Let them eat cake

[RedCelt69]

This statement was made in the is-the-NHS-shit? thread. I thought it deserved attention in and of its own right.

People get all sorts of stupid treatments on the NHS, that they seem to think they have some right to! The resources of which should be going to those that are more in need of it but maybe the balance is right its just my opinion is slightly one side of the line. I would be inclined to be less lenient with a lot of people that want cosmetic surgery, fertility treatment or end up there due to their own stupid consumption of too much al-co-mo-hol or even cake!

Which raises a question I've pondered in the past. If people deliberately put themselves at risk, do they deserve what happens to them, or should they be helped?

The example given above was people drinking too much or eating too much.

Personally, I ponder the issue when I see someone on the news being rescued by Mountain Rescue. If a mountaineer gets into difficulty, should the tax payer have to foot the bill for a resource-hungry rescue involving dozens of people (putting the rescuers at risk) and (for instance) helicopters?

How about someone who gets into difficulty at sea? Based on the above logic, they put themselves in harms way, so they deserve everything they get, right?

So. Should we scrap Mountain Rescue and the Coastguard?

Should we tell fat people that they won't be treated for diabetes or have their stomachs stapled at the expense of the tax payer? Should smokers be denied treatment for lung cancer? How about sportsmen who injure themselves pursuing their sport? How about old folk who slip on ice and bust their hip? They should stay indoors in the winter, right? And women out alone at night are simply asking to be raped? They chose to put themselves in harm's way, right?

I'm hoping that nobody agreed with any of the above. Yet they're all examples of people ending up physically or mentally damaged due to decisions that they made.

If you agreed with some of it and disagreed with others... you're being inconsistent.

Discuss.

[Humphrey]

Well, we already discriminate for some treatments.

http://www.telegraph.co.uk/news/uknews/ ... imate.html

[Hennessy]

As a smoker I am taxed about 70% every time I buy a pack of fags. Smokers put about £10 billion (2007-8 figures) into the NHS through tax per year. According to the BBC's latest article on smoking related diseases they cost about £3billion a year to treat. So by virtue of my disgusting habit I can justify any treatment I get for it by arguing that my fellow smokers and I are putting up triple the amount needed for our habit's unfortunate side-effects into the NHS. That should be buying us the best healthcare on the market, indeed cancers caused by smoking should be getting thrice the treatment of any other cancer, thrice the R & D and thrice the hospital experience of their non-smoking peers

Instead it's going to people who have never smoked a day in their lives, being lost in the pay of obsolete middle-management schemes and thrown into the toilet of red tape earkmarked "Government Scheme for..."

I'm not at all bitter about this though, and most smokers aren't even aware of it. The NHS must have a moral basis to treat anyone who becomes invalid, applying any kind of strident capitalist philosophy to it simply won't work because it is at it's base a national humanitarian project, certainly designed not entirely for selfless aid but by virtue of its existence a frequent giver of such care regardless.

No I havent read the other thread, but shall proceed there at my leisure to see what has been written...

[donpablo]

Can't argue with that Hennessy. You almost make me feel ashamed now for being a non smoker and not doing my bit and potentially (although hopefully not) cashing in on your investment down the line. Smokers are hereby vindicated.

[Guest]

The difference here is that someone going on a tough hike may be putting himself at risk, but it's still a risk, i.e. there is a chance they will be injured, but it is far more likely that they will be okay. Similar logic would require people never to drive cars because there's always the risk of crashing. Eating oneself to dangerous levels of weight is entirely different, because it's almost a certainty that a person's obesity will cause expensive (and unpleasant) health problems. Personally, I think it would be wrong to deny treatment to people for that reason, but it has to be said that it's an altogether different situation. Personally I like to think that if my taxes are paying for another person's healthcare, he'll have the decency to take at least the tiniest bit of care of himself, as I do of myself. I recognise that this sentiment can't really be defined logically or legally or whatever, but I think it deserves to be mentioned.

Going back to the USA vs UK health system thing, it should be noted that in the US private insurance companies charge more for people who smoke, because obviously they are putting themselves at a greater health risk than those who don't. Here, taxes on tobacco are extremely high so it could be said that smokers are effectively paying for [some of] the health costs they will someday stack up. Nothing like that exists for fat people. Maybe there should be a tax on chips and fried foods or something...

