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 How Fat People Reduce Global Warming [15:25m]: Play Now | Play in Popup | Download (64)

When DrRich was a little tyke, he always loved it when Uncle Harry came to visit. Uncle Harry was a large, rotund man with a ready smile and a jolly laugh, who was genuinely delighted to spend hours entertaining little DrRich and all the other children with his jokes, stories, magic tricks, and samples from the large stash of candies he always kept in his coat pockets. We all loved Uncle Harry.

But we were deceived.

Little did DrRich know, in his youthful innocence, that far from being the cheerful and beloved amateur prestidigitator delighting us with his his egg trick, Uncle Harry was actually a menace. For Uncle Harry was obese.

We now know, of course, that obese people, through their gluttony, sloth and lack of self-control, are causing untold harm to our society. They are unpleasant to sit next to on buses and airplanes. They use more than their rightful share of healthcare resources. They snore. They cause excessive tire wear (and if they sit in the same seat all the time, the tire wear will be asymmetrical, probably leading to an increase in automobile accidents).

And now, thanks to a recently published academic article, we know that the obese are largely responsible for global warming.

That global warming is taking place, and that it is being produced by mankind, of course, is a settled issue. DrRich is led to understand that a great council of hand-picked environmental scientists, taking a lesson from the Council of Nicaea, has met and has decreed it to be so. The entire body of scientific evidence has been formally considered, and like the Holy Scripture has been carefully locked down into its final form, and has been divided into orthodoxy (the study of which is holy) and heresy (the study of which leads to perdition). And having accomplished this task, the scientific community will hereafter countenance no dissension on the matter, and will admit no further debate or even any further data (unless it is corroborative data). For this is how science is supposed to work, at least for matters as critically important as global warming.

DrRich calls it Environmental Scholasticism, and believes it is about time we returned to a system of thought that was good enough for some pretty important Saints. The notion that scientific viewpoints should never be considered “closed,” and should always be open to challenge as new evidence and new ideas come to light, is a relatively recent invention initiated by the likes of Galileo and Newton, and has led to nothing but trouble (such as, for instance, global warming).

In any case, now that we know once and for all that global warming is man-made, it behooves us to figure out which men (and women) are causing it. And now, according to two eminent scholars at the Department of Epidemiology and Population Health, at the London School of Hygiene & Tropical Medicine, we know that among the chief culprits are the fat. That is, fat people, through the office of their obesity itself, are responsible for a significant degree of the carbon emissions that are unarguably (and officially) destroying our planet.

This fact, heralded by radio and newspaper reports proclaiming, “Fatties Cause Global Warming,” was revealed in a “scientific” paper written by Professors Edwards and Roberts and published by the prestigious Oxford Press in the International Journal of Epidemiology.

The paper really ought to be perused directly to appreciate the elevated level of scholasticism employed by the authors, which would make even Thomas Aquinas and Albertus Magnus themselves sit up and take notice. For this paper, which indicts a whole class of individuals with the supreme crime of global warming, a crime whose disastrous effect on our planet eventually will make the atrocities perpetrated by even Hitler and Stalin seem mere trifles in comparison, reaches its conclusions without ever offering even one tiny glimmer of actual data or evidence.

Rather, the authors rely (as true scholastics must) on the approved body of scientific work, choosing from that body an array of assumptions based on bits of sanctified data from physiology here (e.g., Basal Metabolic Rate = 11.5 X body weight in KG + 873kcal), and behavioral science there (e.g., that the average daily activities of humans consists of 7 hours sleeping, 7 hours of office work, 4 hours of light home activities, 4 hours sitting, 1 hour standing, 30 min of driving and 30 min of walking at 5 km/h), then applying these bits to an incredible chain of assumptions and estimations, to demonstrate that the negative impact of the obese on our society goes far beyond what we currently think. Indeed, through such machinations it can be concluded that the obese are melting the ice caps, killing polar bears, flooding the seacoasts, and turning our farmland, forests and fields into hot, dry, desert.

Anyone with a cheap telescope can conclude from all this that Martians, when they existed, must have been really fat.

This information, of course, will come in very handy when we are forced at last to reduce our healthcare costs, and we find we need somebody to blame. We can already discriminate against smokers with a clear conscience. And now discriminating against the obese can be accomplished not only with a clear conscience, but with a sense of duty. For, far from merely costing the healthcare system a lot of money, they are killing us all and ruining our planet.

Indeed, DrRich himself was sharpening his pitchfork, when a thought occurred to him.

The paper in the International Journal of Epidemiology comports to the classical scholastic practice of “lectio,” whereby a learned person expounds on a certain interpretation of the approved texts, and allows no dissension or questioning. But scholasticism also offers a process for “disputatio,” whereby alternative interpretations of the approved texts are permitted to be offered, and the two viewpoints are then subjected to logical analysis through which the truth is determined. (Though in classical scholasticism, the “truth” is ultimately determined by the scholar who delivered the original lectio, and the disputant is put in his/her place.*)

So in the spirit of Environmental Scholasticism (but for the ultimate purpose of discovering whether the healthcare system ought to cure, ignore or euthanize the obese), DrRich would like to propose an alternative interpretation of the argument that the obese are causing global warming. That is, he will offer a disputation.

The logic of the two eminent scholars Edwards and Roberts, once you wade through the incredible morass of scientific-sounding language they have produced, essentially rests on two arguments. First, that the obese require more food energy for their basal metabolic requirements, and second, that because they are so fat they travel in cars (and very big cars at that) much more than normal people do. For these two reasons the obese produce way more carbon emissions than they are supposed to. The authors go on to calculate the excess carbon emissions produced by the obese via the aforesaid impressive chain of assumptions and estimations, and the magnitude of that excess shows us plainly that the fat are largely to blame for global warming.

This is when it occurred to DrRich that both of the basic arguments of Professors Edwards and Roberts can be easily countered, well within the bounds of the scholastic arts, using only the approved texts and without introducing any new (which is to say, heretical) data.

So, to their lectio, DrRich advances this disputation:

First, DrRich asserts that while the basal metabolic rates of the fat are indeed higher than those of the thin, one reason the thin are thin is that their non-basal metabolism is high. That is, often they habitually engage in exercise, even running marathons and triathalons, which burns many calories and produces much CO2. Scientific studies have shown that the obese tend to be still, serene, relatively inanimate. On the other hand thin people are fidgety, they pace about, wave their hands, bounce their legs, and excrete much CO2 through largely habitual and non-useful activity. Perhaps we should punish the calorie-burning thin rather than the fat. At least when the obese burn calories they are generally doing something useful.

