Left out in the cold

So I was up for a while reading The Siberian Curse: How Communist Planners Left Russia Out in the Cold, which is about how Russia has historically been big on colonizing the ends of Siberia, especially under the communist system, when cost was no constraint on the Great Struggle. This is a problem here in the modern day, because living in the coldest places on Earth is expensive: people get sick and die; under -15 degrees Celsius (on the Farenheit scale: cooooold), some types of steel will break.

Much of the project of colonizing the East was via prisoners who couldn't leave. One effort to get people out there voluntarily failed miserably: Birobidzhan was to be a ``Soviet Zion'', a homeland for the Jews within the USSR, where they could enjoy the privelege of not being persecuted. Here's the record [all this plagiarized from the above book]:
1928: 950 arrived, 600 left
1929: 1,857 arrived, 1,125 left
1930: 2,560 arrived, 1,000 left
1931: 3,250 arrived, 735 left
1932-3: 11,000 arrived, 8,000 left
In summary: cold sucks. This is all a modern problem, because you now have these giant cities which are fundamentally a bad idea. Further, just as we in the USA have immigration restrictions internationally, the Russians have a system, propiska, of internal migration restrictions. You're a citizen of your city, and if you want to visit Moscow, you'll need a visa. The restrictions have been especially tight in the last few years because of (can you guess!?) terrorism issues. Under the claim that it makes Moscow safer, it's become yet harder to leave Irkutsk. Economic inefficiency and human misery ensue.

But I've already had that rant, so you can fill in the blanks. No, instead, my rant for the day is about Albuterol. See, I was reading this book about the cold in my brick house, whose floor isn't quite as well attached to the wall as one would hope, so it's pretty darn cold if I don't run the oven all night. Thinking I'd be somehow safer, I turned off the oven to sleep, and then my lungs sorta stopped working.

A pal of mine in med school tells me that lungs are nothing like the schematic you see in textbooks. They're more like two slabs of blood-imbued tofu (after draining, freezing and thawing the tofu---try it!). Under normal conditions, they expand and contract normally, these slabs of tofu, but when it gets cold, my slabs become distressed. My mother ran a day-care center from her house before I started school, so you think I'd be better off, but I've always had this problem.

I also have pretty harsh allergies. I went to the U of Chicago hospital, nose streaming snot, eyes twice their normal size and bright red, just like it is every autumn, begging for medication, and they told me, `Oh, this could be any of a number of things. Let's run a blood test.' A week later, the blood test came back and established that I was incredibly allergic to pollen, like I told them I was, and I got my prescription.

Similarly, every time I came in complaining of lung problems, the doctor would tell me, `oh, take your frigging allergy medication.' And I would, and I still wouldn't be able to breathe. After about four years like this, I demanded to see a pulmonologist, who, after about twenty minutes, gave me an inhaler of Albuterol. I took a puff and my problems were completely solved.

A few weeks later, I needed a refill on my allergy medication, and called the Caltech Health Center. They wouldn't give it to me, figuring that I wasn't really allergic to anything, it was just those lung problems I'd complained of last time. Seeing red in a new and different way, I brought in my blood test results, got my prescription, and never went back there.

My impression regarding drug prescription is that 80 percent of the time, it's a no-brainer. Doctors go to school for years in preparation for that other 20 per cent. This makes for doctors who feel a desparate need to demonstrate some sort of intelligence in all cases, and who therefore characterize most drugs as more dangerous than they are; and for massive inefficiency in 80 percent of the cases.

The Spaniards have a nice system: I walked in to the pharmacy one day and told them I had the flu, they looked at me for a second or so and, using their two years or so of training in pharmacology, established that I definitely have the flu, and gave me a strip of antibiotics. Oh, what could be easier.

Some drugs are definitely more complex than others. Some drugs have weird interactions, and antibiotics have that `the more you take the less they work' characteristic. Meanwhile, Albuterol is easy. If you can't breathe, you probably need it. If you can, you're not going to bother with it. There are no Albuterol junkies. It doesn't really interact with much of anything. Its main side effect is a stimulant effect, which is a little less powerful than a can of cola---and thus the endless chatter on the box about heart issues. [Why aren't there medical warning about heart conditions on cola cans?] If I had to point to one drug that is not worth regulating, it'd be Albuterol.

So, that said, how do people deal with Albuterol in the real world? Me, I have two canisters left, and then, as they say in the medical literature, I'm dead tofu, since I don't have a prescription to obtain more, and it'd therefore be wholeheartedly illegal for me to obtain some. One day, Brandon Kivi, 15, gave his girlfriend a puff from his, since she forgot hers and couldn't breathe, and the school nurse handed him in for distributing drugs on school property. He was expelled from school, but the third degree felony charges were dropped. All this because his girlfriend was getting no oxygen to her brain and could have died if he didn't act; in her own words: "I still think he did the right thing 'cause he was just doing good and he did the right thing." Oh, I can't find links, but a kid or two have actually died because their inhaler was kept at the nurse's office.

I was really hoping this one'd go to the Supreme Court, who would maybe re-evaluate the evil that is our current drug-dispensing system. There's a strong incentive for many groups to keep drugs as mystical and incredibly dangerous potions which only a few can comprehend well enough to administer. Blurring the distinction between illicit drugs like crack and decidedly useful drugs like Albuterol (they're both stimulants!) further makes the situation seem more precarious than it is. No, drugs shouldn't all be OTC, but a system like the Spanish, where somebody with a few years of education and a modicum of common sense dispenses drugs to you, would be orders of magnitude cheaper and as safe for all but the most exceptional cases (who will probably find their way to a plain old doctor anyway). As long as we keep this up, people will die from lack of medicines which it's a no-brainer that they should have had, and society will continue to collectively suffer. Next time you get a paycheck and there's a giant social security deduction on there, you can think to yourself, `well, at least nobody will get Albuterol or insulin unless they actually need it.'