Lastly, I think that in a country where universal healthcare is funded by all taxpayers, and where pretty much every kind of drug is illegal, tobacco may as well be illegal too. I mean, it's actually bad for you (unlike some other, illegal drugs). You can barely smoke cigarettes anywhere anyways!

[RedCelt69]

I agree wrt smokers. I've had people tell me that smokers should be refused treatment on the NHS.

My reply is thus:-

Fine. Pay me back all of the money I've paid in tax over the years. I'll charter a private jet, fly to Tahiti and get my cancer treatment there. Which is obviously in jest. I've no idea what Tahiti's health care system is like

Doesn't alter the fact that I've already paid for my treatment (should I need it) along with subsidising the treatment of non-smokers.

None of which addresses my initial question wrt whether tax-payers should help people who put themselves in harm's way. If it helps, ignore the part about smokers.

[donpablo]

Simple answer yes, by all means but that is assuming there is enough to go round everyone.

More complicated answer no not really if there isn't enough to get round then its time to be harsh on some of those that put themselves in harms way. Obviously there are intricacies to the system e.g. although soldiers put themselves in harms way all the time but they should be certainly entitled to help maybe the first as they defend us (let's not get into the politics).

Alternatively we could just tax cake.

[Cain]

If people deliberately put themselves at risk, do they deserve what happens to them, or should they be helped?

What about people who are hit by cars when they aren't crossing with the green man? Do they deserve what happens to them?

Or people who are stabbed in bar fights?

Or people who are crushed at concerts?

Or a million and one other medical problems that result from people's lifestyle choices.

The NHS put my teeth back in my mouth and stitched me up when I was 19 because I was too stupid to put in a tackle properly in hockey. Ninewells on a Saturday afternoon is full of people in sports kit. Is it their own bloody fault that they're there and thus they should not be given medical help?

[wild_quinine]

Life is full of risks, and it is richer for everyone if you choose to take a few of them. One could argue that there is very much a social benefit to guaranteeing the treatment of various pioneers of sports, exploration and scientific inquiry. The world is undoubtedly a richer place for their endeavors... hell, even the stupid ones are at least entertaining.

A few years ago, the government killed the grant system and introduced loans and tuition fees, all at pretty much the same time. This was done with very little warning - little enough that some people who took a gap year came back to find themselves much, much, much worse off.

The problem was not so much about how society chooses to pay for its education. It was that, if we had known that we would be expected to pay for our education, our parents would have had college funds. If there was a different model, we would have made arrangements that suited this model. Education was free in this country, and we were led to believe that free education was a core value of the country. When it was taken away, all our parents knew is that they had subsidised the generation before, whilst their children would have to pay again, with money that had not been set aside for it.

It's the same with the NHS. You can't deny treatment to the obese, to smokers, to drug addicts, regardless of what they 'deserve'. We have promised them a certain level of entitlement, and their life decisions have been made with that entitlement in mind - no matter how bad those decisions are, it is an injustice at some level to reverse our committment to those people.

I'm not saying no changes can ever be made to established systems - sometimes the good of doing so, or the necessity, will clearly outweigh the harm done. But starting from a premise of what people 'deserve' is always going to fail. If they have been promised something - healthcare, education, whatever - then to some degree they do deserve to get it - and if they don't get it, then the person or entity who made the promises is more at fault than the person who made poor life choices based on those promises.

[donpablo]

Oh no the internet strikes back.

If you dislike some cliched internet humour maybe best you avoid the internet in general and / or stfu about it. Or maybe post what your problem is exactly instead of whining behind guest posts. Seems like I've got your back up whoever you are. Maybe something I have said has hit a nerve somewhere or you just didn't get enough emotional support as a child in general? Really if you take anything said on the internet that seriously it's you that has the problem not me. I couldn't give a shit about your opinion, I'll leave it to the mods to tell me if I have crossed the line anywhere. I might be a moron with the idiot brain of a child in your opinion but at least I can manage basic grammar so where does that leave you?

