If it is not torture, why bother?

There is an on-going debate in America about whether water boarding and other so-called enhanced interrogation techniques constitute "torture." On the surface, everyone pretends to agree that when pain or discomfort rise to a certain level, they become "torture" and are no longer morally acceptable. The entire debate is a farce.

No one really believes that mild pain or discomfort is an effective interrogation technique. Just image that hardened terrorist breaking down because of mild or even moderate pain. The very idea is comical, even worthy of a Monte Python skit. I do not know if real torture is an effective way to get information, but anything less certainly is not. (Of course, there are other techniques that do not involve any meaningful pain or discomfort at all; I am not referring to those here).

Reasonable minds can differ about whether torture is ever morally acceptable and/or a good strategy in the long run. But half measures are silly, and I cannot believe anyone seriously contends otherwise. Those who are advocating the use of these techniques must really believe that they inflict intolerable pain, otherwise they would not even bother.

So, let's give up the charade and either agree that torture is acceptable under some clearly defined and limited circumstances, or ban it altogether and stop fooling around.

Phasing Out Pharmacies

There was a time, or so I was told, when pharmacies and pharmacists played an important role in our health care system. If those days existed at all, they are now long gone. It is high time that we begin to phase out the pharmacy. We should do so by progressively making more and more medications available without a prescription. At the same time, we should ban advertisements for any medication.

Pharmacies add a significant layer of expense to our health care system. While I can buy aspirin or ibuprofen at the 7-11 store, I can only get meloxicam (an anti-inflammatory that serves the same purpose as ibuprofen and is no more dangerous) at a pharmacy. That creates two different kinds of expense. First, it adds to the cost of the medication. A pharmacy must have a highly trained -- and highly paid -- pharmacist on duty at all times. In addition to the pharmacist, there is almost always a second employee who hands out the prescription medications and often rings them up on a separate cash register. Furthermore, the pharmacy incurs expenses in complying with various regulations. Compare that to the cost of selling aspirin. A store simply stocks the shelves with bottles, and the customers help themselves.

The pharmacy also imposes a non-monetary cost, one which I find particularly vexing. I can get an aspirin at the 7-11 or Trader Joes at any hour, without a prescription and without an appointment. Getting propanolol (a common beta blocker) requires a prescription, which must be presented at a licensed pharmacy. I must then wait until the pharmacist fills the prescription, and stand in a special line to receive that one item. That process is a waste of time, in addition to a waste of money.

I suspect that the prescription system imposes yet another cost, which may be even more important than the two costs described above. The prescription system discourages patients from being good consumers and paying attention to the choices they are making. Prescription drugs are treated as holy: only the doctor decides which ones we take, when and in what doses. The insurance companies have their secret formularies, which try to impose on the doctor's choice. Then, only the pharmacist can actually deliver the goods. Even a patient who wants to get involved in choosing a medication will have a hard time doing so in the face of those three forces.

Compare the purchase of pain killers, where the patient can select from a variety of over-the-counter medications, in various doses, brand name and generic. These medications quickly lose their magic aura, and patients learn to make intelligent choices. Consumers feel free to think for themselves and experiment appropriately with the available products. They learn to avoid overpriced brand names, and they learn which medications work best for them. I suspect that eliminating the prescription requirement on a medication would quickly create more savy consumers and thus reduce the price the market would bear in many instances. I bet the big pharmaceutical companies would hate the idea of phasing out the pharmacy.

We do not get anything worthwhile from pharmacies. Few, if any, patients actually seek the advice of the pharmacist. If a few patients want to pay for such advice, they should of course be free to do so, but there is no reason to require everyone to pay for advice which very few of us want or even receive. Pharmacists do not tell us how and when to take medication; doctors do that. The pharmacist simply copies what the doctor wrote down and, in my case, often makes mistakes in doing so. Theoretically, a pharmacist could alert a patient to conflicts between medicines. That only works, however, if the patient always uses the same pharmacy. The only time I have been alerted to a conflict was by my doctor, and one of the conflicting medications was non-prescription, so a pharmacy could not catch it, even if it knew all of the prescription drugs I was taking.

The prescription system most certainly does not protect those who would abuse drugs from getting what they want. Even making a drug completely illegal does not prevent determined buyers from getting ahold of it. The prescription system provides even less protection than an outright ban. One who is determined to get his hands on a prescription drug can always find a crooked doctor, forge a prescription, fake a symptom and/or send the same prescription to ten different online pharmacies. Pharmacies are not in the business of preventing the improper sale of medications.

