Tuesday, May 21. 2013
Woke up screaming, around noon today: leg cramp, high up my thigh. My wife ordered me to stand on it. Good advice, but I couldn't find my way out from under the covers until she pulled them off. Finally swung my legs over the side, tilted out of bed and steadied myself leaning against a dresser or something. My mouth was parched, so I asked for some water. A couple sips dissolved the residue that had gummed my jaws together. I stumbled to the bathroom. The sharp pain subsided, leaving a sore knot. Put on some socks and pants, and ventured downstairs. Good thing we put that new stair rail in.
Not a typical day, but most days have something unpleasant sooner or later. The dry mouth is an everyday occurrence. Back in the winter I tried going without antihistamines, but my sinuses only got worse. Now that the skies are thick with pollen (plus whatever else the recent onslaught of storms dredged up) I'm doubling up on the over-the-counter meds. For many years I took a prescription super-dose of Allegra, but the insurance company dropped that from their formulary so we tried the loratidine and I eventually started supplementing it with benadryl. Nothing works. I haven't had a completely clear breath through my nose since 1986, on a vacation to Cape Cod.
Among the unpleasant tasks scheduled for today is another formulary problem: Blue Cross/Blue Shield [MA] and/or Express Scripts have decided that the two anti-cholesterol meds I take now require physician override paperwork, so my prescription renewal has been held up. (And because Express Scripts canceled my "auto renewal" on those prescriptions unawares to me, I'm real close to running out of both.) What they want, aside from my death, is to force all their "customers" to switch to generic atorvastatin (Lipitor), and when you look at the price tags of Crestor and Zetia you can see why. Those drugs are "protected" by patents which allow their "owners" to charge whatever the market will bear, and the pharmaceutical companies do just that, ruthlessly. Changing their formulary rules is one way that bulk buyers like Express Scripts can fight back against getting gouged, but in doing so they inflict real costs as well as hassles onto physicians and patients. In my case, to get the same results I'm currently getting will require recalibrating my statin dosage upwards -- several visits and tests -- and expose me to further side effects, not that any of those things matter to the insurer.
If I could wave a magic wand and fix one thing, it would be to get rid of patents. There are lots of bad things about patents, like how they increase the cost of innovation (obviously by involving lawyers), and how they disincentivize others from improving patented inventions, but the worst aspect is the "reward" of monopoly rights. Free markets work precisely because they are free of monopoly. One could come up with some regulatory scheme to limit patent rents: for drugs, you could assign royalties for generic duplicators, which would allow for some measure of competition around a higher cost point while still rewarding the patent holder's development efforts. But that would mostly make the patent process more political, and perhaps even more litigious. Better to get rid of patents altogether, then put public funds into "open source" research and development, which manufacturing companies could then build products on -- less potential gain, but also less cost and liability.
Patents work in various ways in other industries, but the effects are much the same: they subvert capitalism by promoting monopolies; they push research into dark secrecy, often hiding flaws until it's too late; they reduce incentives for others to offer improvements; they add legal costs, both to file patents and to defend against them; they can be assigned or sold to parasitical trolls; they lead to an increasingly inequal world where a few "owners" extort rents from everyone else. What they don't do is stimulate innovation, or even do a very good job of rewarding it. Many innovations occur to multiple people independently, and many more would if research spaces weren't so compartmentalized by corporate interests. And most patents fail to pass the basic test of unobviousness. In drugs, for instance, all it takes to get a patent is a new molecule -- something that chemists create all the time. Take away the patents, the monopoly pricing, the ridiculous marketing budgets, and all of that and you'd wind up with a world where Express Scripts had no reason to make doctors jump through hoops to get away with prescribing the drugs they regard as most fit for their patients. And that would be one less hassle for me on a day that has way too many of them.
Much of my politics, by the way, is driven by a desire to reduce the amount of unnecessary hassle I -- and by extension other people, since I figure that we're all pretty much alike -- have to deal with. One facet of this is that I don't get all worked up over "personal responsibility" -- the great bugaboo of the right. They think that people prove their personal worth by overcoming adversity, so they back policies that create a lot of it (like our current health care system, or our "education" and "justice" systems), although most of them wind up being races rigged by the rich for the rich.
Much of the day I try to process some music, and today hasn't been very productive. I woke up not only in pain but bleary-eyed, something that happens a lot. Today I have a lot of trouble copying down info from the microscopic print on CDs -- looks like my eyes will end my music review career before my ears do (although my grandfather and father lost most of their hearing by close to my age). Also had trouble concentrating: took me four plays of Christian McBride to get a little squib written down, even though the album was pretty obvious. Will Calhoun got two plays. Played Black Host twice and held it back for tomorrow. Listening to Daft Punk on Rhapsody as I write this.
One thing that slowed me down was interruptions. The HVAC guy came over for a Spring system check, so I watched what he did, thinking I could do all but the pressure test myself, and picking his mind on how to install a new condensate pump -- a project I keep procrastinating on although I've had all the parts for about a year now. Didn't start that but did knock off one little project that's been sitting around for a couple weeks. I have a little space in the downstairs half-bath between the vanity and the back wall; hard to get to, but wide enough I thought I could slip in one of those roll-out baskets they make for under-sink cabinets. I bought the unit and built and painted a bracket to hold it a couple weeks ago, but the space is so hard to reach it would be hell to secure -- and indeed it was, as every possible approach involved painful contortions. I couldn't get one wall anchor in, or get close enough to see why. (Probably hit a stud, which otherwise would have been good news.) And I left the wall side sitting loose on a pair of corner braces -- I would normally have screwed them tight but couldn't negotiate the angle. Still, pretty sure it's solid enough, so I felt like I got something done today.
And wrote this little "day in the life" screed -- more therapy for me than info for you. Some of this may just be inevitable wear and tear, but much of the hassle seems unnecessary. And the more I struggle with nuissances, the less good I get done.
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