Just a Spoonful of Ducats

June 30, 2008 8:59 AM

Please take your meds. Here's some cell minutes if you do. Or hmm, how about a chance for $10 or $100 if you take your meds? No? Well fine - it's your funeral, and then maybe we can just give you a lil somethin to take those organs off your hands.

About the lottery:

"Employers will have to consider whether a lottery is fair, Kampa said. It could appear to reward employees who are sick and must take medication, while workers who keep themselves healthy and don't need the drugs don't even get a chance to play, she said. Another potential issue is whether a cash lottery would be viewed as a bribe to people who should have taken more initiative on their own to protect or improve their health."

About the organ donation incentives:

"Critics also worry that the prospect of even modest payments could lead patients' families to withhold vital medical information that could lead to rejection of an organ, or to prematurely withdraw care from a patient."

posted by cashman (23 comments total)

Somewhere in a business school in North America, a bright young MBA student is working on a futures market model for this.
posted by Burhanistan at 9:05 AM on June 30, 2008 [1 favorite]

Other than because of the cost to get the pills, what kind of idiot deliberately declines to take their meds?
posted by DU at 9:15 AM on June 30, 2008

Sometimes incentives can have the opposite effect from that intended.
posted by fiercecupcake at 9:29 AM on June 30, 2008 [1 favorite]

On not-preview, I'm guessing DU has never had to take anything with frightful or even just annoying side effects.
posted by fiercecupcake at 9:30 AM on June 30, 2008

Other than because of the cost to get the pills, what kind of idiot deliberately declines to take their meds?

Having a chronic illness can cause depression, and sometimes the focus of that depression ends up on the pills- especially those with side effects. I take bromocriptine for hyperprolactinemia- it's a Parkinson's drug, and one of the side effects is uncontrollable movement. If you've watched Michael J. Fox speak lately, it's not the Parkinson's that makes him sway the way he does- it's the bromocriptine.

Now imagine this: my pituitary disorder is obnoxious, but contained inside me. It doesn't affect my motion or my thought processes. But I have to take a drug that makes me sway uncontrollably, unable to hold a pen or pencil very still, to control a disorder that is obnoxious, but contained inside of me. Imagine that you're 25 years old, swaying uncontrollably, can't hold a pen, don't feel safe driving, knowing everybody's looking at you, but you have this ONE pill that makes all of that happen. Just one. And you have to take it.

Forever.

Sometimes, you simply get sick of being sick and don't want to deal with it anymore. You're tired of the drugs, the doctor's visits, the weird side effects, the inability to just *be*. You want to be left alone for a while, and that's when non-compliance often happens. Most people eventually get over the depression, or their disorder without the meds is worse than the disorder with them, and they get back on their medication.

That's what kind of idiot deliberately declines to take their meds.
posted by headspace at 9:36 AM on June 30, 2008 [14 favorites]

Oh, that kind of idiot. To be fair, I'd only looked at the TB one when I made that comment.

I actually do have some (tiny amount of) experience with the kind of thing you are talking about, having been teased for wearing glasses when I was a kid and subsequently "forgetting" to wear them sometimes. That said, for a temporary, life-threatening illness, I stand by the "idiot" thing.
posted by DU at 9:50 AM on June 30, 2008

Excellent point headspace. Another reason for noncompliance is showcased in rural India, where you can get a fairly good job driving around on your bike and visiting patients to give them antibiotics. Your job is to make sure they take them right then. The effort is to reduce the number of drug-resistant strains in the wild. When people take antibiotics without supervision, they'll generally stop when they feel better, not when the infection is completely gone, leading to drug-resistant strains.
posted by odinsdream at 9:57 AM on June 30, 2008

.... I stand by the "idiot" thing.

well, idiots *do* bring out the blue in your eyes...
posted by CitizenD at 10:09 AM on June 30, 2008

I think we should just make organ donation mandatory. You don't need your organs after you die, but your fellow living human beings do need them.

If he government can make me pay income tax and sales tax, I don't see why they can't have my organs too.
posted by jrockway at 10:09 AM on June 30, 2008

Well, I have a bit of a problem with making it mandatory. I think I should have enough of an absolute property right over my own body to prevent the government or anyone else from doing anything in particular with it after I die (except that which is necessary on public health grounds, such as some kind of sanitary disposal of the body).

What I do agree with is making organ donation opt-out and based entirely on having a special bracelet/necklace/implanted chip/etc on your person. No opt-out identifier when you die? Then your organs can be harvested for transplant. No wasting time trying to ask or convince grieving family members, no trying to find an organ donation card or driver's license. Just a quick glance at the body or a check with an RFID scanner.
posted by jedicus at 10:24 AM on June 30, 2008

I don't think organ harvesting is going to be much of a practice in a few years. Commercialized organ cloning will obviate all the problems and stigma of using someone else's guts.
posted by Burhanistan at 10:39 AM on June 30, 2008

If one is paid for his/her physical or mental labor during life, why not for what is left after death, especially if a transplant could benefit another person? On the surface it seem more reasonable than the waste of entombment or cremation. If the surgeon and the hospital are paid, why not the donor?
Anyone need a live appendix or a couple of tonsils? I will entertain any reasonable offer.
posted by Cranberry at 10:58 AM on June 30, 2008 [1 favorite]

"I stand by the "idiot" thing."
In the back of my mind I have this thought that, when I'm tired of living, I'll stop taking my meds.
posted by francesca too at 12:36 PM on June 30, 2008

The effort is to reduce the number of drug-resistant strains in the wild. When people take antibiotics without supervision, they'll generally stop when they feel better, not when the infection is completely gone, leading to drug-resistant strains.