Far more importantly, only a small minority of prescription medications are drugs of abuse, i.e., fun. No one is going to pop Lipitor at a party. Sudafed, on the other hand, can be turned into a drug of abuse.

Most prescription medications are no more dangerous than over the counter medications. It is easy enough to kill oneself with all sorts of household items, beginning with alcohol. I doubt that taking an entire bottle of Crestor is any worse than taking an entire bottle of ibuprofen.

In the end, pharmacies are just another entrenched special interest. We take it for granted that they are necessary, but they are not. It is time to start phasing them out.

Giving

Most of us have heard the saying: "Give a man a fish, and you have fed him for today. Teach a man to fish, and you have fed him for a lifetime." It seems to me that the old saying may not go far enough. Giving a man a fish may provide a lesson along with the meal: the way to get a fish is to wait until someone gives you one. Simply handing out free food may, in the long run, do more harm than good.

It seems that most charity focuses on eliminating an immediate need without addressing the underlying problem. In fact, Mother Teresa herself, that icon of giving, has been criticized for perpetuating poverty, rather than trying to alleviate it. She is alleged to have said: "I think it is very beautiful for the poor to accept their lot, to share it with the passion of Christ. I think the world is being much helped by the suffering of the poor people." That, in my view, is not kindness.

Government charity is often in that vein: food stamps, unemployment payments, medicare, welfare and Section 8 housing vouchers address the need of the moment without doing anything about the underlying problem of poverty. The unintended result of this kind of charity is poverty that is passed down from generation to generation. Similarly, food kitchens and homeless shelters do nothing to address the underlying problems of poverty, addiction and mental illness that lead to homelessness in the first place.

I realize that there is a place for simply giving support to the needy. Victims of one-time disasters such as hurricanes need help now. Similarly, there are those who simply will never be able to take care of themselves for whatever reason. There is no point in trying to teach them to fish, because they simply cannot learn for whatever reason. In these instances, it is makes sense to provide what is needed. In my view, however, the more important task is addressing the underlying problems that leave people sick, uneducated and poor.

Recently, I have become a fan of Kiva.org, a micro lending organization that allows people to make no-interest loans to small businesses in the third world. The borrowers include taxi drivers in Moldova, small farms in Peru and grocery stores in Nigeria. The borrowers do pay interest to Kiva's local partners, but at lower rates than would otherwise be available to them, assuming that they could get a loan at all. One of the biggest problems in the third world is the lack of access to capital. Hopefully, these small loans help people grow their own businesses and move them up just a little bit towards economic Independence.

eBay "Giving Works" and MissionFish are a Scam

eBay now allows sellers to auction an item for charity. Sellers can agree, in advance, to donate anywhere from 10% to 100% of the proceeds to the charity of the seller's choice, so long as that charity is on eBay's approved list. The listing shows a cute little ribbon, telling the bidder that the auction is for the benefit of charity, as well as a short paragraph extolling the benefits of the particular charity that will benefit. What's more, eBay discounts its fees in connection with charity auctions. The discount is proportional to the percentage donated to charity; eBay gives up almost all its fees if the auction is 100% for charity. Sounds great, but sadly it is a scam.

In the fine print, it turns out that all donations must be made through "MissionFish." What's more, MissionFish takes a fee for its service. There is a small notice on each charity listing stating that a "small deduction may apply." Those words are in faint print and small type. There is no "may" about it, and the deduction certainly is not "small." In fact, MissionFish charges far more than eBay. That's right, you would be better off ignoring eBay's offer to waive part of its fees. Simply sell the item, pay the fees and donate the balance to charity. Far more will go to charity that way than if you take eBay up on its supposedly charitable offer.

MissionFish charges:

20% of the first $50

15% of the next $150

10% of the next $800 and

5% of the amount above $1,000

So, for an item that sells for $500, MissionFish will charge $72.50. That's right, MissionFish takes $72.50 from the charity for the "service" of delivering your $500. By way of comparison, on the same $500 item, eBay would charge a $4 insertion fee (at most), plus a $19.69 final value fee, for a total of $23.69. So, eBay does not waive its fee. Quite to the contrary, the fee nearly triples! And, what is worse, you do not even see it unless you look very carefully.

