Public Health versus Private Health - can everyone win?

Feb 17 02:43 UTC 1998

     I have been reading about the obligatory treatment of
rhesus-negative first-time mothers of rhesus-positive babies to
prevent their developing antibodies to a possible rhesus-positive
future child.  This entails some risks, due to errors and
allergies, but saves society the cost of caring for severely
impaired children, and of course benefits the children.  However,
many women do not plan to have another child - should they be
required to be sterilized if not rhesus-treated?  Or to consent
in advance to an abortion in case of a rhesus-positive fetus?
     My schizophrenic uncle was tranquilized.  He and other
mentally ill were subjected to shock treatments against their
will.  (These treatments do benefit many people, but not all).  
     Then there is Turing, the great mathematician, 'an unabashed
homosexual during the twilight period when homosexuality was
still illegal in Britain.  As a result he was arrested and forced
to receive masculinizing hormone treatments, which slowly
undermined his health until he finally committed suicide...'  
Presumably this benefited both individual and society.
     A Canadian friend told me how he falsified vaccination
records for his children, because he was afraid that they might
be harmed by the vaccination.  If an AIDS vaccine is developed,
should it be obligatory for everyone, even those of us who don't
practice the risky behavior which spreads it, or to all children,
in case they don't know enough to act sensibly?  What if a
certain low percentage of the vaccinated become ill as a result?
     My neighbor with two kids buys bottled water to avoid
fluorine, which she worries is harmful.  If a few people are
allergic to it, and only children benefit, should it be added to
everyone's water?  How about adding iodine to table salt?  A few
people are allergic, and many people don't need it.
     Premature babies, many of whom are premature because they
have some genetic defect, or were injured in utero, are kept
alive at tremendous expense.  Should parents be forced to pay?
     Should smokers, whose habit causes society to pay for the
costs of increased health care and fires, be forced to attend
smoking-cessation programs rather than just pay higher premiums?
     How do you weigh individual rights against society's rights? 

response 2 of 59:

Feb 17 19:41 UTC 1998

    It is not necessary to make vaccinations mandatory. Available and
affordable will suffice. If the vaccine is good, and someone doesn't want
to get the disease, then it will behoove him to get vaccine, and most
of the people will get vaccinated. This should be sufficient to reduce
the incidence of the disease even in those who do *not* get vaccinated,
if communicability is the main worry.

    The problem here is that for whatever reason, the powers-that-be too
often do not inspire trust.

response 4 of 59:

Feb 17 22:05 UTC 1998

Fear mongering. For one thing, www.cadvision.com/fluoride/calgary/htm does
not exist. For another, dentists, who lose business because of the
effectiveness of fluoridation, are strongly in favor of it, because they
support good dental hygiene. I submiy that almost all of your statements
are balderdash. The world is full of these baloney-mongering
conspiracy-theorists, who prey on ill advised and poorly educated people,
though I cannot imagine for what end, except to oppose "authority". 

Rather than a hoax site, consult the Center for Disease Control, at
http://www.cdc.gov/nccdphp/oh/flintro.htm  

Incidentally, fluorine is not a metal. 

response 6 of 59:

Feb 18 00:55 UTC 1998

Thanks for the correction, Michael.  I checked for iodineroblems with lynx
altavista + iodation + toxic (4 documents) and for iodine allergy with
+"iodized salt" +allergy (and almost entered a slash instead of a period for
a website there).  The statements on fluorine, etc., are not my personal
opinions but are taken from other people's writings, and presumably they know
at least as much about the subject as the average grexer.