Second, while thin people do ambulate more than the obese (indeed, this is DrRich’s first point), the assumption that the obese must make up that mileage by driving cars is entirely ridiculous. The thin actually drive far more than the obese, because they have places to go and things to do, and they’re in a hurry to get there and do it. In contrast the obese are efficient in their movements, they preserve their energy. Thus, they do not drive to the grocery for a pint of milk on a whim. They plan their trips carefully, and shop for the entire week with one trip. There is no evidence that the obese require more support from internal combustion engines than do the thin, and simple observation in fact suggests the opposite.

DrRich could, with some effort, produce a paper just as scientific-sounding as that of the Professors to “prove” his points, but will not do so here. Instead, he will just state his points as bald assertions – which (despite all the fancy math they attached to it) is just what his opponents have done.

DrRich maintains that his two assertions – which entirely counterbalance those of his opponents – make his argument equally compelling to theirs. So thus far we have a draw. But DrRich’s third assertion, which follows, wins the day.

To wit: The obese are unarguably sequestering carbon.

Storing fat, in fact, is simply a relatively efficient way to store carbon. The obese consume massive amounts of carbon in the form of food, and then they fail to burn it off (unlike thin people, who convert their food to CO2 immediately through their habitually wasteful activities). Instead, the obese store their carbon intake in massive reservoirs of fatty tissue, taking it out of circulation forever, and removing it from the carbon cycle which (we find) is so fatally damaging to the earth. Indeed (at least according to the zero-sum crowd for whom redistribution is invariably the answer to all problems), the more food consumed by the obese, the less food remains available for the thin people who would just go ahead and metabolize it, with all their jogging and whatnot, excreting lots of excess CO2 in the process.

When we finally institute our cap-and-trade economy, the obese should get a tax break based on their weight.

Carbon sequestration, of course, is one of the holy grails for environmentalists. Lots of methods for sequestration have been proposed, but none seem particularly practical. One method that has been considered is called “Biomass Burial,” in which we would take some form of biomass (plants have been the main source proposed) and bury it under the earth. The carbon from the buried biomass will stay in the ground, and will not contribute to global warming, at least not for a long time. (This is how fossil fuels were formed in the first place.)

As long as we insist that fat people are buried (preferably after they die), and make cremation of the obese illegal, then putting the obese into the ground will constitute the much-sought biomass burial. When we bury deceased fat people, it is plain to see that we are removing tons and tons of carbon from the carbon cycle and thus from the atmosphere, and instead sequestering it in the ground. It brings a tear to DrRich’s eye to imagine that his king-sized Uncle Harry, gone now for the better part of three decades, by virtue of all that carbon he took with him under the earth continues to make the world a better place for all us former kids he used to delight with his card tricks and his stupid jokes.

And finally, this happy conclusion at which we have arrived – that the obese actually reduce global warming – at last informs those of us who are interested in healthcare how we ought to behave toward the obese. As long as fat people are maintaining (or better yet adding to) their weight – that is, as long as they continue to remove large amounts of carbon from circulation – we should encourage their continued good health. If, however, they start exercising or in some other fashion begin to burn off their large carbon deposits, then of course we might logically withhold medical care from them, or even encourage euthanasia.

But please, for the love of our precious planet and for the sake of our polar bear citizens, let us not discriminate against the obese, or discourage them from their important work.

*This, of course is where Martin Luther went wrong. The 95 Theses he nailed to the church door at Wittenberg was essentially an offer to engage in a classical scholastic “disputatio.” He was merely inviting a debate, like any other scholastic debate, and nothing more. The clergy, however, proved a bit too easily offended, and Luther proved a bit too tetchy, and the intended academic exercise turned into 300-years of bloodshed. DrRich sincerely hopes to avoid such a result here.

________________________________

Now, read the whole story.

DrRich explains it all in, Fixing American Healthcare – Wonkonians, Gekkonians and the Grand Unification Theory of Healthcare.

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 Global Warming and the Importance of Bias in Scientific Progress [14:59m]: Play Now | Play in Popup | Download (75)

DrRich is relieved to learn that the world’s most famous global warming experts have now been exonerated by three separate formal reviews. Dr. Michael Mann from Penn State University was cleared by a review conducted by Penn State University. Dr. Phil Jones, Director of the University of East Anglia’s Climate Research Unit (CRU), was cleared by a review conducted by the University of East Anglia, and also by a four-member “independent panel,” one of whose members was Prof. Geoffrey Boulton, a personage who had been on the faculty of East Anglia’s School of Environmental Sciences for 18 years, and who (prior to being placed on the “independent panel”) had been a vocal defender of Dr. Jones’ actions regarding Climategate.

Right-wing global-warming-deniers, of course, have decried the results of these reviews as a “whitewash,” pointing out, among other things, that Penn State and East Anglia both continue to receive tens of millions of dollars in federal “research” funds so they can continue to prove that global warming a) exists, and b) is man-made, thus suggesting that these institutions were determined to acquit their star grantsmen of scientific misconduct no matter what the objective findings. This kind of whitewash, they say, not only supports the global warming “hoax,” but even worse, further undermines the integrity of the scientific process upon which so much of modern society so utterly relies.

Of course, if right-wingers are correct, then reversing modern society and putting us all back in the glorious horse-and-buggy days is the very goal of the global warming mavens. (DrRich, a student of history, is well aware of how difficult it must have been 110 years ago to walk the streets of New York City without ending up splattered with dung to your knees, and he wonders what life would be like today, navigating the highways and byways of America, if all 300 million of us were relegated again to modes of transportation that defecate nearly continuously.)

It must be admitted, by anyone who has perused some of the leaked e-mails sent and received by Dr. Jones (making it doubtful that any of the three review panels had actually done so), that from any really objective viewpoint the global warming experts had engaged in some very questionable behaviors, which appear to have been aimed at advancing their theories, and suppressing any opposition, by any means at their disposal. The e-mails depict Jones and prominent colleagues discussing how to “tweak” climate change data in order to hide such embarrassing climatic phenomena as the Medieval warming period, “the little ice age” that followed it, and the global cooling we’ve been seeing over the past decade. Including these historical temperature fluctuations in their data would make their famous hockey stick graph look less like a hockey stick, and more like the random profile of a mountain range. (And once Al Gore won an Oscar for showing slides of the hockey stick, that was not an option.) They also collaborated to “control” the peer-review process so that only the “right” peers would be doing the reviewing, and the “wrong” peers would be cut off altogether. And, as a final deft touch, they all shared electronic high-fives when a noted global warming skeptic died unexpectedly.

