A government run by idiots

There is increasingly little doubt that this is a government run by idiots. Yesterday, Kevin Drum highlighted this piece by Mark Kleinman:

The Office of National Drug Control Policy is working hard to make sure that opiate addicts keep dying of overdoses. At least, it's hard to put any other interpretation on this story:

Public health workers from New York to Los Angeles, North Carolina to New Mexico, are preventing thousands of deaths by giving $9.50 rescue kits to drug users. The kits turn drug users into first responders by giving them the tools to save a life.

[snip]

The nasal spray is a drug called naloxone, or Narcan. It blocks the brain receptors that heroin activates, instantly reversing an overdose.

Doctors and emergency medical technicians have used Narcan for years in hospitals and ambulances. But it doesn't require much training because it's impossible to overdose on Narcan.

[snip]

New data compiled for NPR by researcher Alex Kral of the consulting firm RTI International show that more than 2,600 overdoses have been reversed in 16 programs operating across the nation.

[snip]

John Gatto, executive director of the Cambridge program, says such dramatic results are unusual in the world of substance abuse treatment and prevention.

"In the work that we do, oftentimes the results are very intangible," Gatto says. "This is amazing to be involved in something that literally can save people's lives. Why wouldn't we do it?"

But Dr. Bertha Madras, deputy director of the White House Office on National Drug Control Policy, opposes the use of Narcan in overdose-rescue programs.

"First of all, I don't agree with giving an opioid antidote to non-medical professionals. That's No. 1," she says. "I just don't think that's good public health policy."

Madras says drug users aren't likely to be competent to deal with an overdose emergency. More importantly, she says, Narcan kits may actually encourage drug abusers to keep using heroin because they know overdosing isn't as likely.

Madras says the rescue programs might take away the drug user's motivation to get into detoxification and drug treatment.

"Sometimes having an overdose, being in an emergency room, having that contact with a health care professional is enough to make a person snap into the reality of the situation and snap into having someone give them services," Madras says.

Got that? Preventing thousands of deaths isn't "good public health policy" if it doesn't involve the appropriate laying-on-of-hands by the medical priesthood. Anyway, if heroin addicts aren't afraid of dying, they might keep using heroin.

Why not just go all the way and poison the heroin supply? If withholding Narcan in order to generate more overdoses in order to scare addicts into quitting were proposed as an experiment, it could never get past human-subjects review. But since it's a failure to act rather than an action, there's no rule to require that it be even vaguely rational.

And, today, the New York Times editorializes as on another health issue as follows:

How’s this for a nonsensical regulatory position?

The federal Office for Human Research Protections has ruled that it is perfectly fine for hospitals to use checklists to remind doctors and nurses to wash their hands and follow other sanitary procedures — provided the goal is to improve the quality of care given to patients. But if those hospitals want to analyze what impact the checklists might have in reducing infections, that counts as research and they must first seek approval from institutional review boards.

These review boards were set up to protect patients from being harmed — by risky drugs or treatments — in the course of medical research. Seeking approval is a cumbersome process that could delay studies for months. Surely, as the nation’s health care system works to reform dysfunctional practices, this makes no sense. The rules intended to protect patients could instead slow organizational reforms that would benefit the patients.

This bizarre outcome came to light when Johns Hopkins researchers coordinated a study of whether bloodstream infections acquired in intensive care units could be reduced if doctors and nurses followed common-sense procedures to wash their hands, wear sterile garb and wash a patient’s skin with antiseptic before inserting a catheter. The results in 67 cooperating hospitals in Michigan were astonishing. Infection rates dropped by two-thirds, and the procedures saved an estimated 1,500 lives and almost $200 million.

Then an anonymous critic complained to federal regulators that the study had not been approved by an institutional review board and had failed to obtain the informed consent of human subjects. The Office for Human Research Protections, a unit of the federal Department of Health and Human Services, forced Johns Hopkins to suspend further research until review board approval was obtained. It stressed that hospitals were free to follow the procedures if the goal was to improve patient care, and they could even monitor their infection rates. But once a research component is added, federal laws and regulations require that human subjects be protected by review board oversight.

Q. Average IQ of a Bush appointee? A. 20