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Entrenched Inefficiency

Here's a good example of how special interest groups entrench their privileged positions to the detriment of society.

Millions of people who travel between the Mid-Atlantic and the Midwest each year fight through Breezewood, Pa., a strange gap in the Interstate System. A leg of Route I-70 brings drivers north from Washington and Baltimore to plug into the Pennsylvania Turnpike and the great road network that runs west to the heartland cities of Pittsburgh, Cleveland and Chicago.
But no ramps join these two huge highways at their crossing. Instead, drivers travel an extra two-mile loop that takes them out of rural Appalachia and into several suddenly urban blocks with traffic lights and a dense bazaar of gas stations, fast-food restaurants and motels. ...
Many other drivers vent similar — often profane — anger and confusion about this notorious choke point. ...
The institute estimated that if ramps were built permitting drivers to avoid Breezewood, the trucking industry would save as much as 142,362 hours in driver time and $9 million in operating costs every year. ...
But if there were such a connection, millions of potential customers wouldn’t be funneled into Breezewood. Jim Bittner, who manages the Gateway Travel Plaza that offers fast food and gas in Breezewood, and whose family has owned businesses there for three generations, said he knew that Breezewood annoyed the people who don’t stop but that preserving it was important for this economically struggling region.
- CHARLIE SAVAGE, As Trump Vows Building Splurge, Famed Traffic Choke Point Offers Warning, NYT, FEB. 6, 2017



Here's another example:

Doctors and hospitals failed to tell the Food and Drug Administration about cases in which cancer was spread around inside women’s bodies by a surgical tool used to operate on the uterus, according to a report issued on Wednesday by the Government Accountability Office.

Scattering cancer cells worsens the disease and decreases a patient’s chances of long-term survival.

Because information was lacking, the tool, called a power morcellator, was widely used for more than 20 years before the F.D.A. acted to limit it, after being alerted to the problem in 2013 by a patient who was harmed. The device, with a spinning blade that shreds tissue, was by then being used in at least 50,000 women a year in the United States.... It had become a mainstay in minimally invasive surgery, slicing up tissue so it could be removed through tiny incisions.

But some women with fibroids have undiagnosed cancers, and morcellation can spray malignant cells around inside the abdomen and pelvis like seeds, “upstaging” the disease to a more advanced and deadly form.

Before 2013, the F.D.A. had received no reports of uterine cancers being disseminated by morcellators. But after the 2013 case, which was widely covered by the news media, reports began to pour in, and by September 2016 there were 285. Some of the women have died.

The government report points out a major flaw in the system for detecting harm from drugs and devices like morcellators: It is passive, relying on “adverse event” reports to the F.D.A. from doctors, hospitals, drug and equipment manufacturers, and consumers.

But doctors and hospital officials told investigators with the accountability office that before November 2014, when the F.D.A. explicitly stated that cancer spread after morcellation was an adverse event that had to be reported, they would not have regarded it that way or reported it. ...

In November 2014 the F.D.A. said the devices should no longer be used in “the vast majority” of women having fibroid surgery. ...

The F.D.A. knew when it first allowed morcellators for uterine surgery that there was a chance the devices could spew hidden tumors around. But the risk was thought to be small, with one in 500 to one in 10,000 women who had fibroids also having undetected cancer. Subsequent research found the risk was greater, about one in 350.

The problem came to light in 2013 when Dr. Amy Reed, then 40, an anesthesiologist and the mother of six children, had her uterus removed because of fibroids at Brigham and Women’s Hospital in Boston. A biopsy after the operation found a hidden sarcoma, an aggressive type of cancer. Morcellation had spread the tumor, transforming it to advanced, Stage 4 cancer.

Dr. Reed and her husband, Dr. Hooman Noorchashm (pronounced NOOR-chash), a cardiothoracic surgeon, have been campaigning ever since to stop morcellation, hoping to spare other women from what happened to Dr. Reed.

- DENISE GRADY, Weak Reporting System Let Risky Surgical Device Stay in Use, NYT, FEB. 8, 2017


It appears it took about a year after the problem came to light for the FDA to tell doctors not to use morcellators. With a risk greater than 1 in 500, and 50,000 uses per year, over 100 women per year are expected to have existing cancers spread, likely leading to great suffering and early death. It would seem rational to make avoiding those scores of tragedies a matter of some urgency. The problem was obvious, as was the likelihood that women would continue to die unnecessarily from cancer so long as the deadly device was used. Yet it took around a year to take the needed action. Why the delay? Why not a month? Why not a week? This inexcusable slowness provides a crude measure of the inefficiency of society. Larger organizations tend to be bureaucratic and inefficient. The government is large and growing, as it must to keep up with the growing complexity of society. Drones are invented; so drone regulations must be established and enforced; so government grows, and tends to grow more inefficient. Will it eventually grow so inefficient that the system collapses?



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