The answer to bacteria that can resist antibiotics is more antibiotics? That's awesome. Next time I get something wrong on a test I'm just going to keep being wronger until something good happens.

Other than because of the cost to get the pills, what kind of idiot deliberately declines to take their meds?

More importantly, what kind of society decides to institute major programs of forcing people to take medicine? Today TB, tomorrow ADHD. "What are you in for? Kill somebody?" "Failure to ingest Ritalin."

And before someone says "that's ridiculous!", please come up with a hard rule for when it is okay to let someone not take a pill, when it isn't, and why everyone's private decisions are suddenly the responsibility of society at large. I don't have any problem with regulating and restricting actions that are harmful to others, but assuming you're otherwise mentally balanced, if you choose to hurt yourself, it is not the responsibility of anyone else to help you. People may help you, for sure, but it should not be a legal requirement. Modern life is already far, far too mollycoddled. Which should be obvious with all this oil whining we've got these days.
posted by Super Hans at 1:47 PM on June 30, 2008

what kind of society decides to institute major programs of forcing people to take medicine?

Please notice that this program offers incentives to encourage people to take their medications (which, as pointed out in the post, poses its own problems). It's not a program to criminalize refusal to take medication.
posted by Elsa at 3:32 PM on June 30, 2008

The answer to bacteria that can resist antibiotics is more antibiotics?

Yes. Different antibiotics.

That's awesome. Next time I get something wrong on a test I'm just going to keep being wronger until something good happens.

Okay. Don't take your antibiotics. Then lots of people can have the fun of catching something like MRSA or MDR-TB, having gotten it from you.

TB is infectious. ADHD is not.

Sometimes not taking your meds can have an effect on people besides you - like, they can catch what you have. Awesome, right?
posted by rtha at 3:45 PM on June 30, 2008

The effort is to reduce the number of drug-resistant strains in the wild. When people take antibiotics without supervision, they'll generally stop when they feel better, not when the infection is completely gone, leading to drug-resistant strains.

The answer to bacteria that can resist antibiotics is more antibiotics? That's awesome. Next time I get something wrong on a test I'm just going to keep being wronger until something good happens.

When someone stops a course of antibiotics early because they feel better, there is a chance that some of the bacteria causing their infection will have survived, in numbers insufficient to cause symptoms but sufficient to reinfect the individual. It's likely that these surviving bacteria are the ones which are more naturally resistant to the antibiotic. Soon the patient has large numbers of the resistant bacteria and can no longer be treated with the same antibiotic or, sometimes, any antibiotic.

And before someone says "that's ridiculous!", please come up with a hard rule for when it is okay to let someone not take a pill, when it isn't, and why everyone's private decisions are suddenly the responsibility of society at large.

Rule: when your failure to take a pill has a high chance of causing you to become infected with a disease which is (a) contagious, (b) lethal to some people and (c) difficult or impossible to treat, it is entirely reasonable for you to be required to take it. If you refuse, I would have no problems with you being locked up until you get better. Nothing personal.
posted by A Thousand Baited Hooks at 5:26 PM on June 30, 2008

Rule: when your failure to take a pill has a high chance of causing you to become infected with a disease which is (a) contagious, (b) lethal to some people and (c) difficult or impossible to treat, it is entirely reasonable for you to be required to take it. If you refuse, I would have no problems with you being locked up until you get better.

As someone who has wanted for some time to have all gays locked up to contain the spread of HIV, I'm glad you agree with me.
posted by vsync at 10:05 PM on June 30, 2008

But gayness isn't treated with a pill!
posted by The Castle at 8:04 AM on July 1, 2008

there's a not insubstantial part of me that thinks that people who don't want to do what they need to do to live should not only be allowed, but encouraged, to die. life can be very difficult, and having to constantly be a cheerleader for those too stubborn to find their own way can be tedious. the ramifications to society at large are not small, either. that statement stands whether you have an infectious disease or a mental disorder or bulimia or if you smoke a pack of cigarettes a day (like i do). medical costs aren't free, even in countries with socialized medicine.

there could well be a time when i'd rather die than live. i hope my decision is honored.

the remark about quarantining gay people, though ... that just blows.
posted by msconduct at 5:12 PM on July 1, 2008

Some workplaces offer employees $10 for every month they're able to kick their smoking habits; others give people lottery tickets every day they don't take a drag. But rewards and contests designed to help smokers quit aren't effective in the long term, according to a review by the Cochrane Collection, which analyzes medical research. None of the 17 studies analyzed was able to see higher long-term cessation rates from rewarded would-be quitters than from a control group. Quitters were able to abstain from smoking at a higher rate for a short period after participating in some of the contests. But researchers concluded that any positive effects inspired by the contests faded away shortly after the incentives ended.
posted by cashman at 7:00 AM on July 18, 2008

open sesame!
posted by mwhybark at 8:21 AM on July 31, 2008

Will it close at 8:59a? Stay tuned!
posted by mwhybark at 8:52 AM on July 31, 2008