I was talking to my wife about health care today and two interesting points came up.

First, she was offended by a doctor who was complaining about smokers, as they "bring it on themselves." As this is a topic I have addressed before ("It Doesn't Matter to ME..."), I was quite interested, especially as it is sometimes used to justify the nanny state interventions many favor. Often we will hear "We should ban drugs because of the costs to society", or "transfats cost society so much". However, people who make such arguments never really think things through. They would never, for example, talk of making homosexual activity illegal due to the increased health risks, or ban bicycling because of the increased risks of head or neck trauma, nor would they blame motorcycle riders for their increased injuries. It seems their ire is reserved for those whose valuations they find "wrong".

And that is the dishonesty of this decision. Everyone on earth makes decisions with negative health consequences every day. They may drink more than they should sometimes, or eat a bit too much, have sex with a stranger or skydive or ski. It is hard to think of anyone who does not take some health risk because they value the option they chose more than the health risk. But when it comes to smoking or drugs or other "bad" decisions, suddenly health becomes an "absolute" ("Absolute Values"), and no risk to health should be tolerated.

The truth is, they are not really arguing about health costs at all. What they are doing is fishing about for a reason to make a universal rule of their own prejudices. They disapprove of smoking so the health risk is too much, but the risk of STDs from promiscuity is acceptable. Or the "risk" of drugs is unacceptable as they "have no benefit", but drinking is an acceptable risk. The truth is every decision is a trade off of risks and benefits, and the only person who can make such a decision is the individual. There is no "rational" valuation, every preference is personal and irrational, and to try to substitute your judgment for another's only ends up making them less happy. It does not produce any "social benefit", except the small thrill you get from playing the petty tyrant.

After we discussed that, my wife also brought up the incidence of COPD and lung cancer. She asked a very pertinent question. "How can lung cancer be increasing when we used to live in filth, inhaling smoke in enclosed places from cooking fires?" And she is right, even in terms of air quality, we live better, even with smoking risks, than we did in the past. So why do we see "an epidemic" of cancer, heart disease and respiratory problems?

And the answer is simple. We have so much heart disease and cancer because we live long enough to get those diseases. You see, you must die of something. I know no one likes to admit that, but everyone will die of some cause. And, where int he past we died of influenza and polio and infections and animal attacks, we now live well into old age, when we start to develop degenerative diseases. And yes, smoking does make lung cancer more likely to be the disease which will kill us, but only a few years earlier than everyone else is likely to die of heart failure or some other cancer. It isn't as if the "epidemic" of lung cancer is wiping out twenty year olds, it is a disease of late life, by and large* So, even if we eliminated smoking entirely, we would only add a few years to life, and that by shifting the "epidemic" of lung cancer to an even greater "epidemic" of heart disease.

The truth is, we will never "solve" or "cure" death. I cannot foresee a way we could so thoroughly cheat the second law of thermodynamics to prevent the eventual breakdown of our genes or the degeneration of our physical forms. Even if we find a way to cure cancer and stave off heart failure, something else will begin to break down. Cells will stop replicating or the liver will fail or the nerves will begin to degenerate or terminal Alzheimer's will set in. In some way the human body will fail.

And that si why it is important to take talk of a "crisis" of heart disease or cancer with a grain of salt. yes those are the primary causes of human deaths in the US, but that is in many ways a good thing. If we have to die of something, and we do, then dying of those is a sign of longevity. If we were dying of typhus, cholera and sepsis, that would be a crisis. Dying of cancer and heart disease is a sign of good health**.

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* Please don't tell me of individual exceptions. Obviously some get lung cancer early. There is early onset Alzhiemer's as well, but that does not disprove the generalization that Alzhiemer's is a disease of old age. Smoking related lung cancer does take some years off of life, but most smokers still live far longer than we did even fifty years ago.

** Which makes me laugh quite a bit at environmentalists who find the "surge" of cancer cases a sign of deteriorating environmental conditions. If we continue to live ever longer, how could that be a sign of bad conditions? Yes, we eventually die of cancer, but long after we would have died in the past. Would a bad environment cause that to happen?

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POSTSCRIPT

For my earlier thoughts of things medical, including regulation and other matters, see the following:

Standing By My Principles
For Your Own Good
Medical Regulations
It Is Time
Shameless Self-Promotion
Unintended Consequences I
Unintended Consequences II
A Question
Who Does It Harm?
Manipulating the Law
It Doesn't Matter to ME...
Medical Regulation II
We're From the Government and We're Here To Help You
Another Thought on Regulation
Absolute Values
Government's Abusive Behavior
The Secret Behind the Rhetoric
A Great Article

And for some talk of environmentalists and their misues of statistics, as mentioned in the footnote above, see these posts:

A Thought on Oil Reserves
Knowing Our Limits
Transfats?
Statistical Artifacts
Endangered Species
The World's Most Stupid Bureaucrat
A Brief Comment on Oil
Why I Doubt Peak Oil Predicitons
Some Global Warming Links
Several Convenient Untruths
Rejecting "Peak Oil"
Safe Nuclear Power
Organic Absurdities
Sampling Changes and Fictional Trends
Pet Peeve
Once Again, Confused by Our Own Data
Twice in a Row
Historic Myopia
More About the Hockey Stick Graph
The Failure of Peer Review
Allergies
A Dearth of Common Sense
Again Improving Science Misleads
The Perfect Model
How Green is Green Energy?
Debunking "Debunking Global Cooling"
More On Biodeisel
Interesting Evidence
Bad Science and Environmentalism
An Interesting Article

I would also recommend "", "Special Cases", "Cognitive Dissonance Part 2", "Smaller Government , Fair Weather Friends and Special Cases", "Appealing to Arrogance", "Conservatism, Incremental Change and Federalism", "When Help Hurts" and "Absolute Values" on the error of absolute values and substituting your values for another's.

As some of the arguments about smoking mirror those used to ban drugs and enact other nanny state legislation, you may also find some useful posts on my other, though recently neglected, blog "Examining the War on Drugs".