Iodized salt has either potassium iodide or potassium iodate added.  The
former is unstable to heat, light, acid, moisture and impurities, and is
used in the USA and Canada.  All other countries listed at website
www.idrc.ca/mi/idddocs/iodman.7.htm add potassium iodate.  Doses are based
on per capita salt consumption in each country, which averages 3-25
g/day.  The minimum required is about 1, the recommend maximum 2.
Michigan soil is particularly low in iodine so people used t get goiter
(but who eats locally grown food nowadays?).  One article said not to eat
lots of kelp because too much iodine can also cause goiter, hypo- or
hyperthyroidism.  The maximum normally ingested is only 20% of the lowest
possibly toxic level.  BUT, some people have allergies/sensitivity to
iodine.  They should avoid putting Betadine on fresh body piercings,
purifying water with iodine tablets when abroad, or having diagnostic
radiology with radioactive  iodine.  Some people with asthma and
dermatologic allergy should avoid foods containing bromide or iodide,
which the author says includes salty nuts, cheeses, seafood, tomatoes,
melons and dark greens (and they should eat more vitamin A and protein).
I had heard iodide was added only to the table salt sold retail, not to
processed food, so the salty nuts may be okay.  Misti, I think it was,
said the iodine in cheese may come from a disinfectant used in milking.
Methyl bromide is used to fumigate buildings for termites and cockroaches
but is said to rapidly dissipate.  I have not found reference to problems
with residual bromine (or could it be methyl bromide) in bleached white
flour, although it may affect what is left of the vitamins after refining
(most of which are not added back, such as B6).  Cooking vegetabies in
chlorinated water destroys vitamins, and chlorine reacts with organic
compounds in water to form carcinogens.  It can be removed with a carbon
filter, along with the organic compounds.  I had not heard of ozone
leaving any residues.  The AA water department treats the water with ozone
now, but then adds chlorine at the end just in case of any microbes
leaking into the system.  The chlorine concentration of 3 ppm is the same
used in swimming pools, and the water, especially when heated, liberates
free chlorine, which can bleach swimmers' hair and is not healthy.

The Calgary article seemed very much based on good science research.
Is iodized salt labelled as possibly causing allergies?

response 8 of 59:

Feb 18 08:07 UTC 1998

The types of assertions stated in #3 and in www.cadvision.com/etc (thanks,
Michael, for the correction) are refuted, with specific references, in
http://www.bda-dentistry.org.uk/press/pr1997.html. These refutations come
from reputable scientists backed by major scientific associations - "and
presumably they know at least as much about the subject as the average
grexer".

Potassium iodide is not particularly "unstable", though it will decompose
and the iodine value lost if in an acidic medium, and heated. There is
really no definitive reason for choosing between the iodide or the iodate. 
I think the iodide may not taste as good as the iodate, though at the
concentrations used it is tasteless to most people. (Actually, I like the
taste of iodine - I acquired the taste using it to steriize water when I
was backpacking in the Sierra Nevada.) 

All in all, I think public health authorities have made the right decision
in fluoridating public water supplies. There is no evidence for
detrimental effects except in a very few instances, and the public health
benefits are well documented and very evident. (I know how much dental
caries have been reduced by fluoridation - I have a mouth full of amalgam,
and most young people I know today have no or few fillings. Our daughter
did not need a filling until she was 15 - I am very thankful for that.) 

I think the controversy arises because the public health benefits of
fluoridation are *imposed* and, at the same time, are not as immediate as
those of chlorination or ozonation (where we would have massive illness
and death if they were discontinued). I agree that those that don't like a
benevolent government providing more than roads might object to a general
public health measure on which, in a sense, they were not consulted (other
than by electing the representatives that were convinced by the evidence
that fluoridation is a good thing).  However, I agreed with the
desirability of fluoridating the water supply before it was done, based on
the results of many studies, so I had no objection. So, count me as a
grexer in favor of water fluoridation (though I know you tried to swing
opinion with your ominous reference to the "central government"). 

response 10 of 59:

Feb 18 16:15 UTC 1998

Heh.  I think there are plenty of health problems to accommodate all the 
cardiologists (and all the other doctors, for that matter) even if we 
eliminate smoking and drinking.  If people stop having the heart 
problems they are having now, then they'll live longer, and then they'll 
have other heart problems, or liver problems, or lung problems, etc.