Here is how MissionFish and eBay hide the fact that they are stealing from charities. Again, say you auction an item for $500 to benefit charity. The buyer sends the money to you. You then take the $500 and give it MissionFish, which tells you that you made a donation of $500. You never find out that about 15% of your money went to MissionFish.

Finally, eBay (which owns paypal) gets a fee when the money is sent to you by the buyer. So, you end up with less than $500 because paypal/Ebay takes a bite up front, but then you have to give MissionFish the full $500 so that MissionFish/paypal can take their next bite. And, if you forget to feed MissionFish the full $500, they will bill your credit card. Want to take your credit card off their account? No problem, just enter a new card and click that you authorize them to charge that. The website does not allow you to simply remove your credit card.

Do not be fooled! If you want sell something for charity, by all means do it, but do not tell eBay. Just sell the item and donate the proceeds yourself.

Letting Go of Gay "Pride"

For years, western society has preached that being gay is a sin. Most gay people internalized that message and were ashamed of being gay. Eventually, some gays began to stand up for themselves, and they stopped being ashamed. Instead, they became proud. After all, being proud is, in most people's mind, the opposite of being ashamed. In fact, this new gay "pride" misses the point entirely and is ultimately counter productive to the gay rights movement.

Being gay is not something to be proud or ashamed of. Sexual orientation is a preference, and it does not make sense to be proud or ashamed of a preference. For example, no one is ever proud that they like ketchup, or cold weather, or that their favorite color is blue. The fact that people are born gay is not even the point. Being gay still simply means that someone has a sexual preference for people of their own gender. There is nothing to be proud or ashamed of, no matter what one prefers.

The use of the phrase "gay pride" is far more than a simple gramatical error. Quite to the contrary, it confuses the debate about gay rights and alienates straight people. It confuses the debate because it perpetuates the wrongheaded idea that sexual orientation is one of those things that we should be either proud or ashamed of. The entire point of the gay equality movement is that sexual preference is not something good or bad. Saying otherwise frames the issue in a way in which gays will lose. If sexual orientation is something to be proud or ashamed of, then straight people will surely decide that they are proud of being straight -- and that gays should be ashamed. It creates a pitched battle over who is better, gays or straights. That is the opposite of the message gays should be sending: we are different in our sexual orientation, but those differences do not make us better or worse than you.

United Airlines' Charity Policy

I had a few extra United Airlines upgrades in my account recently, and realized that I would not be able to use them before they expire. I know that United does not allow the sale of upgrades or miles, but they do allow members to donate miles. I therefore decided to donate my upgrades by holding a 100% charity auction on Ebay, with all the proceeds going to Kiva.org and Much Love Animal Rescue. In the listings, I expressly stated that the auctions were subject to United's rules, and that if United objected, I would remove the listings.

United waited until the listings were over, then told me I had violated their rules. Even though 100% of the proceeds went to charity, United still views what I did as a "sale." Moreover, United penalized me by taking away two systemwide upgrades which, based on the Ebay auctions, were worth $500 each. Even worse, United took away the upgrades from the Ebay bidders. So, they did not get what they bargained for. The charities already have the money, so I cannot get it back to return it! I protested with United, but got nowhere.

I am done with United Airlines. Hello American!

Cancer as a Political Issue

For the eight years of the Bush administration, our political were dominated by an irrational fear of terrorism. Even now, with President Obama providing immeasurably better leadership, terrorism still plays far too large a role in our political debate. Terrorism killed a total of approximately 3,000 people in the continental United States on September 11, 2001. It has killed approximately zero since then.

Cancer, on the other hand, kills thousands of people every day. Cancer is the greater threat to public health, by a huge margin. In fact, in terms of the threat to publich health, terrorism is lower than the common cold, while cancer is at the very top of the list. As far as I am concerned, a death by terrorism is no worse, and maybe in some ways much better, than a death by cancer. Yet, we spend far more money on preventing terrorism than we do preventing cancer.

The most important function of a government is to do for the people what they cannot do for themselves individual. This includes things like building roads, maintaining a currency, national defense and disease control. Basic cancer research is far too expensive and far too long term for any individual to undertake it alone. Only the government can fund it adequately.

Moreover, the benefits of successful advances benefit not just all Americans, but everyone on the entire planet -- as well as everyone who is born in the future. The market cannot provide adequate incentives under those circumstances.

If there is anything that our government should do for us, it is to fund basic cancer research and make the result as widely available as possible. This is something that we all have an interest in, and it should be a major political issue, well ahead of relatively smaller threats, such as terrorism.