[d_24]

[the Empress]

I'm wary of a 'blame culture' in medicine. I don't doubt people do stupid things but - medicine should be about treatment rather than societal baggage. What if you treated someone different simply because they had lung cancer, because it equalled 'smoker' (pariah) - but the patient may have never smoked. Or had an STD, and didn't seek treatment because of attitudes in healthcare. This has come up before in HIV and abortion discussions - it happens, it may have happened for a number of reasons, but refusing treatment/demonizing the patient will not solve the long-term problem, and may exacerbate it.

Some conditions are misunderstood too, and can easily fall under the blame bus . . . . anorexia nervosa, clinical depression and ME being classic examples. Possibly because 'anorexic' and 'depression' are often used as non-clinical terms.

Saying that . . . I was reading an article on cocaine today. According to 'Glamour' (I like it, OK?): female cocaine deaths have gone up 50%, 1 in 4 reader respondents use cocaine and - this I found interesting - almost all bank notes in circulation in the UK are contaminated with cocaine, albeit trace amounts. 25% seems ridiculously high to me, so I'm assuming there was heavy respondent bias (as expected in voluntary reader surveys). I've read numerous articles along these lines in women's magazines, including a mother (daughter died from cocaine) quoted 'I knew she was using, but didn't realise it was so dangerous'. This, I find exasperating. It's a class A drug, with well-documented effects. How could you not know?

[Ragamuffin_artist]

The possibility of nationalized helthcare necessitating various 'sin taxes' on unhealthy behavior has recently been a big talking point here in the states among conservatives. As in the UK, and Canada (and elsewhere, I presume) smokers already pay quite a bit of tax per pack. But since obesity is also famously a much bigger problem here, taxes have also been proposed on sugary foods. For example, New York Gov. David Paterson implemented an 18% tax on soda pop last year (but repealed it after much opposition). Under nationalized care, I can see the logic of this. Why should my taxes pay for the healthcare of others who lead such unhealthy lifestyles? But the libertarian in me questions at what point government intervention in our lives is too much. Should the tax on a Big Mac be comparable to the tax on a pack of cigs? For that matter, since so many people get in auto accidents each year, should taxes be raised on those who drive cars? Essentially, this is just the government curbing our behavior by making it expensive to behave badly (I believe that's also large part of how the current cap-in-trade bill is going to work here in the States. According to my admittedly limited understanding, in part it helps the environment by basically making energy consumption more expensive, thus discouraging its use). So at what point do we draw the line?

[the Empress]

while I don't know the bill in question, usually the idea behind cap-and-trade proposals is that GHG *emissions* are to be expensive and thus companies forced to reduce emissions - this may have an initial knock-on effect on energy price, but is not intended to make energy prohibitively expensive.

However, with regard to sugary foods. I read an article a while ago which had evidence that there is a 'pleasure point' which these foods trigger, and we are thus unable to stop or judge excess consumption as it were. There's evidence with respect to physical craving (pleasure), marketing (psychology) and consequences (health) - yet these foods are still readily availabile. Hence it's very hard to stop - in which case enforcing strict guidelines on companies makes sense. I don't see it as a tax on obesity - currently chocolate bar sizes are smaller, calorie content more prominiently advertised - and reducing exploitation (if everything is aimed at the brain - pleasure and marketing - the whole hand is weighted against you).

[wild_quinine]

1 in 4 reader respondents use cocaine and - this I found interesting - almost all bank notes in circulation in the UK are contaminated with cocaine, albeit trace amounts. 25% seems ridiculously high to me, so I'm assuming there was heavy respondent bias (as expected in voluntary reader surveys). I've read numerous articles along these lines in women's magazines, including a mother (daughter died from cocaine) quoted 'I knew she was using, but didn't realise it was so dangerous'. This, I find exasperating. It's a class A drug, with well-documented effects. How could you not know?

Because trying to read between the lines of the ridiculous propaganda we get handed down on drugs is an almost impossible task, and the classifications system is pretty much bullshit. In fact, let me be quite clear: what we are told about drugs in the media is pretty much all bullshit, period. Any sane, rational person knows this, if they have thought about it.

Sure, we know that cocaine is dangerous - and people do die - but most of us have no idea how dangerous.

A cursory glance at some figures suggests that well over half a million people do cocaine every year in the UK, and that the number of deaths linked to cocaine is probably between 100 and 200 per year. Now consider that 'deaths linked to cocaine' almost certainly means deaths 'where the person who died had cocaine in the bloodstream', whether they died whilst drinking, or driving, or both, or doing other drugs too. And that it doesn't account for cocaine being mixed with whatever other toxic shit is out on the street, either.

