Japan is Nervous about Pig Flu

The Japanese have been holding passengers arriving from North America at Narita international airport in quarantine, checking temperatures, etc.

Japan is well known in public health circles for being exceptionally nervous about flu; it has an aging population and a national obsession with cleanliness that makes even Switzerland look messy.*

Indeed, my wife, who is Japanese, spoke with her mom in Tokyo this weekend who was still freaked out about swine flu. There are nearly 130 cases of confirmed swine flu in Japan, with 0 deaths. Actually world-wide, excluding Mexico there have only been 6 deaths, or 1 in 1000 people with confirmed flu.

End of Rebel War in Sri Lanka?

I doubt it, although it will be interesting to see how an apparently crushing military defeat of a rebel militia will ensure peace. Just like when we took out Saddam Hussein. It seems to me there are ample examples in modern history that teach just the opposite. The real danger of political terrorism (rebel separatism) is not violent warfare. It's the hatred and passion buried deep in people's hearts. You can't crush that.

http://www.nytimes.com/2009/05/19/world/asia/19lanka.html?hp

Health Insurance is Not Like Others

James Kwak has a good, short piece on why health insurance doesn't make sense as a free market instrument, as other forms of insurance do:

The analog in health insurance, however, quickly becomes unsupportable. Unfortunately, sick people (and, to a lesser extent, old people) have much higher expected health care costs than young, healthy people. In an actuarially fair health care system, their annual premiums should equal their expected annual health care costs. For someone with a serious illness, those expected costs would easily dwarf his expected income. There is no way to "buy a smaller house." So in an actuarially fair, free market system, he would be unable to get health insurance, would be unable to afford health care, and would . . . die.

Put another way, from the perspective of the insurer, the rational thing to do is charge people more than their expected health care costs, and the efficient outcome is to not insure very sick people. When we say that anyone should be able to get health insurance, we are saying that someone should be forced to lose money insuring sick people.

We've all heard these stories of patients with diabetes or cancer being turned down for coverage. I think this is yet another reason why health care bucks many assumptions we have about free market economics, and why people - including way too many doctors - think that health care is best delivered in a free market system. We're not cars, to start.

Will child abuse expert doctors be too eager to call something abuse?

Being a child abuse expert is soon to become a medical specialty within pediatrics. It is hard to take a critical view toward this, I'm mean who wouldn't want experts to help us identify such heinous crimes against children?

However, specialization comes with a significant cost, as many generalists in medicine can attest. The adage that is often used is "when you're a hammer, everything looks like a nail." To a cardiologist, everything is a heart problem, and so on. The problem with specialization is that - like anyone - the specialist doctor can become overly invested in their knowledge niche, which is narrow and circumscribed. This can lead to bias, over-simplified conclusions, and missed insights.

My concern is of a slippery-slope nature. How much behavior toward a child will fall under the scrutiny of the child abuse expert? Good old fashioned discipline, such as spanking or washing out the mouth with soap, that many older adults experienced at the hands of their own parents? Forcing a childing to do house chores when they don't want to do? Making a child eat veggies when they refuse? These seem to be a far cry from "abuse" but there is little doubt that our politcolegal culture has also lost common sense in matters of personal responsibility - a disciplining children probably lies at the heart of that.

Here's a recent story about a daycare that was charged with putting hot sauce on tongues and squeezing arms of children that were misbehaving. You can question the style of discpline, certainly, but to call this abuse - as some in the community are - sounds like overreaction (we don't know the whole story). Ideally a child abuse expert could assist in the case with objective appraisal of evidence and clarifying what is and is not abuse. But this could backfire if everything starts to look like a nail.