A good friend of my wife's doesn't have his kids vaccinated.  He says 
the schools require either vaccination records, or that he sign a waiver 
form.  I think he's wrong; myself, I want my kids to have all the 
generally available vaccinations.  But those are his kids, and no one 
cares about their well being the way that he does, along with his wife.  
I'm glad he has the choice.

response 12 of 59:

Feb 18 19:54 UTC 1998

Rane, thanks for finding more recent info on fluoridation (which I will go
read).  I think each public health case has to be analyzed differently.  One
difference is monetary.  Dental health is a private economic burden, goiter
from lack of iodine or disease due to bacteria in water is paid for through
insurance, which affects all of us.  Vaccination also reduces health care
costs paid for by insurance.  When there is a controversy, should one try to
minimize total costs, or minimize total harm to individuals, or maximize total
benefit?  There are no easy answers.  In the case of iodine, we are free to
buy iodized salt, uniodized salt, or no salt.  Chlorine can be filtered out
at the water tap, for 'pennies a gallon', which also removes carcinogens. 
But how do you defluoridate water (or did you mean 'stop fluoridating water').
I am not supporting either side of the argument, but it is clear that there
is a fair amount of opposition, and people can easily and cheaply buy fluoride
toothpaste or fluoride mouthwash if they want fluoride, while it is not that
cheap to buy bottled water if they don't want it.  (A gallon a day would be
at least $200/year).  I think the issue here is that society has chosen to
make the decision as to children's health, since they can't make their own,
and their parents are presumably not well informed.  What percentage of people
have to disagree with some public health policy to change it?  Does anyone
know what was involved in the fairly recent ban of lead in solder?  How long
was this disputed first, and is it nationwide?  What sorts of decisions on
health should people be allowed to make for themselves?  Legal suicide, legal
addictive drugs?  When does it make sense to sell a potentially dangerous
product but put on warning labels (not only alcohol and cigarettes but many
cleaning products), and when should it be banned?  How much is government
policy influenced by business interests, as in government recommendations on
eating meat?  How much protection should be imposed on us?  

response 14 of 59:

Feb 19 06:30 UTC 1998

That sums it up pretty well, with the addition that any of those decisions
that create the social compact can be changed by democratic procedures. It
is much better, however, if we don't have domagogues and truth-twisters
having too much say in the process. 

A lot of dental health is covered by insurance. Mine is, though not
completely for restorative procedures. So dental hygiene is also a
societal burden because of dental insurance. 

Double-resin water softeners (total deionizers) remove fluoride. 

In the choice between fluoridating public water supplies, and having
people deal with this themselves, public health is *much* better served by
the former, simply because the adverse effects of not fluoridating is
greatly delayed. It is like a lot of things people do that are not harmful
"today"  but will be in the long run. Smoking, for example. The motivation
for public action to decrease the introduction of kids to smoking is very
similar to that for floridation. 

response 16 of 59:

Feb 19 16:45 UTC 1998

#14, I thought dental insurance, for those lucky few that had it, only covered
cleanings and checkups.  I have lots of motivation to take care of my own
teeth.  I am still awaiting the outcome of the controversy over fluoride. 
What I read was that yes, it does increase bone and tooth density, but it does
this by weakening the structure.  Before doing Internet research I was sure
there was no scientific evidence against fluoride.  (Sorry, I have not gotten
aroudn to reading your second website, Rane, too busy with dowsing stuff).

More facts on the rhesus treatment.  At present, or at least a couple of years
ago, the antibodies used to treat rhesus-negative women came from pooled
serum, which could be contaminated by stray proteins (causing allergic
reactions) and viruses such as hepatitis and AIDS.  In this country, women
were successfully suing doctors who did not administer the treatment.  Is it
possible that the law requiring treatment was supported by doctors who would
rather be sued for causing allergic reactions (they could blame the producers
of the preparation instead) than for not preventing the possibility of
rhesus-reactions in second children?  Why should a woman who does not intend
to have another child be forced to be subjected to a risky treatment?  (There
is now a safer method of antibody production under development, or it may be
in use already by now.)
Was this law passed before AIDS became common?  The rhesus treatment was
developed prior to 1967.  