Then, of course, just a few days after the embarrassing e-mail leak, the CRU was forced to admit (thanks to Britain’s Freedom of Information act) that they had, apparently intentionally, destroyed all the raw temperature data upon which their elaborate computer models were based. (They say they ran out of space to store it, apparently failing to recall the many forms of magnetic storage readily available to scientists today). The destruction of this data utterly precludes other scientists from checking, and attempting to reproduce, the critical predictive model upon which the theory of man-made global warming largely rests.

Oops.

This inconvenient truth renders their climate change model a black box. It places the rest of us in the position of having to “just trust” the global warming experts, upon whose work (for instance) President Obama bases his proposal for a fundamental change in our economy, our way of life, and our foundational political philosophy.

So it is perhaps somewhat understandable that right-wingers object so vociferously to the alleged “whitewash.” Their general complaint seems to be that the scientific process should always be pristinely unbiased, and that the gross bias so clearly displayed by global warming experts in this case not only corrupts the case for global warming, but also corrupts the scientific process itself, to the extent that every scientist in the world should be screaming for the heads of the miscreants, and indeed, must do so, to salvage the very legitimacy of science.

DrRich is sympathetic to the argument that the implications of Climategate are troublesome, but not because the climatologists have behaved in a terribly biased way. Biased thinking within a scientific debate is not only common practice, but also it is a critically important part of the process. Raw contention between very biased scientists with very different viewpoints is how we get scientific progress in the first place. DrRich is not even disturbed that the currently-entrenched global warming experts have used their position of relative strength to suppress the upstarts who dared to oppose them. That’s also pretty much standard behavior in the academy, and it, too, serves a useful purpose.

Rather, what’s troublesome about the global warming controversy is that outside authorities of incredible power have taken an extraordinarily strong position in the scientific debate, and have lent their massive influence to one particular side. Whenever this sort of thing happens, the “winner” of the scientific contest is often not determined by superior scientific merit, but by other factors.

Scientific progress works like this: A new theory is conceptualized to explain some phenomenon, usually by a whippersnapper of one variety or another. The entrenched experts, whose careers, reputations, social status, incomes, and sexual fulfillment are based on the old conception, find the new theory to be absurdly wrong (or in some cases heretical), and probably dangerous. Since preserving the “truth” is the highest calling of all, the experts engage in every device they can muster (from “controlling” the peer-review process to burning heretics at the stake) to see that the truth (as they define it) prevails.

To the uninitiated – and certainly to the upstart whippersnappers – this process seems primitive and unkind. But actually it is quite useful and practical, and in the long term is very beneficial to mankind. For most of the new theories thought up by whippersnappers are, in fact, garbage. In order to break through the imposing barriers of bias constructed by the entrenched experts, the novices really have to believe in what they are espousing, and their new theory, ultimately, has to actually offer some substantial improvement over the currently accepted one. The whippersnapper, if very lucky, finally becomes the foundation of a new generation of experts – and the process begins all over again. Hence, science progresses. The process is geared toward the gradual discovery of truth, and not toward the nurturing and vindication of whippersnappers. And eventually, truth always does prevail – and often it does so within just a few generations.

In the short term, of course, this process can look very messy and unfair. It is certainly subject to great bias. In fact, we take pains to set up the accepted experts with lots of grant money, prestige, titles, &c. precisely to make sure they’ll do everything they can to preserve the status quo. We do this so that when the paradigm actually shifts, it shifts because the merits of the new paradigm are sufficient to overcome all the bias – and not because of a whim. This process keeps science – and society – from being whipsawed this way and that.

Where the process breaks down is when a powerful outside influence – say, a religion or a government – firmly takes a side in the scientific debate. For example, just ask any of the would-be astronomers from the time of the pre-Renaissance Popes how well the scientific process of competing biases worked out for them.

It seems apparent, to DrRich at least, that  most of the world’s governments, including ours, find that the bias of the global warming experts very nicely aligns with the historical bias of governments, which is to say, accruing ever more power over the endeavors of the people.  It may possibly be for this reason that governments have thrown in – body and soul – with this side of the debate, to the extent that “global warming” has now become largely sacrosanct. Man-made global warming is officially deemed (like the 2011 U.S. Budget) to be  “settled science,” and is beyond reasonable question. No new scientific evidence to the contrary is admissible. Competing viewpoints are, in fact, heretical. And even when gross evidence of academic misbehavior on the part of global warming experts is revealed, that evidence is excused, paved over and ignored.

This mindset is the only one that fully explains the tone and the content of the Climategate e-mails, and the subsequent exoneration of the climate scientists who wrote them.

Most readers, DrRich expects, agree with him to this point. (For, how could it be otherwise?)  But, you may be asking, what does any of this have to do with healthcare, or more specifically, with healthcare rationing?

As we enter into a new era of healthcare, where medical decisions will be taken out of the hands of imperfect physicians and entrusted to panels of federally-sanctioned (and thus pretty much infallible) experts, who will analyze the available data and construct the guidelines of behavior by which all physicians will henceforth be judged, we ought to keep the problem of unbalanced bias in mind.

Today we have a healthcare system in which competing interests, and their competing biases, battle for prominence. The process is messy, ugly and often unfair, but with long-term results that are generally reasonably favorable. Or at least, the damage is generally contained.  But we are headed toward a healthcare system in which only one great interest – that of our government, with its overwhelming bias toward cutting the cost of healthcare – will predominate.

A great fallacy under which many of us labor is that the government has no strong biases, and that a process overseen by the government will be inherently far more “fair” than a process that incorporates the biases of for-profit enterprises. But in truth, the government is the biggest, meanest, special interest of all. And like all sovereign authorities, this one is not only able to, but is expected to get the results it deems necessary by the measured application of violence.

For those who believe any government, anywhere, which has total control over any human enterprise can still behave fairly, DrRich begs you to please have another look at history. When we allow government (and its agents) to have the only say over medical decisions, then those medical decisions will be made with all the robust, open-minded, free, give-and-take exchange of ideas we are seeing from the global warming experts today. And while medical progress – like progress in general – cannot be forever halted, it will become as sclerotic as the scientific progress enjoyed by those pre-Renaissance astronomers.

The scientific process will always be biased. Where we invite serious damage is where we admit only one form of bias, and forcibly stifle all the rest. It’s bad for climate science, and it will be bad for healthcare.
________________________________

Now, read the whole story.