You might very well say 'Well, if it's dangerous, you just shouldn't do it at all', and I absolutely respect your right to feel that way. But sooner or later you have to draw the line on that kind of inconsistent thinking, even for things that are recreational.

Well over quarter of a million people get injured in a road accident every year in the UK alone, but we usually don't stop to think before we drive off to the beach/mall/themepark/museum, about how dangerous it is - honestly, most of us would be more worried about the environmental damage we might be causing by unnecessary driving.

If everyone you know does cocaine, and nobody ever got sick, ODed, or died whilst doing cocaine, you probably wouldn't worry either.

Now I can't imagine any parents I know giving their blessing to a coke habit, but the statement "I knew she was using, but didn't realise it was so dangerous" is probably an honest one, and not as stupid as it sounds.

I'll put money on the fact that you think it is more dangerous than it actually is.

Now I'm no coke advocate - I'm enough of an asshole already without putting that part of myself on steroids - but I think that when it comes to drugs we should be cracking down on inconsistency first, and susbtances second.

For that matter, since so many people get in auto accidents each year, should taxes be raised on those who drive cars?

That will happen anyway.

You know we pay 70%+ tax on petrol at the pumps, and then VAT is charged on top... in other words we pay a service tax on something which is already 70 per cent tax? (That's right, you get a tax on tax!)

Essentially, this is just the government curbing our behavior by making it expensive to behave badly ... So at what point do we draw the line?

Probably some time before it becomes 'just the government curbing our behaviour by making it expensive to...' That's the death of freedom by 1000 cuts. And it also means that only the rich get to be assholes, which is already too true.

[the Empress]

1 in 4 of all heart attacks in people under 40 is caused by cocaine.

Cocaine is an anaesthetic - one line could trigger a shutdown in your body mainfesting in a stroke or a heart attack.

When combined with alcohol: alcohol is absorbed into the bloodstream depressing the central nervous system, adding cocaine (a stimulant) causes the heart muscles to race, the bloody supply to quicken and prevents you breathing as well. The combination is toxic, especially to the liver.

the drug can also be a trigger for schizophrenia and suicide.

In the first 6-8 weeks of pregnancy (when you probably won't know) the babie's face and brain develops. That's when the baby is most susceptable to the mother taking cocaine - leading to physical and brain abnormalities characteristic of 'crack babies'

You're right. It's not dangerous at all. It's the media. And, some people just can't handle it, right? *wink*

[edit] for some weird spelling and . . . here's a book link: http://books.google.co.uk/books?id=5tZq ... re&f=false

[wild_quinine]

1 in 4 of all heart attacks in people under 40 is caused by cocaine.

Cocaine is an anaesthetic - one line could trigger a shutdown in your body mainfesting in a stroke or a heart attack.

When combined with alcohol: alcohol is absorbed into the bloodstream it depresses the central nervous system, adding cocaine (a stimulant) causes the hear muslces to race, the bloody supply to quicken and prevents you breathing weel. The combination is toxic, especially to the liver.

the drug can also be a trigger for schizophrenia and suicide.

You're right. It's not dangerous at all. It's the media. And, some people just can't handle it, right? *wink*

The thing is, I don't care to dispute any of these things, apart from your super-sarky last line. I'm not saying everyone or anyone should do it. I'm not even saying it has any benefits other than pleasure.

But 500,000 people in the UK do it each year. 100, or 200, of them die doing it - often of something other than a purely pharmacological reaction.

If every student in St. Andrews did cocaine, there'd be maybe a couple of deaths per year, they'd almost all involve alcohol too, and most likely half of them would be due to dangerous driving, or overconfident naifs thinking they can climb the rocks at castle sands with a skinfull.

Does the media make it sound more or less dangerous than this, would you say?

Please lock your knees down and engage your brain. This isn't an argument of two sides, with me being pro-cocaine and you being anti-cocaine. This is me asking you to engage your powers of reason, and see that it is quite possible to believe that you won't die using cocaine, and quite logical to reject propaganda that suggests a more serious risk than is actually present.

