A group of health policy researchers, including Aaron Carroll, write about US health care costs and evidence-based medicine, debunking common medical myths.
HN commenters recommend Aaron Carroll's series on why US health care is so expensive, and cite its posts on prevention and cost-effectiveness.
>You don't seem to attach much value to the lives of the elderly and those who have underlying health conditions. I presume that's because no one you care about, including yourself, is in that category. That's a pretty callous attitude.
My parents are in that category, but I attach a very high negative value to using violence (or threat of it) to control people's behaviour. From my perspective it's extremely immoral to say to a huge swarth of the population: you can't work or meet your friends for the next few months, or else we'll throw you in jail if you're caught. I.e. human rights (free movement, association) are human rights; they're not compromisable just because somebody decided it's an emergency or there's some greater good that needs to be enforced. Yes it's reasonable to argue that those at risk have a right not to be infected (e.g. to require potential carriers to stay away), but this doesn't extend to requiring people they have no proximity/interaction with to stay at home and not interact with each other.
> 10 years thrown away so some people can go on a march because they're angry about someone dying.
10 years lost by one person, vs 2-3 years lost by 10 people due to the permanent negative effects on lifetime outcomes of poverty resulting from the lockdown-induced depression. Not to mention lifetime reduction in standard of living. In terms of measure that actually account for this, Quality-Adjusted Life Years, it's like the intervention is probably not a…
> In most proposed treatments the discussion is not if they are more or less "effective", the problem is that they don't work, and some of them even have side effects.
Well, in this context, whether treatments work or "don't work" is the definition of effectiveness, and whether or not they have deleterious side effects is the definition of safety. But apart from that, I'll again point out that whether or not a treatment works is determined by what results the patient considers satisfactory, and whether or not something is safe depends on what risks the patient is willing to bear; generalizations simply don't suffice here.
If the unlikeliness of a procedure's success and the nature of the possible side-effects are known, then they can be communicated to the patient so that he can decide whether the higher probability of side effects is justified by the lower probability of relief according to his own hierarchy of values. If how well the treatment works and the nature of its side effects aren't known, then no one has the relevant knowledge to make an informed decision, and it still remains up to the patient to weigh the unquantifiable possibility of relief against the equally unquantifiable risk of a bad outcome.
There's simply no way around the fact that the question always boils down to a deeply personal value judgement that no third party has the right to usurp.
> Terminal ill people are often desperate and would try whatever is trendy
Right. They're desperate…
A take from one of my favorite medical bloggers:
>Where to begin? I didn’t see any sample size calculation, nor any discussion of what they expected to see. One of the reviewers did a power calculation for them (page 37) and found that based on 90 rats per group, the power was about 14%. This means that false positives are very likely. The cancer difference was only seen in females, not males. The incidence of brain cancer in the exposed groups was well within the historical range. There’s no clear dose response. Why schwannomas? Schwannomas in other locations than the heart were not significantly different. These are rats. I don’t know how this compares to real world exposure. And one more thing – the survival of male rats in the control group was relatively low, and if these tumors developed later in life, this could be the whole reason for the difference.
>Cell phones are UBIQUITOUS in the United States. If they were causing cancer, we would expect to see rates of [brain] cancer going up, right? That’s not what we’re seeing. They’ve been decreasing since the late 1980’s. At least when we talk about vaccines and autism, the rates of the latter went up as we increased the former. With cell phones, there’s an inverse relationship. What’s going on?
I suggest reading the whole post.
Personally, I am unconcerned by this single study of rats, in groups of only 90, that found barely significant correlations out of many possible correlations looked…
> Medicaid options vary much more (and they're different in every state, because Medicaid is administered at the state level), but the equivalent private plans for Medicaid coverage also typically perform much better than the public ones.
I'd be interested to see these findings. Do you have links?
As far as Medicare Advantage is concerned, it's not the least bit surprising that patient satisfaction is higher. But I wouldn't go treating that as some kind of referendum on Government-run healthcare:
"Many private [Medicare] plans require no additional monthly premiums, yet the government pays an average of $849.90 in monthly subsidies to insurance companies for a person on Medicare Advantage, according to the Kaiser Family Foundation. That is about 14 percent more than the government spends on people with standard Medicare, according to the nonpartisan Medicare Payment Advisory Commission."
MA was supposed to demonstrate that private insurers could deliver care at lower costs than Medicare, and it hasn't done that. Basically, for every $1.00 the gov spends on a medicare patient, it pays $1.14 in subsidies for an MA patient, with the evidence indicating a lot of that goes straight into the pockets of insurers as profit [2]
[1] http://www.washingtonpost.com/wp-dyn/content/article/2009/10/14/AR2009101403953.html?hpid=topnews&sid=ST2009101403963
[2] http://theincidentaleconomist.com/medicare-advantage-cuts-once-more-with-feeling/
It seems some people have forgotten the rhetoric of the time. The opposition had a wide variety of arguments against universal health care, such as government death panels[0], increased wait times for essential care[1], government control over 1/6 of the economy, free medical care for illegals, etc. I particularly remember a claim coming out that Stephen Hawking would have died under a universal system like the NHS[2].
As such, Obama proposed the ACA as some kind of middle road[3], with the goal of having something that both sides would be in favor of, and to hold the moderates that were against single payer[4]. After the better part of a year of negotiation and multiple efforts to reach out to the opposition, the ACA was passed without any Republican votes, who then spent the following eight years running for office on the idea of repealing it (with at least 50 attempts in a four year span).
Unfortunately, the Republicans don't have any plan for healthcare themselves, resulting in a failed repeal attempt three years ago even after taking control of the house, senate and presidency.
It should be fairly obvious at this point that logical arguments for or against policies are irrelevant, even more so than they were ten years ago - and yes, a great many people would vote against it. They spent the last decade doing just that.
[0] https://www.politico.com/story/2009/08/palin-doubles-down-on-death-panels-026078
[1]…
You should probably also mention this:
http://theincidentaleconomist.com/wordpress/when-checklists-work-and-when-they-dont/
Atul Gawande is probably the foremost proponent of surgical checklists and in that article is responding to an Ontario study reporting that checklists were not significant---it sounds like a pretty bad study.
Surgeons don't particularly like checklists.
"For starters, the most controversial idea for teams to accept is perhaps the simplest item in the checklist. Require all team members say their names prior to the launch of the procedure.
"'This has been one of the most important things that help people feel comfortable speaking up' if they're unsure or unclear, for example, that this is the right patient, right site, right procedure.
"'It acknowledges that you're part of a team and are allowed to speak.'
"Gawande says that there has been resistance to accepting checklists at another level. 'The concept has forced us rethink what it means to be great at what we do. And I hadn't grasped this until I saw it recur over and over again. There's a set of values in the idea of a checklist, and they're in distinct conflict with some of the values we have in medicine.'
"'We value physician autonomy, which works well when there are just two full time equivalents providing care, but when we have 19.5 FTEs trying to make things work, it becomes a problem.'"[1]
Any of that sounding familiar?
[1]…