DrRich explains it all in, Fixing American Healthcare – Wonkonians, Gekkonians and the Grand Unification Theory of Healthcare.

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 DrRich's Global Solution To All Our Problems [8:47m]: Play Now | Play in Popup | Download (65)

Dr. Marya Zilberberg has an interesting post on Kevin,MD, speculating on the effect a worldwide oil shortage will have on healthcare, and what we ought to do about it. Marya is herself a notable blogger who has commented here several times (but whose comments, alas, were among those lost when the catastrophe struck), and she is one of the more thoughtful critics of DrRich. Her criticisms are always fact-based rather than ad hominem, and thus she always gets DrRich to thinking. Her post on Kevin, MD had that typical effect.

So DrRich hopes his readers will give Marya at least a little of the credit for what follows.

We as a nation face several apparently intractable problems at the present moment. Indeed, the problems individually seem so unsolvable that it will obviously take some major “outside of the box” thinking to solve any one of them, let alone the whole mess.

DrRich refers, of course, to the following five problems:

1. We as a nation face more than $50 trillion in debt obligations over the next several decades, thanks to Social Security and Medicare alone. This is an obligation we have no prayer of meeting.

2. Thanks to that massive accumulation of debt, we as a nation are mortgaging our futures to foreign nations, principally China. In fact, this totalitarian power will soon have veto authority on any initiative the US proposes to take.

3. We face an apparently growing threat of terrorist attacks whose base of operations (while it may be insensitive to say so) is in the Middle East.

4. Thanks to our profligate use of oil products, we are causing runaway global warming (and anyone mentioning the past decade of global cooling is a global warming denier).

5. As Marya points out, we appear to be drawing ever closer to a worldwide oil shortage that will threaten every aspect of our lives, even our healthcare.

Marya’s post was the key for DrRich.

DrRich, being a conservative American, has previously subscribed to a “Drill, Baby Drill” sort of philosophy. After all, we have oil in the ground, and we need oil to run our economy – so let’s go get it ourselves, instead of paying all that money to Middle Eastern and Venezuelan dictators, who just turn around and give it to terrorists.

But now DrRich sees the error of his ways.

There is a simple and straightforward solution that addresses all five of our intractable problems, indirectly if not directly.

Here it is: Stop drilling altogether. Leave American oil in the ground. And buy up all those other peoples’ oil (and take physical possession of it) – as fast as we can.

The estimated worldwide oil reserve is about 1 trillion barrels. Let’s buy as much as we can of those reserves, and bring it here. At $100 a barrel that’s only 100 trillion dollars, or only twice what we’re obligated to pay for our old farts over the next few decades. But the difference is, when we spend all that money on Social Security and Medicare, all we’ve got to show for it is old farts who are even older. But when we spend that money buying up the world’s oil, we’ve got a corner on the market.

Where are we going to put all that oil, skeptics might ask? Why, we’re going to store it in the rapidly-depleting Ogallala Acquifer, which is capable of holding up to 978 trillion gallons. The world’s oil reserves, if we choose to follow DrRich’s plan, will be right under Kansas and Nebraska – the heartland.

Even if the price of oil rises to substantially higher than $100 per barrel (which it certainly will as the world’s supplies become sequestered beneath Lincoln and Dodge City), it will still be a bargain for us to buy it up. It will be a bargain at any price. After all, we’re already in a debt hole so deep we cannot possibly get out of it. If we’re destined to perish in a sea of debt, we might just as well drown in $500 trillion as $50 trillion of debt. We’ll be just as dead either way.

So we should be delighted to accumulate whatever amount of debt is required in order to corner the world’s oil market. It’s our only hope.

Because, when the only oil left in the world is American oil, we strike back. Our oil will be a precious, life-sustaining commodity, which nobody in the world can do without. Even if energy technology develops to the point where people can really fly around in airships powered by solar batteries, oil will remain precious. Just try building those solar batteries without petroleum products. Marya herself points out that it’s only petroleum products which allow us to do all the remarkable stuff we do every day in healthcare, as well as in every other modern endeavor.

We’ll be able to charge whatever we want for our oil – DrRich (a humanitarian) is thinking merely $1000 a barrel, as a nice round number. We’ll be able to pay China back, and any other of our debt holders, in a trice. And in another trice they will all owe money to us (like in the good old days).

The Middle Eastern terrorists will become defunded.

Since nobody else in the world will be able to engage in hydrocarbon pollution any longer without our say so, we can control worldwide carbon emissions as we see fit, and “tune” the earth’s temperature like a fine clock.

Best of all, since (according to the current plans of our leaders) the American government will remain permanently in the hands of benign progressives, who by definition care very deeply about the people of the world, all this will be done with the most beneficent of intents, which will assure the very best of outcomes.

Of course, none of this will work if it turns out the world’s oil reserves are vastly greater than current official estimates. This might be something to think about, considering that today’s oil reserves are twice what they were in 1980, even though we’ve burned through (and, of course, spilled) 30 years of oil since then. Thankfully, the experts assure us that this time they’re correct. And if we’re not going to listen to the experts, what the heck are we paying them for?

Besides, given our current situation, we have nothing to lose by trying. So: Cap, Baby, Cap!

________________________________

Now, read the whole story.

DrRich explains it all in, Fixing American Healthcare – Wonkonians, Gekkonians and the Grand Unification Theory of Healthcare.

Now on Kindle!

(A Heartfelt Plea To Certain Authors Of The Health Care Renewal Blog)

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 Defending the Anti-Obesity Movement, Again [12:35m]: Play Now | Play in Popup | Download (53)

The other day, President Obama gave a commencement speech in which he pointed out one of the downsides of living in a new age of electronic communication:

“Meanwhile, you’re coming of age in a 24/7 media environment that bombards us with all kinds of content and exposes us to all kinds of arguments, some of which don’t rank all that high on the truth meter. . . .[I]nformation becomes a distraction, a diversion, a form of entertainment, rather than a tool of empowerment. All of this is not only putting new pressures on you; it is putting new pressures on our country and on our democracy.”

In other words, too much information can be bad (since it can be untruthful, and places pressure on our country and democracy). Clearly implied in this statement is the idea that something ought to be done about all that extraneous information out there. Presumably, disinterested truth-tellers in our unbiased government bureaucracies ought to sort out fact from fiction, and take the necessary steps to get rid of the fiction. This is not the first time the White House has offered to monitor the utterings of wrong-thinking Americans, and to do what is needed to correct their misapprehensions. Rather, it is simply another reinforcement of a consistent theme under our current administration.

