Think Before You Say “Yes”

Last August I talked about the Cost of War and how taking it into consideration beforehand improves our understanding and choices. In this post I would like to show how those deliberations help in our day to day decisions as well.

When someone asks you to do something — anything — think before you say, “Yes”. As adults our primary responsibility is to take care of ourselves first. That involves providing the basic inputs required to survive. It also includes fulfilling any commitments and obligations that we have taken on including the tasks involved in every day living. Either we perform the required tasks ourselves, provide goods and services to others in exchange for the ones they provide us, or earn the income necessary to purchase them.

Regardless of how we get those goods and services, what we use up is our own time, energy, resources and funds. Let’s call it our TERF. Since there are only twenty four hours in a day, the amount of TERF each of us has available is limited. Survival requires that certain things be done first including making sure we have enough of the basic inputs — clean air, fresh water, food, rest, clothing and shelter. Providing for them is our primary priority. That always requires a certain amount of our TERF. Another priority is allocating the TERF required to fulfill any commitments and obligations we have taken on. They include those involving our spouses or partners, having and raising children, taking care of sick or aging parents, friends or animals, etc. Here again, each of them requires more of our limited TERF.

Continue reading “Think Before You Say “Yes””

Should I Enter a Clinical Trial–Part Four

What to Consider Before Deciding

choiceIntervention is frequently based on the medical and public perception and assumption that doing something is better than doing nothing. That is not always the case. There are times when the net benefits of all interventions are negative — that is, anything you do will make you worse off.  Rather than starting with the underlying philosophy, “You/We should be able to do something that will fix it” begin by asking what are the likely benefits and costs of each of the alternatives. Then chose the one where the net benefits — the benefits minus the costs — are likely to be the greatest. Take no action when that provides the best results.

When the patient/consumer is not paying for the service, he/she is placed in the position of not having to consider what they are giving up when having the procedure. When that happens they are more likely to elect to have more services than they would if they had to pay for them. Historically, that goes under the name “Moral hazard”. Moreover, the prescribing practitioner and the PhysicianFirm almost always benefit from the additional revenue they receive from providing those services. Often it is someone else, like an insurance company or the government, who ends up paying the bill. Continue reading “Should I Enter a Clinical Trial–Part Four”

Should I Enter a Clinical Trial–Part Three

An Example of What Happened

We would like to provide a concrete example about the consequences of participating in a clinical trial. It is based on Amanda Bennett’s The Cost of Hope. She is a fine journalist and currently Executive Editor of Projects and Investigations at Bloomberg News. The book documents her husband, Terence Foley’s, seven year bout with kidney cancer. Initially, Foley was diagnosed with an atypical and aggressive form — collecting duct kidney cancer. It was spotted in December 2000 during the operation to remove his intestines to treat his ulcerative colitis. There were only 50 known cases of it worldwide at the time. This alone makes questionable whether his participation in the clinical trial contributes to our understanding of the potential benefits for future patients. In January 2001 when it was diagnosed, the prognosis was that he had a few months to live. [Bennett, p. 66] He died of it seven years later in December 2007. Continue reading “Should I Enter a Clinical Trial–Part Three”

Thinking About How You Spend Your Time

Enshi-girl-with-teaTime is a limited resource. There are just 24 hours in a day. No more, no less. All mammals must consume the basic survival inputs — clean air, fresh water and food, resting and using clothing and shelter. Time must be spent gathering, preparing or producing the food and other inputs, in making them ready for consumption, and in cleaning up afterward. Whatever time is not spent on those activities is available for other things.

If you are not directly involved in making any of those inputs, someone else must do that. In order to compensate them for the time, effort and other resources they spent in the production of inputs and making them ready for your consumption, you must use some of your left over time to create an income — either as physical outputs or their monetary equivalent — to pay for the goods and services they provide. That enables you to compensate them. Otherwise, you are expecting or getting a gift from them.

You’ve heard of discretionary spending. It is buying things after you have taken care of the necessities. The same thing goes for time. Once you’ve utilized your time to take care of providing the basic inputs, you have the opportunity to allocate the balance of it to those other things you want to do most. But the available time is limited. Every hour you spend on anything, you are giving up the possibility of using it for something else. Typically you have a number of alternative ways to spend the next hour. Some are more important than others. Clearly, spending time on the basic necessities comes first. After that, then what? Continue reading “Thinking About How You Spend Your Time”