response 18 of 59:

Feb 19 21:47 UTC 1998

I'm afraid #13 was intended as sarcasm.  I don't agree with a lot of 
what Rane is saying.  I didn't expect Rane to accept the equivalence of 
affirmative action and tobacco subsidies for the purpose of this 
discussion.  I underestimated Rane's belief in big government.  Myself, 
I generally oppose big government, and favor the rights of individuals 
over those of "society".

response 20 of 59:

Feb 20 08:12 UTC 1998

I believe in democratic government. Anyone that rales against "big" 
government labels themselves as a hypocrite and demogogue, since there is
no definition of how big is big enough offered in the categorization.
Government should be "big" enough to provide society with the services
that are best provided nationally (or within a governmental jurisdiction),
or when forcing people to fend for themselves will lead to unacceptable
consequences (disease, areas of poverty, discrimination...  and other
things not conducive to the "public welfare", for which our government was
founded to foster - read the constitution). 

response 22 of 59:

Feb 20 16:07 UTC 1998

I'm like anyone else.  There are things about the government I like, and 
things I do not like.  I like the postal service (though it shouldn't be 
a monopoly), the highway system, and the military.  I like the FBI -- 
the part that deals with real, serious crimes.  I don't like the War on 
Drugs.  I don't like Social Security, federal mandates for everything 
from seatbelt laws to state funded abortion, and federal funding for 
(approved) art.  I don't like foreign aid, but since I don't understand 
it and it's importance to foreign affairs in general, I don't kick much 
about it.

I don't like the role of the federal government in almost every major 
decision made by almost every American.  It strikes me as an immensely 
strong indication of the extreme overfunding of the government.

My car cost thousands of extra dollars because of federal mandates such 
as air bags -- with the effect that, in order to protect my kids from 
the safety features of the car, they cannot ride in the front seat, 
ever.

If I'm ever to have a house, I'll spend more time and effort figuring 
out how to deal with the federal government aspects (loans, taxes, the 
swamp on the land where we want to build) than in what I want it to look 
like.

My kid spends school time learning about drugs and alcohol, even though 
he's only 6, instead of anything of benefit to him, because there's a 
federal mandate that the schools have to teach that.

Around a third of my income goes directly to the federal government, 
paid to the government by my employer before I can even sniff it.  This 
is so I don't "cheat" the government by not giving it a fair share of my 
money.

The president wants to take away some more of what money we have, which 
isn't as much as it could be because my wife doesn't work full-time, so 
she can be with the kids.  He wants to give it instead to people who 
have someone else raise their kids.  It's a penalty on parents who want 
to raise their own.

But I certainly wouldn't say all of what the government does, even all 
of what I call Big Government does, is *bad*.  There's obviously some 
benefit even to the things I listed that I don't like.  There's not 
*enough* benefit, which is why I don't like them.

If you listed the 100 things the government does that cost the average 
American the most and/or affect the average person the most, with a 
column of choices for what I want the government to do with those 
things, "More", "The Same" or "Less", I bet I would pick "Less" for at 
least 80 and "More" for 5 or fewer.  I'll bet Rane would reverse those 
numbers.  I'll further bet that most people would have at least 50 
"Less" choices, and at most 20 "More" choices.

response 24 of 59:

Feb 20 19:29 UTC 1998

I personally would like to see more money spent on foreign aid and less on
highways (and have the train system improved instead) but before we get into
this sort of a discussion, is anyone out there interested in public health
and the rights of individuals/children/society?  Why must children get
vaccinated but not adults?  (I got mumps at age 30.)  What sorts of public
health issues should be left up to local government (such as fluoridation)
and which ones to national government (chlorination, iodation - by the way
the US probably iodizes simply because it is cheaper than iodating), and why?
In my opinion, controversial programs are best carried out by local
government, in order to give more information on how well they work for a
while.  Are there any other public health issues that are locally controlled?