We had best take it seriously.

And so, it is with some reluctance that DrRich finds it necessary at this time to perform an intervention. He does so with the kindest of motives, namely, to protect two people he greatly admires from finding themselves on the wrong side of a Federal disinformation bust.

DrRich speaks, of course, of Dr. Roy Poses and his colleague MedInformaticsMD (who had best not rely on an easily-decoded pseudonym for protection), two of the principle authors of the excellent Health Care Renewal blog. Both of these highly respected physicians and bloggers have posted articles this week which are critical of individuals who have spoken out against obese Americans.

Dr. Poses started it, pointing out that certain high-profile executives who have made recent public statements decrying obesity, and ridiculing (and offering to discriminate against) the obese, are pontificating on an issue about which they have no professional expertise.

MedInformaticsMD upped the ante by referring to these same executives as obesity bigots, and pointing out (rather colorfully) that such a person “talks stupidly and discriminatorily out of his anal orifice about how much people put in the other end of their GI tracts.”

Now, DrRich does not know how likely it is that Federal truth-tellers will stumble across these offensive posts. Given the stuff DrRich himself has said about healthcare reform and our government, he hopes it is unlikely indeed.

But Gentlemen of the HCR blog! Whereas DrRich habitually employs enough irony in his writings that most stone-witted bureaucrats (he hopes!) will have trouble discerning what he actually thinks, your prose is uncomfortably straightforward, and leaves no room for interpretation. If they find it, you are screwed.

And so, DrRich begs you to allow him an opportunity to set you straight on American obesity, and the importance of the anti-obesity movement.

To understand this, one must understand the underlying premise: Under any soup-to-nuts universal healthcare system (which, DrRich submits, is the ultimate goal), our central authorities, in the name of controlling costs, have got to be able to restrict, control and tax virtually any human behavior they can claim may lead to an increased risk of healthcare expenditures – which, really, encompasses virtually any human behavior you can think of.

Such power on the part of our central authorities will feel “unnatural” to many if not most Americans, if not developed judiciously. And so, it makes sense to develop such power – to set precedents which, once set, will be impossible to stop – by demonizing the obese, and making it not only OK, but imperative, for the government to control their unutterably selfish behavior, and, failing that, to punish them.

It is not difficult to demonize the obese. In literature and films the obese have long been portrayed as unreasonably jolly, slovenly and lazy, or just plain evil. (Hello, Newman!) Nobody likes to sit next to them on airplanes or buses. They block the aisles at the grocery store (their favorite haunts), and they reduce miles-per-gallon (and cause excessive tire wear) when they ride in our cars. On humid days, they sweat (and thus smell) more than you and I. So, with rare exceptions (and it is unfortunate that you two Gentlemen comprise one of these), nobody complains when the obese are criticized and attacked.

Given the current hypersensitivity to anything smacking of criticism of various races, ethnic groups, professions, political movements, sexual orientations, immigration status, victims of certain diseases, and scores of other categories of Americans, the obese present us with a refreshingly – and indeed the only – safe target. As the authors of the HCR blog point out, prominent and respected figures feel no compunction whatsoever against making the most offensive public statements against the obese, and when they do they receive (with rare exceptions such as provided by you HRC Gentlemen) applause rather than condemnation.

Obesity is a condition which is immediately visible to all – and from a great distance – and which immediately labels one as being selfish and lazy, and, now, as entirely unconcerned that their bad behavior is costing the rest of us our healthcare dollars, and thus, potentially our lives. Hating the obese has become nearly a patriotic imperative.

Fully government-funded and government-controlled healthcare (by whatever subterfuge we finally get there) permits – nay, demands! – that we declare to the obese that their unsightly physiques are no longer a matter of personal choice, but are now a matter of legitimate public concern. The choices they are making – that is, their gluttony, sloth and all other manner of self-indulgence – are placing unwanted and unsustainable demands on us purer, svelter, fellow-citizens, not to mention placing us in danger of not receiving the healthcare which we (in contrast) actually deserve.

It is already far too late, Gentlemen, to appeal to mere reasonableness, rationality, or, especially civility.  We are well past that stage. Observe: It has become acceptable to write, and accept for publication, “scientific” papers claiming that the obese are the chief cause of global warming. Observe again: It has become acceptable to write, and accept for publication, “scientific” papers claiming that obesity is contagious, and that – never mind associating with the obese themselves – it is risky associating with the very friends of the obese. (That is, even those who like, or tolerate, fat people are to be shunned.)

By their own selfish actions, actions which threaten the collective far more than merely themselves, the obese have become fair game for whatever manipulations our government can devise to cause them to either lose weight, or pay for their sins. Such maneuvers may begin with simple taxes on foodstuffs favored by the obese, but the sky’s the limit. A special “carbon tax” based on their BMI would be legitimate, for instance, since it will always cost a lot of energy to move a fat person from point A to point B, whatever the mode of transportation. The periodic mandatory public “weigh-ins” such a tax would justify would serve the useful purpose of public humiliation, an important incentive to weight loss. And it goes without saying that the ultimate censure – already employed in more enlightened cultures such as Great Britain – would be simply to withhold certain healthcare services if one is deemed too fat.

Demonizing the obese provides several important precedents to our central authorities. That it sets an important precedent – and establishes the mechanisms and techniques – for controlling the private behaviors of American citizens is obvious. But it also allows us to place the blame for a medical condition, which largely depends on genetic predisposition, solely on the chosen behavior of its victims. Discriminating against those who have genetically-mediated conditions thus becomes possible.

Discriminating against obesity also sets a precedent for discriminating against the lower economic classes (since obesity, rather than starvation, is the chief nutritional problem of the poor in America). This will prove a useful tool when we set future behavioral standards to reduce healthcare spending, since so much of that spending is for the economically disadvantaged.

And so, Gentlemen of the HRC blog, it ought to be painfully clear that successfully demonizing the obese is a vital pillar of our new healthcare system. And when you express the unfortunate ideas the two of you have published this week (namely, that discrimination against the obese is somehow unhelpful), you are placing a large target on yourselves, and on your otherwise excellent blog. (And by extension, you may be placing more innocent blogs, like this one,  under more official scrutiny than might be comfortable.)

DrRich sincerely hopes you will take these comments in the communal spirit in which they are intended.

