33 Comments

I constantly think of the ~$500+ cost of missing a red light by a fraction of a second and the $300+ cost of a speeding ticket if I get ticketed. This follows getting tickets. I am also under the impression over the years that increasing police ticketing in locations where there are high accident rates does reduce the accident rates, but I can't cite a link for that.

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Sorry, but I don't understand this comparison either.

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@Jamie Olson

No. Read my initial comment again. I said specifically I think there are few to no studies that show police and traffic courts are effective at reducing accidents. I've never read any. I have read studies comparing physical infrastructure improvements like lights vs. roundabouts, energy deforming devices, and traffic calming techniques.

People rarely think about the administrative consequences when they are acting unsafely, so I personally don't think police and traffic courts do much good for road safety.

I said I do think much of the infrastructure improvements are probably effective. A good example of this is the cable barriers on highways that TxDOT pioneered. They prevent highway crossover accidents that happen head on at high relative speed, by softly bouncing errant cars back in the following flow of traffic that the car was in.

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Consider the vast legal apparatus we maintain to reduce the US’s ~30,000 annual car crash deaths. This includes a vast complex of traffic laws, such as re speeding and stop signs, auto safety rules and tests, and huge police forces and courts devoted to enforcing all this.

And we actually take it easy on drivers that kill people. Most state legislatures have invented something called "vehicular manslaughter" which is the same as manslaughter except (1) the perpetrator killed the person with their car, and (2) the punishment is much less than normal manslaughter.

I see no justification for the differentiation. Manslaughter is basically non-intentional killing due to reckless (a standard higher than negligence) action. Perhaps it is due to the fact that most people could imagine themselves engaging in reckless driving, but not in other similarly reckless behavior.

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If it's a law, how do you enforce it? We have a police force who already monitor roads. We'd have to create another police force for hospitals. The Dept. of Health (DOH) periodically checks restaurants for cleanliness, I don't know but maybe they already check hospitals too. We could now have them do random checks to monitor the catheter process. Maybe that wouldn't be too difficult.

I'd also recommend having hand-washing laws for all citizens. That would save a lot more lives than catheter laws. Then the DOH could walk around all public places and workplaces to monitor whether or not people are washing their hands before a meal, after using the bathroom, etc. This would be a huge success in reducing deaths. Or maybe that would be a little insane...

I guess the difference would maybe be in the government protecting customers from others who do them harm, as opposed to protecting them from themselves. But then germs do spread and affect others. Just a little food for thought.

I'm all for regulation, I just want to make it effective. Whether regulation or recommendations or institutions, etc. they need to be both practical and effective. If we had public healthcare, would those same employees follow procedures? Or if we had less healthcare red-tape in other areas (either by institutionalizing it or liberating it), maybe administrators could focus on other outcomes besides just navigating financial/legal nightmares.

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I don't understand. Are you claiming that despite each specific intervention causing a reduction in accidents and mortality, the overall effect might not exist? That does not seem particularly plausible to me. There might be more cost-effective solutions, but I can't imagine that things like stop signs and traffic lights and well-maintained roads don't reduce fatalities.

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I would think that historical evidence based on reduction in injuries and mortalities after substantial regulations were introduced (e.g. seatbelts) would be more than sufficient evidence.

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Great post!

We certainly don't do a great job of picking low hanging fruit, which is to say, of regulating from the biggest-bang-for-buck down to smaller bangs-for-bucks. You don't need to know the cause of a problem to recognize that problems with similar costs (i.e. deaths per year, QALYs adjust this result but don't change it by a large factor) deserve similar expense at addressing.

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I wouldn't presume so much. Money spent in making roadways safer (e.g. TxDot and CalDot along with federal motor regulations) are almost certainly very effective as almost every change is studied for impact either by the gov. organization or safety researchers after.

I am unaware of any studies that try to demonstrate the effectiveness of traffic patrols and traffic courts over the broad community, compared to the cost of those regulatory structures. This doesn't mean that traffic patrols at a specific point) like a dangerous intersection) don't reduce traffic accidents there.

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Get nursing matrons back in charge instead of administrators. A good matron will make sure that staff understand the negative consequences of bad catheter procedure. Specifically that the matron will tear strips of them, whether or not they have "M.D." after their name. This sort of thing was a hell of a lot less common when career nurses were in charge of nursing.

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The effectiveness of many kinds of safety regulation we have varies over three orders of magnitude (so I was taught). Good to collect a long list of these regulations (and potential regulations), and work out what makes some appealing and others not. In this case I bet it's that doctors don't want to be monitored for fear they'll be caught screwing up.

Atul Gawande talked about the issue of lists in medicine at length in the New Yorker a while back: http://www.newyorker.com/re...

He's always a good read.

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I just returned from my board of directors meeting at a heart hospital in which I am an investor. The risk control manager tells me that the hospital is not reimbursed at all for any patient who develops a methicillin resistant staph aureus (MSRA) infection while in the hospital, regardless of the total bill, and regardless of private or Medicare insurance. The hospital eats the entire expense.

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The Post article says the cost of an infection is around $30K. But this is not a cost to the hospital, it's income. If insurers, especially Medicare, refused to pay the $30K, then it would actually be a cost and the incidence of infection would probably fall.

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Don't you think it's a bit misleading to compare car accident death's and catheter deaths? Surely the loss of QALYs from an average catheter related death is substantially lower than that from a car accident.

QALYs=Quality Adjusted Life Years in case the abbreviation isn't well known.

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Besides, it's just not true that avoiding death is that important of a societal goal. I mean certainly form a utilitarian/happiness maximization standpoint it's quite strange to think that average (or time integrated) happiness keeps increasing as you extend people's life span. More likely is that after a certain average lifespan further extension either has no effect on happiness or lowers it (people become more risk averse, greater calcification as the population becomes almost exclusively composed of established figures invested in the current system/theory).

Given this background it seems totally reasonable for the government to radically prioritize certain kinds of deaths, those that we find particularly scary/sad/tragic or those that preferentially target those with the largest expectation of future societal contribution (young adults who haven't yet yielded many dividends on society's investment in them).

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Are there two types of trust - assumed trust and learned trust?

We learn to trust certain individuals or groups. We assume the trustworthy status of certain other individuals and groups.Those assumed to be trusty might be a simple matter of convenience. If you can't trust doctors to "do the right thing", who can you trust? We all have to trust someone. IT admins have to be trusted - what other option is there? Also in the case of doctors, surely their relatively high social status plays a part in our implicit trust, which again is an example of having to trust the top of any hierarchy.

Another reason might be that we have found that certain modes of behavior are good candidates for regulation, others aren't. So its a learning exercise, like learning what goods and services can be effectively banned.

I notice you didn't give an answer to your own question, Robin.

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The video claims that there are no rules. I don't think that is quite right. What it should say is that, there is no legislation of rules. The rules are conventional (Nash equilibria).

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