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 Two–The Beneficiaries

The Beneficiaries

It is at best uncertain whether you or anyone else currently in your condition will benefit from your participation in a clinical trial. If the trial is successful — and as we have mentioned earlier not all of them are — and the drug or appliance is cleared for marketing, some of those who get a similar condition in the future may benefit from it. Your participation is your legacy to them. But the important question is, “Who benefits now?” That is particularly relevant since large amounts of time, effort and money go into clinical trials. Someone must believe the investment is worthwhile. Let’s take a look at each of the stakeholders.

The stakeholders

Those conducting trials are stakeholders in it. They benefit from it. They include:

  • The doctors and other practitioners involved.
  • The organizations and institutions they are a part of and represent– the Medical Centers, Hospitals, Universities and PhysicianFirms.
  • The pharmaceutical and medical equipment companies whose products are being tested and who sponsor the trial whose self-interest is definitely connected to the success of the project.

The principal investigators — a.k.a., the lead doctors — have their reputation on the line. The study is based on their hypothesis. If the clinical trial turns out favorably, they can say, “See I was right!“ Not only is that a boost to their ego, it enhances their reputation and all that goes along with it. If successful, they get to publish the results and present the findings at national meetings. Moreover, it enables them to test out their ideas, to get funds for their projects and it increases their income as well. Those personal benefits contribute to their wanting you to participate and, perhaps, inadvertently encourage you to do so. That is particularly true when the number of possible candidates for the clinical trial is limited, and the lack of participants threatens the validity of the results or even makes it impossible to conduct the trial. In fact, the possibility of being pressured to enroll has led to the requirement that in order to participate in a clinical trial you must sign a form indicating that you are giving your informed consent. Continue reading “Should I Enter a Clinical Trial–Part Two–The Beneficiaries”

Aging

george-booth-i-would-embrace-the-aging-process-if-i-could-lift-my-arms-new-yorker-cartoonMy Mom, when she was 80, said to me, “Bernie, I wish I was 20 and knew then what I know now.” My response was, “Mom, That’s a contradiction in terms.” Perhaps by sharing my experiences and what I have learned from the time I was 20 until now can help others. Just to prove I’m keeping up with the technology, from time to time I post my experiences on this blog. Trust me, when I was growing up we didn’t have blogs! In the following series of posts on aging, I’ll tell you about some of the issues I’ve faced and how I’ve dealt with them. My hope is that this series will help you, no matter what your age, to understand some of the challenges older folks, like me, have.

Aging is isolating. It’s harder to get around. Friends die off or disappear. Your energy level ain’t what it used to be. You can’t do what you used to. Much of the new technology leaves you behind. Even though I use a computer and even have a blog, I never learned to text or twitter. I-Phones with their Apps are too difficult to deal with, even if I could afford one on my limited budget. People don’t talk to one another now, not the way we used to. Instead of picking up the phone they e-mail or text, and I don’t use a cell phone except for emergencies. Moreover, younger people have their own lives and appropriately, their own agenda. Continue reading “Aging”

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”