Yesterday, DrRich noted (with his usual affecting humility, modesty, self-deprecation, &c.) that the Covert Rationing Blog has been named a Finalist in the 2009 Medical Weblog Award Competition, in the category of Best Health Policy/Ethics Blog. He now calls to his readers’ attention the fact that, among the other two finalists – both of which are of very high quality and undoubtedly are more deserving of this award than DrRich – is none other than the ACP Advocate Blog.

The ACP Advocate Blog, written by Bob Doherty, is a publication of the American College of Physicians, and its purpose is to explain, elaborate on and advocate for the ACP’s positions on important matters related to health policy and medical ethics that affect its members, namely, internal medicine specialists. Doherty – who DrRich does not know, but of whom he has heard many very complimentary things – is an insightful analyst of matters related to healthcare policy, and to boot he is an excellent writer. DrRich is a loyal reader of the ACP Advocate Blog, which in fact has habitually led off DrRich’s blogroll.

Here’s why this is interesting. While both the ACP Advocate Blog and DrRich’s blog are finalists in the medical ethics category, it so happens that DrRich and the ACP are far apart on that very issue. DrRich (himself formerly a proud member of the ACP for over 30 years) has been a vocal critic of the ACP’s stand on medical ethics, ever since it joined a group of professional organizations a few years ago to formulate “Medical Ethics for a New Millenium.” DrRich believes that this “new medical ethics” is harmful to patients and to the medical profession alike, and has not been bashful about saying so.

So here we are – DrRich and the ACP Advocate Blog – both selected, as fate would have it, as co-finalists in the venerable Medical Weblog Award Competition in the category of medical ethics, when, regarding this very topic, the former has been quite vocal and persistent about criticizing the latter. Meanwhile, DrRich’s effusions on the subject have been completely ignored by the ACP in general, and by Doherty in particular. Now let’s be clear – DrRich does not blame them in the least for failing to respond to his criticisms, since they are very likely completely unaware of his existence (being, as he is, merely one tiny voice in a great sea of blogospheric pontificators). Also, truth be told, even if they were aware of DrRich’s criticisms, prestigious organizations such as the ACP do not owe a debt of response or recognition to every lone crackpot who criticizes them or their policies. If they had such an obligation, then how would they ever get any work done?

But still and all, here we are, fellow finalists.

So what, prithee, is the correct etiquette here? Quite likely, the correct thing for DrRich to do would be to avoid disharmony, to ignore the tension built-in to this unasked-for situation, to pretend there is no major point of contention over medical ethics between himself and one of the other medical ethics finalists, to spend the next couple of weeks writing about some other of his favorite subjects – how fat people prevent global warming, say, or on the most politically correct way to move old farts expeditiously into the next life – and, for propriety’s sake, to simply leave contentious medical ethics alone for another time.

But really, where’s the fun in that?

Plus, medical ethics is important. In fact, DrRich believes that the very point of contention, between the ACP’s conception of medical ethics and his own, is of such critical importance as to define the ultimate viability of the medical profession itself, and more importantly, the actual, physical (life-and death) viability of patients. And this being the case, it would be a shame – and possibly unethical – to let the subject just lie there, at the very time when taking it up might at last engender some of the give-and-take the subject sorely needs, and failing that, at least might gain a broader audience than it has had to date. (For DrRich has discussed this all before, but to little avail.) Such a broader awareness could be useful, since doctors and patients who fully understand the danger in which this new system of ethics has placed them can take the steps necessary to protect themselves (and each other).

And so, at the risk of being impolitic, impolite, boorish, boring, incorrect or incorrigible, and quite likely at the risk of rendering himself completely unworthy of his status as a finalist in the Medical Weblog Award Competition, and possibly even at the risk of forfeiting his status as same (though he has not been apprised of any particular rules he may be about to violate), DrRich hereby lays down the following proposition, and cordially invites the ACP Advocate Blog (or any other interested or offended party) to reply:

A Proposition

The New Medical Ethics, as espoused by the ABIM Foundation, ACP-ASIM Foundation, and the European Federation of Internal Medicine (hereafter referred to collectively as the Millennialists), and as laid out in a tract entitled, “Medical Professionalism in the New Millennium: A Physician Charter,” (Annals of Internal Medicine, February 5, 2002, vol. 136, pages 243-246), is deficient in the following ways:

• it undermines the foundation of the doctor-patient relationship,
• it threatens to fundamentally destroy medicine as a legitimate profession, and
• it places patients at grave personal risk whenever they encounter the healthcare system.

Just so.

What’s Wrong With the New Ethics?

To see how the “New Ethics” declared by the Millennialists is harmful, it is useful to first review old-fashioned, or “classic” medical ethics.

Classically, doctors have been obligated to recognize two ethical precepts: Patient Welfare and Patient Autonomy.

The precept of Patient Welfare (also called the precept of beneficence, or “first, do no harm”), obligates the doctor to always behave in a way that accrues to the benefit of the individual patient. The needs of the individual patient come first, and must be the doctor’s primary concern, above, for instance, personal and financial considerations.

Under the precept of Patient Autonomy, patients are acknowledged to have the right to self-determination regarding their own healthcare. Fundamentally, this means that patients have the right to know, and the doctor is obligated to inform them, of any and all information that might help them make their decisions regarding their own healthcare.

So classically, doctors were obligated to do whatever they must to assure that their individual patients were fully informed about all their medical options, and to act to assure that their individual patients got the care they needed (as long as, fully informed, they agreed to it).

By the late 1990s, however, the Millennialists – quite correctly as it turns out – detected a severe problem with this classic medical ethics. Namely, modern physicians were, to a very large extent, unable to comport with it. Quite simply, this is because under a system of covert healthcare rationing (such as was in full bloom even by that time), doctors cannot follow these two precepts. It is not possible for doctors to ration healthcare covertly, at the bedside, and at the same time fully honor their patient’s welfare and autonomy.

The problem was explicitly recognized as early as 1998, in an article by Hall and Berenson in the Annals of Internal Medicine (volume 128, p 395) which stated: “It is untenable for the medical profession to continue asserting an idealistic ethic that is contradicted so openly in clinical practice. . .We propose that devotion to the best medical interests of each individual patient be replaced with an ethic of devotion to the best medical interests of the group. . .”

This influential article, among other things, led to the formation of a commission to study the issue (the issue being, apparently, that if it becomes difficult to follow ethical precepts, then one ought to go ahead and change them). And this commission led to the Millennialists and their New Ethics.