The funny thing is that if we were given more accurate information on drug use, we would probably be more inclined to trust it. But so many people think that it makes more sense to exagerate the risks, as a deterrent. Let me ask you, honestly, do you think that makes sense?

Cocaine is dangerous. There are risks. The most severe risks are pretty rare, but the stakes are damn high. Yet millions of people use it all over the world and do not die because of that. Moreover most people who use it do not die because of it, which is not necessarily something you can easily say about some legal drugs such as cigarettes.

Even the risks of smoking are exagerated beyond reason, and that's a certified killer by any reasoned view.


Eight St. Andrews students died in my Fresher year. It was a rare time, I'll admit. More than half those deaths you could call 'sports related'. Sports are dangerous, too, aren't they? More dangerous than cocaine? What's the common thinking on Sports in the media? Only about sixteen pages of praise and soap opera at the back of any given tabloid.

[donpablo]

Whatever your perception on cocaine I think in general it is still less dangerous than alcohol (and probably tobacco) in moderation.

The link was interesting reading but I am not convinced cocaine is worse than alcohol as the book focussed more on addiction not moderate use. I present some counter arguements here. http://www.guardian.co.uk/commentisfree/2009/jun/13/bad-science-cocaine-study

Some of the worst end of the specturm scenarios of alcohol are truly awful as with cocaine. There's also the social impact and not to mention many of the pregnancy and STD problems that drunken one night stands pose not to mention foetal alcohol syndrome. Even if cocaine is safer though I wouldnt trust that it hasnt been tampered with. And like you say adding alcohol in to the equation is just asking for trouble. I don't know anyone that just does cocaine but doesnt drink. Not that I know many people who do or have done coke in the past.

I love the cocaine on bank notes studies though. It's quite amusing that the amount of notes you would need to actually get one lines worth of coke kinda puts a stupid perspective on things. It's a hell of a lot of money to be blunt.

Listen to Mr Mackey. 'Drugs are bad mmmkay.'

EDIT: I didn't want to bring this point up for fear of being branded an even more insensitive ass than some people may think I am but since it's been touched on already... how many st andrews students have died from alcohol related problems compared to cocaine? I don't know the figures but I know theres been a lot from alcohol recently and none that I'm aware of from cocaine. The statistics should be strongly on the side of alcohol in that one once you take into consideration usage, not that I have the exact figures.

[the Empress]

There are studies that some people are more prone to cocaine addiction than others - addiction isn't a moral weakness.

But - if you take a narcotic, haven't done any research, and get sick due to it's effects . . . when there's plenty of information. Tragic yes, but please, spare me 'but, *I didn't know *'. Addicted fine. Taking a risk, fine. But not knowing what you were doing? Bullshit. I'm eternally frustrated with celeb recovery stories: yes, it's amazing and laudable that they recovered, but they still took it in the first place.

This has nothing to do with sports. Frankly, take whatever risks you want.

[wild_quinine]

But - if you take a narcotic, haven't done any research, and get sick due to it's effects . . . when there's plenty of information. Tragic yes, but please, spare me 'but, *I didn't know *'.

I think my point is that the information available is often very unreliable, because it is usually presented with an agenda. And this is a bad thing, and leads to uncertainty in the most, not the least, reasonable of people.

Knowing the worst thing that could happen as a consequence of a given action is not nearly so useful as knowing how likely that is, and is not a very accurate measure of how dangerous something is.

We could amuse ourselves for hours coming up with worst case scenarios for common activities.

Just for example: The worst case scenario of walking downstairs is death. Should we avoid sympathy in the relatively few cases where this occurs, or warn off the activity altogether? Probably not, if only because the worst case scenario for taking the elevator instead is also death.

This has nothing to do with sports.

I disagree. It's a bad analogy, because most sports have health benefits to weigh against the risks. But most people I know are into sports recreationally. But have you considered the worst case scenarios for some very common sports? Some of those worst case scenarios are truly awful. Almost any physical activity involves the risk of breaking your back or neck, which is pretty much game over from a quality of life point of view, and has a pretty high risk of death.

Would you have given Christopher Reeves the "Tragic yes, but please, spare me 'but, *I didn't know *" line?

One of my friends is into running, and he's frankly a mess. As I understand it, there's good evidence that running is awful for the body, long term and can be hilariously scary in the short term. My friend loves it when new runners piss blood and think they're dying.