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Archive for January, 2013

Today, one of my medical school friends admitted to me that because of the workload, he’s been in and out of colds 12-15 times in the last year.  That’s quite inhuman.  If the common cold and it’s post-cold state of phlegminess lasts roughly 10 days per occurrence, that’s  over a third of the year being subjected to headaches, joint-aches, bizarre body-induced temperature changes, and all sorts of wonderful pains in vicinity of the head.  I had one particularly bad year in undergraduate where I was sick at the beginning of every calendar month, and I have had some sort an irrational obsession with eating oranges ever since.

Personally, Canada’s system has been great to me; I’ve been in and out of emergency rooms without a hitch, and while the wait times have sometimes been in the range of hours, I have never really needed immediately treatment, so I can’t really judge their efficacy.  Some people are arguing that our healthcare system is in need of some reworking in order to bring in elements of privatisation, while some people think not enough money has been invested in a public system to enable its success.  I’m starting to think it may have something to do with this:

New York City Hospitals to Tie Doctors Performance Pay to Quality Measures

If we are just now, starting to pay doctors, for the kinds of things we want to see from them, then what the hell were we paying them for before?

Our fundamental problem is that we don’t live in a society where we fully understand what we want from our healthcare system.   The quintessential North American system looks something like this:

1) ignore a problem

2) ignore it

3) ignore it

4) it becomes a big problem, go to a hospital, ask to be pumped full of drugs, get discharged

We live in a culture full of last-minute treatments, and these often involve lots of strong, expensive drugs.  There’s no culture of “health ideals” or ways for us to maintain our ideal health; our media is always telling us about malnourished celebrities, or overweight talk show disasters, or a new crop of shows in the Oprah timeslot which are all about exploiting people’s lack of familiarity with health by highlighting all the worst possible diseases one can get.  Our problems will likely continue if we have no benchmark upon which to assess our day-to-day state of health.

It is impossible to ask our public health system to deliver on a set of ideals if we cannot define them first.  Until then, it’s potential role is largely ignored, while preventative measures are glossed over, and individuals carry on with their lives and run themselves down to the point where the only solution is a drastic overhaul.  Public health’s role is only to intervene with the permission of those who are already broken down.

Our society’s relationship with public health and healthcare is similar to my understanding of wines; I like having it as an option, but I don’t really understand, and therefore I don’t really appreciate, what an ideal glass of it would do for me.

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I started this post several weeks ago, before the end of term and deadlines took over.  Before the shootings at Sandy Hook Elementary and gun reform became a big topic.  

The Murder of Jordan Davis

The trial of Michael Dunn in the murder of 17 year old Jordan Davis, began at the end of 2012.  If you are new to the trial (like me), apparently, if you are at a gas station, and a group of teenagers blasting music is a bit loud for your liking, and then you shoot the car full of teenagers several times (who are unarmed, by the way) and then flee without telling the police, then this is an act of self-defense.  I think this is ridiculous.   Michael Dunn claims that he saw a shotgun, and thought the teens threatened his life.  It doesn’t explain why he would flee the scene and why he hid from the police.  I will be interested to see how the trial goes.

The Wild Wild Florida

Very un-technically, the Castle doctrine in the United States are the collection of laws that allow for the use of deadly force in the act of self defense against intruders on one’s property (protect your castle).   In some cases, this can itself be overreaching.  However, Stand Your Ground laws will do you one better and allow for the use of deadly force  outside of one’s home, and in the case of Mr. Dunn, it is being allowed anywhere.  Florida has famously found itself at the centre of a mess of “self-defense” related murders in recent months with its own Stand Your Ground law.  Getting to the point of ridiculous, a man was shot because he complained he was waiting too long for his pizza.

An Essay on Bargaining

I think the laws are inherently dangerous, and here’s why.  In its own twisted way, the interaction between a shooter and the victim is a negotiation or a bargain.  Each side communicates a commitment to an action, and then either follows through on that action, or doesn’t.  In other kinds of acts of bargaining, such as union-management negotiations, each side would communicate their demands, the actions they would commit to should those demands be met or not met, and sometimes, a signal that gives this commitment credibility.  In this case, union leaders could encourage members to fire them if they do not emerge from negotiations with the desired objectives.  This seems crazy, but what it does is sent a signal to management that the union’s demands are “binding and final”; leaders can’t leave with anything less without being fired.  It is less about career suicide and more about enforcing the credibility of a threat to stick to the original demands.

Another idea in bargaining theory is the idea of the “last clear chance”.  Sometimes in negotiations, it is advantageous to give the other party the “last chance” to change their minds.  Think about the simple game of chicken.  If somehow there was a perfect way to show that you are committed to driving straight no matter what, then you are placing the obligation to retreat (in order to avoid mutual destruction) on the shoulders of the other person.  The person who supposedly has the last say actually has none of the power, knowing they must bow to the credibility and commitment of their opponents.

Stand Your Ground laws affect both communication of credibility and the “last clear chance” principle.  First of all, it makes gun threats more credible since one can reasonably commit to shooting someone without having to worry about repercussions, like criminal charges (if it is in the name of self defense).  Additionally, Standing Your Ground means that the other party now has the “last clear chance” onus to retreat.  The responsibility of retreating is no longer on the individual making the threat of violent force.

The Problem?

This would all be great because it communicates to trespassers (Castle Doctrine) or random strangers (Stand Your Ground) that you have a gun, you are going to use it, they need to concede or face certain death.  In theory, it would mean the other party retreats faster and without protest in order to avoid getting shot, and this would make the world a safer happier place without all those trespassers and random strangers getting all up in your face at gas stations with their loud music.

The only problem in practice is that the act itself is not a clear cut act of bargaining on both sides.  In Jordan Davis’ murder, the teenagers were not aware that they were in the middle of a self-defense bargain.  They thought they were just arguing over the volume of their music with a grumpy stranger.  In the case of Yoshiro Hattori, he just happened to ring the doorbell of the wrong house.  And in the case of the Little Caesars pizza shooting, I’m sure the victim had no idea that the argument had escalated to a place where guns were necessary.  The problem in the Stand Your Ground laws is that they apply perfect rules of bargaining to imperfect situations where one side feels like it is absolved of all responsibility of diffusing a potentially fatal situation, and the other side is completely oblivious to the situation.

There are many other problems with Stand Your Ground laws.  For example, when does it no longer become a negotiation, and the party with the gun has actually no intent of withholding force?  What about it being used as a defense against pre-meditated murder?

What about the criticisms that the law is applied unevenly across racial groups?  It feels almost too easy to go there.  It is really difficult to get the numbers but this is a good start.

PBS: Stand Your Ground Laws

The laws are a great example of what happens when theory and practice don’t mix well.   Kind of like how hot-tempered gun owners and just about anyone else don’t mix either.

Some extra stuff to think about: 

Are Stand Your Ground defenses racist?

The death of Trayvon Martin

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