The innovation of the Millennialists was to proclaim a third ethical precept: the precept of Social Justice. The precept of Social Justice charges physicians with effecting “the fair distribution of healthcare resources.” That is, it directs doctors to decide which patients ought to get those limited resources, and which ought not to get them. It specifically and directly justifies bedside rationing by doctors.

The reason this third ethical precept was deemed necessary is explicitly because doctors cannot any longer adhere to the other two. (”It is untenable. . .to continue asserting an idealistic ethic,” according to Hall and Berenson. “Indeed, the medical profession must contend with complicated political, legal, and market forces,” [emphasis DrRich’s] according to the Millennialists.)

Ostensibly, the precept of Social Justice gives doctors who are too introspective (admittedly, not a big problem with many of us) an out when they find themselves having to place the interests of payers ahead of the interests of their patients by, say, failing to mention certain medical options that might be available. “Sure, I’m violating Precepts One and Two,” they can now tell themselves, “but I’ve got to do that to honor Precept Three.”

The bottom line is that, having been coerced by the the insurers and the government (who utterly control the doctors’ professional viability) to place the payers’ needs ahead of the needs of patients, doctors found themselves in utter violation of their fundamental ethical precepts. The proper response of physicians (and their professional organizations such as the ACP) would have been to reassert those ethical obligations, to push back against the payers, and enlist the cooperation of their patients (who, after all, have a particularly vital interest in the matter) in doing so. Instead, they have taken a path of lesser resistance, re-defining medical ethics to comport with their new, coerced behavior.

What Does This “New Ethics” Do To the Doctor-Patient Relationship?

The addition of the precept of Social Justice to the ethical obligations of the physician renders the doctor-patient relationship inoperative.

The doctor-patient relationship is critical to the professional survival of the doctor, but it is critical to the actual survival of the patient. Consider that patients – especially when they are sick – are no more capable of navigating a complex healthcare system (whose chief concern, increasingly, is minimizing spending at any price) than are, say, accused felons a complex legal system. And patients are no less in peril than the felon if they run afoul of that system.

Society explicitly recognizes the right of the accused felon to an advocate, a professional whose job it is to protect his individual interests against the conflicting aims of the “system,” and who is expected to leave no stone unturned in guaranteeing his rights and prerogatives under the law. A patient’s need of a similar advocate is no less acute than that of the felon. (When you are sick, you should be entitled to at least the same protections as when you rob a gas station.) And the doctor-patient relationship is supposed to see that you have such an advocate.

Over the ages the doctor-patient relationship has been defined, through rules of ethics and rules of law, as a fiduciary one. When a patient seeks a physician’s help and the physician agrees to give that help, a special covenant is made. The patient agrees to take the physician into her confidence, to reveal to him even the most secret and intimate information related to her health. The physician, in turn, agrees to honor that trust, and to become the patient’s advocate in all matters related to her health, placing her interests above all others – including the doctor’s own personal or financial concerns.

The New Ethics breaks that covenant from the outset. It renders “ethical” the divided loyalty of the physician. Today, when patients go to a doctor for medical advice, they do not know – and cannot know – whether that advice is being given to advance primarily the patient’s own well-being, or the well-being of the society that desires a “fair distribution of healthcare resources.” With the formal adoption of this New Ethics, patients have been essentially cut loose, and set adrift to fend for themselves in an increasingly hostile healthcare system, without being able to rely on the kind of personal advocate they’ve been conditioned to expect, the kind of advocate an accused murderer is awarded without question or hesitation.

Less obvious, but no less profound, are the consequences of this New Ethics to the profession of medicine. Abandoning their primary obligation to the individual patient means that physicians have committed the “original sin.” They have abdicated their traditional, ethical, and legal roles as patient advocates; they have broken a sacred pact. They have fully compromised themselves as professionals; indeed they have become professionals in name only, and not in fact. And as a result, to their utter frustration, they find themselves standing naked before their enemies, the very insurers and regulators who forced them to abdicate their sacred obligation in the first place.

DrRich finds it exceedingly sad that the ACP and other professional organizations, in an honest effort to protect their membership, and thus to devise a form of medical ethics which comports to the realities of the day, have ended up wrecking the doctor-patient relationship, and in the process have done great material harm to patients, and fatal professional harm to the very physicians whose ethical sensibilities they sought to protect.

DrRich does not imply evil intent to anyone here – not even to the insurance companies and the regulators (whose actions to coerce covert rationing are, really, just an effort to fulfill the job our society has assigned to them). Indeed, DrRich assumes all parties involved are sincerely trying to do the right thing. And so DrRich (ever your cheerful optimist!) sees a way out of the ethical dilemma.

That way out requires a new way of thinking about medical ethics – the “right” way, if he may be so bold – and in his next post DrRich will describe it.

In the meantime, DrRich is a bit distressed over his violation of the traditional civility of the blogosphere, for his possibly having abused the honor bestowed on him in his selection as a finalist in the Medical Weblog Competition, and indeed, for exposing himself to the accusation of initiating a Medical Ethics Smack Down. So if some of his readers choose to punish him for this untoward behavior by voting for the ACP instead of the Covert Rationing Blog, DrRich will understand.

Podcast:

 

 Some Implications of the Global Warming Kerfuffle [12:47m]: Play Now | Play in Popup | Download (2)

The recent public release of hundreds of private e-mails sent and received by Professor Phil Jones, Director of the University of East Anglia’s Climate Research Unit (CRU), has created a hot time for global warming mavens everywhere. The e-mails depict Jones and several other internationally prominent global warming experts discussing how to “tweak” climate change data (to hide such embarrassing climatic phenomena as the Medieval warming period, “the little ice age” that followed it, and the global cooling we’ve been seeing over the past decade, so their famous hockey stick graph would look more like a hockey stick, and less like the profile of a mountain range), “controlling” the peer-review process so that only the “right” peers would be doing the reviewing, and sharing electronic high-fives when a noted global warming skeptic died.

Then just a few days later, the CRU was forced to admit (thanks to Britain’s Freedom of Information act) that they had destroyed all the raw temperature data upon which their elaborate computer models are based. The destruction of this data utterly precludes other scientists from checking, and attempting to reproduce, the critical predictive model upon which the theory of man-made global warming largely rests. Oops.

This inconvenient truth renders their climate change model a black box, a sorcerer’s rune. It places the rest of us in the position of having to “just trust” the global warming experts, whose work we are about to make the basis of a fundamental change in our economy, our way of life, and our foundational political philosophy. Such trust will undoubtedly be a little more difficult to come by than it might have been just a few weeks ago, in view of what the new e-mails tell us about the experts’ faithful adherence to unbiased scientific behaviors.

