Stinking Thinking: Obama Advisor Would Reduce Suicide With Smaller Aspirin Bottles

Just when you get over the head-wagging over Mayor Bloomberg’s soft drink size restrictions, another guy proposes a new solution to reduce suicides:

Stop selling large bottles of Tylenol.

Ezekiel Emanuel, bioethicist and proponent of a voucher-based universal health care (aka Obamacare), has penned an op-ed in the New York Times asking the government to consider regulating the number of tablets in a bottle of Tylenol.  This, he thinks, is a “simple way” to reduce suicide rates.

Here’s the logic:  Emanuel, noting that some 20 percent of suicide deaths are committed by poisoning, sees “a simple way” to reduce suicide rates.

There is a simple way to make medication less accessible for those who would deliberately or accidentally overdose—and that is packaging.

We need to make it harder to buy pills in bottles of 50 or 100 that can be easily dumped out and swallowed. We should not be selling big bottles of Tylenol and other drugs that are typically implicated in overdoses, like prescription painkillers and Valium-type drugs, called benzodiazepines. Pills should be packaged in blister packs of 16 or 25. Anyone who wanted 50 would have to buy numerous blister packages and sit down and push out the pills one by one. Turns out you really, really have to want to commit suicide to push out 50 pills. And most people are not that committed.

OK, so let’s get this straight:  Emanuel is saying that a depressed guy will painstakingly analyze his options, pen a suicide note, gulp down the pills with a shot of Jack Daniels, then lie prostrate on the bed and wait for death.  But the same guy will not take time to grab a scissors, cut open fifty plastic blisterpacks, and down the whole caboodle in one final show of bravado?  “Oh, well,” he’ll think, “that’s too much trouble.”   Then he’ll get up and go to work?

I wonder whether Dr. Emanuel remembers that Tylenol and other over-the-counter pain relief products now come with a tamper-proof seal.  These days, the prospective suicidee will have plenty of time to consider his options, just trying to get into the damned bottle.

Or, failing that, he can go out and buy TWO smaller bottles, or half a dozen blisterpacks.  That is, unless Emanuel also wants to put Tylenol and aspirin and other pain relievers on the list of dangerous drugs, to be dispensed only with a prescription, by licensed pharmacist, after a background check.

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Actually, the Tylenol  isn’t the only radical societal fix proposed by Ezekiel Emanuel.  Emanuel, who happens to be the brother of Chicago Mayor and former White House Chief of Staff Rahm Emanuel, serves the Obama Administration as health-policy adviser at the Office of Management and Budget and a member of Federal Council on Comparative Effectiveness Research.  In that role, he has advocated taking a hard look at what treatments health plans should cover, and how much leeway your doctor will have in prescribing a course of treatment, and how much remedial health care seniors should receive under Medicare.

In order to achieve the cost savings which President Obama has assured Americans will come from the new health care plan, Emanuel wants to see some serious cuts in coverage.  First, he warned in the Journal of the American Medical Association (June 18, 2008), doctors will need to change how they think about their patients.  Doctors, he wrote, take the Hippocratic Oath too seriously—“as an imperative to do everything for the patient regardless of the cost or effects on others.”

According to the New York Post:

Rather than doing their best to save their patients lives and restore their health, Emanuel wants doctors to look beyond the needs of their patients and consider social justice, such as whether the money could be better spent on someone else.

Emanuel, however, believes that “communitarianism” should guide decisions on who gets care. He says medical care should be reserved for the non-disabled, not given to those “who are irreversibly prevented from being or becoming participating citizens . . . An obvious example is not guaranteeing health services to patients with dementia” (Hastings Center Report, Nov.-Dec. ’96).

Translation: Don’t give much care to a grandmother with Parkinson’s or a child with cerebral palsy.

He explicitly defends discrimination against older patients: “Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years” (Lancet, Jan. 31).