drug expenses. This money was put aside before taxes and it incentivized me to be a good steward of these funds since they were controlled by me. But I had to give up my HSA account when I became eligible for Medicare. This needs to be changed. Expanded use of HSAs has been shown to lower medical costs in numerous studies.

Many of these ideas have been promoted by healthcare economist John C. Goodman and other healthcare analysts like Grace-Marie Turner and Brian Blasé. Goodman helped write the Sessions-Cassidy healthcare bill promoted by Representative Pete Sessions (R- TX) and Senator Bill Cassidy (R – LA). For more on this subject, I refer you to previous posts. (The GOP Solution to ObamaCare) (Sessions-Cassidy Healthcare Plan Solves Problems – I and II)

If Republicans want to avoid government-controlled healthcare, they need to promote their better ideas – and do so with unity. They need to stop Democrats from continuing to promote lies such as Republicans want to eliminate coverage of pre-existing conditions. That may be the one improvement ObamaCare has brought to our system that everyone can agree upon.

Treatment of Covid is getting better. Doctors are learning what treatments work and what doesn’t and patients are benefiting from this learning curve. The graphic below reflects these improvements that result in declining lengths of hospital stays.

Nevertheless, there are those who believe we could be doing even better. One of those is Dr. Joseph Ladapo, associate professor at UCLA’s David Geffen School of Medicine. He believes that pre-occupation with “evidence-based medicine” is keeping doctors from initiating life-saving treatment early enough to make a difference.

As an “old school” physician, I understand Dr. Ladapo’s concerns. We were taught to treat people on the basis of our best judgment. Sometimes that meant initiating treatment before our diagnosis, or our treatment methods, could be completely verified. Years of training and experience usually produced sound judgments that were rewarded with patient improvement.

Today’s younger doctors are lectured on treatment protocols backed by “evidence-based medicine,” a term coined by those academics who insist there is only one way to treat people – their way – based on proven randomized clinical trials. Unfortunately, this kind of “cook-book” medicine is often unrealistic. Many patients didn’t read the book!

Ladapo says a hearing took place on November 19 before the Senate Homeland Security and Governmental Affairs Committee. The testimony given underscored an important issue which Ladapo explains: “Too many doctors have interpreted the term “evidence-based medicine” to mean that the evidence for a treatment must be certain and definitive before it can be given to patients. Because accusing a physician of not being “evidence-based” can be a career-damaging allegation, fear of straying from the pack has prevailed, favoring inertia and inaction amid uncertainty about Covid-19 treatments. For diseases with established treatment options, holding out for certainty may be prudent. But when options are limited and there are safe treatments with evidence for effectiveness, holding out for certainty can be catastrophic. Requiring a high degree of certainty during a crisis may elevate the augustness of medical organizations and appease the sensibilities of medical professionals, but it does nothing for patients who need help.”

This is especially a problem in academic medical institutions where every treatment is scrutinized by well-meaning, but hypercritical, colleagues. It is there that medical elites want to control what their colleagues are doing, lest breakthroughs in treatment occur without their approval.

The penchant for certainty, says Ladapo, is visible in the frequently updated treatment guidelines for Covid-19 from the National Institutes of Health. These guidelines were developed by scientists around the country, but because of a mentality that is biased toward virtually irrefutable evidence, no distinction is made for treatments with evidence for effectiveness that falls below the mark of certainty. He believes this framework has almost certainly contributed to many avoidable deaths during this pandemic.

He gives the following examples:

• Hydroxychloroquine – A meta-analysis of five randomized clinical trials showed that early use of this drug reduced infection, hospitalization and death by 24%. As a medication used for decades, including for pregnant women and breast-feeding mothers, it had a well-established safety record. Yet many criticized the use of it because double-blind trials had not established its efficacy. When President Trump promoted the drug, and used it personally, many criticized its use even more.
• Fluvoxamine – This anti-depressant showed great promise in a high-quality randomized clinical trial of 152 patients published in JAMA which found zero patients treated within seven days of onset of symptoms experienced deterioration compared with 8% of those receiving placebo.
• Ivermectin – This anti-parasitic showed promising results in a randomized trial of 200 healthcare workers at high-risk of exposure to Covid. Only 2% developed Covid infections compared to 10% of the placebo group.
• Quercetin – This drug is being studied in a clinical trial and was used by Senator Ron Johnson, chairman of the Homeland Security Committee, after his Covid diagnosis in October.
• Bromhexine – This congestion medication reduced death rates among hospitalized patients in a randomized study published by BioImpacts.

Ladapo urges local and state governments, research institutions, community clinics, and Covid-19 testing sites to provide patients with access to promising outpatient treatments while collecting data about health outcomes. With almost 200,000 new Covid-19 cases daily in the U.S., uncertainly about effectiveness could be resolved within a few weeks. Until then, it is up to patients to demand outpatient treatment. Unfortunately, most physicians have simply advised patients to quarantine and hope for the best rather than prescribing early treatment.

With hospital facilities once again under the strain of rising case numbers, it seems prudent to do all we can to treat people early and before hospitalization is necessary. That’s the kind of sound judgment I was trained to apply before anyone ever heard of “evidence-based medicine.”