DrRich believes that this recent global warming kerfuffle is a big deal. DrRich happens to believe in climate change – in fact, he is convinced the climate has been changing ever since there has been a climate. Furthermore, he is certain that modern society has created new variables that are likely contributing to climate change. However, whenever somebody in authority or in a position of prominence insists that the rest of us not look behind the curtain, that they have the answer and it’s imperative that we just follow them immediately, and not take the time – because time is of the essence – to check the facts for ourselves, DrRich has learned to dig in his heels. For, would-be Wizards of Oz are ALWAYS up to no good. (We have seen this behavior many times recently – TARP, the stimulus bill, and the healthcare reform bills immediately come to mind – and DrRich submits that the results have not been entirely beneficial.)

So the desperation on the part of the global warming experts revealed by these purloined e-mails – the unwillingness to let the evidence speak for itself, the anxious efforts to control the process – makes DrRich want to slow down, take another look at the data, and figure out what it is these guys don’t want us to see. That’s just the way DrRich reacts to such behavior.

But at the same time, DrRich wishes to correct an impression which some loud-mouths on the right-wing are attempting to create, namely, that this kind of behavior on the part of respected scientists is an egregious corruption of the entire scientific process, and that every scientist in the world should be screaming for the heads of the miscreants, and indeed, must do so, to salvage the legitimacy of science itself.

Nah. This is pretty much SOP.

This is how scientists have always behaved, and it’s not unique to the global warming crowd. DrRich is a student of history, and realizes that scientific progress – or any kind of progress – is not a smooth endeavor. It moves in fits and starts, and in the process there will be blood.

It works like this: A new theory is conceptualized to explain some phenomenon, usually by a whippersnapper of one variety or another. The entrenched experts, whose careers (and in some cases, whose immortal souls) are based on the old conception, find the new theory to be absurdly wrong (or in some cases heretical), and probably dangerous. Since preserving the “truth” is the highest calling of all, the experts engage in every device they can muster (from “controlling” the peer-review process to burning heretics at the stake) to see that the truth prevails. Deus lo volt!

This process sounds primitive and unkind, but actually it is quite practical, since most of the new theories thought up by whippersnappers are, in fact, garbage. In order to break through the imposing barriers constructed by the experts, the novices really have to believe in what they are espousing, and their new theory, ultimately, has to actually offer some substantial improvement over the currently accepted one. The whippersnapper, if very lucky, finally becomes the foundation of a new generation of experts – and the process begins all over again. Hence, science progresses.

More commonly, the whippersnapper will break under the pressure and abandon the heresy and relegate him/herself to the accepted ways, or will fade into sad obscurity, or, perhaps, will persist in advancing his/her insufficiently convincing ideas and be burned for it. For the process is geared toward the gradual discovery of truth, and not toward the nurturing and vindication of whippersnappers. And indeed, the truth always prevails – and often it does so within just a few generations.

In the short term, of course, this process can look very messy and unfair. It is subject to great bias. In fact, we reward scientific experts with money, prestige, titles, honors, and free weekends in Vegas just to make sure they’ll do everything they can to preserve the status quo. We do this so that when the paradigm actually shifts, it shifts because the merits of the new paradigm are sufficient to overcome all the bias – and not because of a whim. This process keeps science – and society – from being whipsawed this way and that.

And so, what we’re seeing with the global warming e-mails is not some brand new corruption of the scientific process, but the scientific process itself – albeit more starkly than is usually seen by the public (and, truth to tell, employing techniques that are somewhat more egregious than DrRich has seen in modern times). For the experts to behave in a grossly biased fashion to preserve their exulted positions, and for them to implement their biases using techniques that most observers would consider at least unfair if not unethical or illegal, is not entirely new, or even particularly alarming. That’s how the system has arranged it, for the long-term (multi-generational) stability of the system.

What does any of this have to do with healthcare, or more specifically, with healthcare rationing?

As we enter into a new era of healthcare, where medical decisions will be taken out of the hands of imperfect physicians and entrusted to panels of experts, who will analyze the available data and construct the guidelines of behavior by which all physicians will henceforth be judged, we ought to keep this model of scientific progress in mind.

Not only is bias something which will be difficult to eliminate from the scientific process, bias (being an integral part of human nature) is an integral part of that process.

Today we have a healthcare system in which competing interests, and their competing biases, battle for prominence. The process is very much like our political process with its own competing biases – messy, ugly and often unfair, but with long-term results that are generally reasonably favorable. Or at least, the damage is generally contained.

We are headed toward a healthcare system in which only one great interest – that of our government, with its overwhelming bias toward cutting the cost of healthcare – will predominate.

A great fallacy under which many of us labor is that the government has no strong biases, and that a process overseen by the government will be inherently far more “fair” than a process that incorporates the biases of for-profit enterprises. But in truth, the government is the biggest, meanest, special interest of all.

For those who have looked at history (Exhibit “A”) and think they have seen even one example of a government which has total control over any human enterprise and still behaves fairly, DrRich offers as Exhibit “B” the behavior of the global warming climatologists. These experts, who rely for their existence on government sponsored grants (and also industry-sponsored grants, but only if the industry’s bias on global warming aligns with that of the world’s governments), have displayed all of the reprehensible behaviors we commonly attribute to researchers who are supported mainly by profit-mongering industries. Further, because the bias of the global warming experts so nicely aligns with the historical bias of government – to accrue ever more power over the endeavors of the people – that bias has become largely sacrosanct. Its scientific viewpoint is “settled,” fully accepted by worldwide government agencies and the mass media, and no new scientific evidence to the contrary is admissible. Competing viewpoints are, in fact, heretical. And even when gross evidence of academic misbehavior is revealed, as it is now, that evidence is excused, paved over and ignored. For there is no other “truth” to consider; only the approved agenda can be advanced.

When we allow government and its agencies to have the final say over medical decisions, and permit all dissenting medical biases to become forcibly silenced, then those medical decisions will be made with all the robust, open-minded, free, give-and-take exchange of ideas we are seeing from the global warming experts today. And medical progress will become as sclerotic as the progress enjoyed by would-be astronomers during the pre-Rensaissance Popes, another era in which only a single set of biases was allowed.

The scientific process will always be biased. Where we invite serious damage is where we admit only one form of bias, and forcibly stifle all the rest. It’s bad for climate science, and it will be bad for healthcare.