Wednesday, July 01, 2009

Somewhere Gregory House is Weeping


Reverse Utilitarianism

The philosophy of utilitarianism says that you should strive to do good for the greatest number of people possible in a situation. It is the classic Spock in Wrath of Khan philosophy, that the needs of the many outweigh the needs of the one. He goes in to the reactor to satisfy the needs of the writers, who outnumber him, to have an easy hook for a sequel.

And this generally makes sense. When presented with equal chances of victory a General will go with a plan that gets 10 people killed rather than 10,000, or even 10 over 100. We expect that in any situation some people will not benefit, and that we should generally go with situations that minimize harm and maximize benefit.

So the FDA is considering limiting the dosages available for the drug acetomenaphin. If this sounds familiar that is because it is what makes major painkillers from Tylenol to Vicodin tick. Currently available in a maximum dosage of 500 milligrams pure, it can be combined with other drugs to make the super painkillers vicodin and percocet.

So following the philosophy of utilitarianism, an FDA panel looked at usage (in perscriptions and purchases) versus people killed/admitted to hospitals each year due to overdose on acetomenaphin. The numbers are 42,000, 400 and 100,000,000+ respectively, and I want you to match each number to it's category, given the knowledge that the panel voted to ban vicodin and percocet, and limit acetomenaphin dosage.

You would think the government would only do such a thing if the numbers went thusly:
1) 400 killed
2) 100,000,000 hospitalized
3) 42,000 number of prescriptions.

But that doesn't make a whole lot of sense, how can more people be hospitalized than take the drug, and if something is hospitalizing 1 in 3 Americans how is it only killing 400? doesn't make sense any other way. Surely if 42,000 people (A little over 1/100th of the US population) are hospitalized each year out of 100,000,000 (33.3 percent of the US Population) the Government won't do anything. Right? RIGHT?

Read it, I'll wait.

Yeah. And for the record if 400 people die per year that is a little over 1/1000th of the U.S. Population that the panel recommends the FDA work furiously to save at the cost of inconveniencing the one out of every 3 Americans that statistically need the pills every year. Oh, and that one hundred million only applies specifically to Vicodin and its' generics, not Percocet (one of the other most popular pain killers in the world) and Tylenol (which needs no explanation).

As you no doubt read (seriously, I waited for you) they recommend (in addition to banning Vicodin and Percocet) lowering the maximum pill size from 500 to 325 milligrams, and lowering the maximum daily dosage to under 4,000 milligrams. Ok, fine, let us suppose that .0001 percent of the population getting themselves killed is worth the million dollars the panel spent on this and the disruption of pain management of a third of the country. But lowering the maximum dosage seems to me to lead to a scenario, which I hope you will follow me on.

Scenario 1) John J. Johnson (the J. stands for Joshua, not John) has a headache that feels like Dwarves of Norse Legend are fashioning an incredibly tiny Mjolnir inside his cerebellum, and he wishes to serve them a pharmacalogical eviction notice. He used to take two 500 milligram pills to get 1000 and subdue them. Now he looks at the bottle and realizes that it has been lowered, so instead he takes three, which gives him 975 milligrams. So the FDA has made him waste another pill and lowered his risk of overdosing by...25 milligrams. Now I don't have the numbers here, but according to the Parker Institute of Common Sense and Outright Fabrications, 25 milligrams doesn't seem to be a major overdose risk. Marilyn Monroe did not sit on the floor looking at the pills and saying 'Damn, 25 mg over...' Especially since everyone knows Robert Kennedy strangled her with a garrote made of 100 dollar bills.

Between myself, Dad, Andrew and Spike we necessitate 8 other people not taking Vicodin each year, as we are proscribed acetomenaphin medications for our head, shoulders, knees and toes. I am not sure what I would have done for my initial gout attacks if I hadn't had a pain killer, so maybe I'm a little bit sensitive on the subject, and maybe I'm being greedy as one of the 33 instead of the .00013. But damn, I want my drugs, and I don't have the money to start up an import business of the stuff from Thailand to get in before any sort of ban picks up. If I get back to the states and get a gout attack and I have to settle for 325 milligrams of tylenol and a fond wish from the government, I might have to research if throttling people to death due to lack of acetamenophin would help raise the fatality number.

God I love this picture.

1 comment:

  1. Dear Matthew,

    To add fuel to this fire I had an emergency tooth extraction on Thursday (couldn't save the poor bastard). On Wednesday the kindly Dr. Brown, DDS, prescribed - you can guess what's coming, can't you? - Vicodin.

    Ahh, nectar of the gods. I went from being actively and persistently uncomfortable and unhappy to being quite comforted and content. Before I even read your blog I was extolling the virtues of Vicodin to any and all who would listen. On Thursday, after the heroic Saving Private Molar came to naught, the good doctor encouraged me to follow the directions and take one Vicodin every 4 hours without fail. It proved to be very efficacious.

    Anyway, the action of the FDA seems to be quite shortsighted, can you say blackmarket?

    Now on to important things, I know you grow tired of my continuing praise, but damn boy that is, once again, some very impressive writing.

    I loved the Rand quotation. I felt Atlas Shrugged was very important when I read it at 14. The last time I read it I was 40 something. It definitely lost a bit over the intervening 30 years. I also realized how poorly written it is. Unbelievably one-dimensional characters and horribly stilted dialog. No wonder the right loves it. Ba dum dum.




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