Unnecessary medical care is harming patients physically and financially (2015) • Hacker News Board

Re: Unnecessary medical care is harming patients physically and financially (2015)

#191

Post by tinokid » Fri, Mar 02, 2018, 4:59 PM UTC

Retric wrote: post #119

tinokid wrote: post #79

Earlier quoted context omitted.

>Heath care has gotten vastly better over time. Look at 5 year cancer survival rates for example. No. These rates are affected by more screening procedures. Some nipped a potentially fatal cancer in the bud, others just found and removed something that wouldn't have killed the person. To first order there is no change in the effectiveness of cancer treatment as compared to 50 years ago.

That's demonstrably false. Early screening is useful, but that's also a medical procedure. Really what we care about is cancer deaths at a specific age AKA what % of 15 year old people die of cancer and that really has dropped. Even beyond that the absolute rate of cancer deaths in the US peaked in 1990 216 per 100k vs 2015 at 158 per 100k. Which is a massive drop even over 1950's pre screening and younger population…

> Even beyond that the absolute rate of cancer deaths in the US peaked in 1990 216 per 100k vs 2015 at 158 per 100k. Which is a massive drop even over 1950's pre screening and younger population numbers of 193 per 100k.

Hmmm... Apply a 25 year lag. https://www.cdc.gov/mmwr/preview/mmwrhtml/figures/m4843a2f1....

>PS: Stomach cancer is flat out much less common because we understand a major cause now. Cervical cancer rates will similarly drop from the HPV vaccine.

Yes...lots of progress in infectious disease treatment, very little with cancer treatment.

Re: Unnecessary medical care is harming patients physically and financially (2015)

#192

Post by hidenotslide » Fri, Mar 02, 2018, 4:59 PM UTC

scottlocklin wrote: post #156

hidenotslide wrote: post #89

Earlier quoted context omitted.

Nassim Taleb is great at providing backward looking advice. My back got better, therefore I was right to ignore the expert advice. He has predicted about ten of the last two financial crises. I wouldn't take medical advice from a financial pundit who can't seem to go more than a day without picking a fight on twitter.

My blog making fun of Taleb used to have higher page rank than his personal website. However, Taleb is totally correct about this, and his Antifragile book is very good (though he still needs an editor). Most of modern medical science is quackery and pharma companies trying to milk the populace for profit. Trauma surgery is quite good, and antibiotics and vaccines are important. Other than that, I'm pretty sure going…

He may be right in this case, I am not a doctor and don't know the details of his anecdote. My point is that if I'm looking for medical advice from a pop science author I'd much prefer Dr. Gawande's evidence and experience based account to some half baked story about convexity.

I'm not even sure whether Taleb's style of writing is meant to communicate much at all, what's the point of all this phony formalism? http://www.fooledbyrandomness.com/medconvex

I'd like to see Taleb acknowledge at least that medical and financial estimation risks have a different character. Financial mispricing is adversarial, whereas you'd have to be more cynical than me to think doctors are always trying to get you to take the maximum care they can sell you.

Re: Unnecessary medical care is harming patients physically and financially (2015)

#193

Post by intrasight » Fri, Mar 02, 2018, 5:02 PM UTC

hestipod wrote: post #131

colordrops wrote: post #129

Earlier quoted context omitted.

Perhaps you could share the procedures so others would know to be skeptical if they are in the same situation?

The nutshell is don't ever have foot surgery unless it's to repair a catastrophic injury/trauma and there is no choice if you want to save the foot. The risk/failure rates are so high and not honestly explained. I was left with ruined joints, damaged tendons, nerve damage, and RSD that spread up my legs and affects my whole body to a degree. I was misinformed and flat out lied to and have never met someone to this da…

I had same experience with shoulder surgery. No lies nor pressure to have surgery - was my choice since I figured "it couldn't make things worse". I was wrong. I think that everyone considering orthopedic surgery should seriously evaluate the data on success rates. My plan is to wait another five or ten years and hope that the state-of-the-art is improved and then hopefully have my shoulder fixed.

Re: Unnecessary medical care is harming patients physically and financially (2015)

#194

Post by kolbe » Fri, Mar 02, 2018, 5:02 PM UTC

fpgaminer wrote: post #120

dharmapure wrote: post #38

In the book Antifragile Nassim Taleb cautions against medical care unless it's truly necessary. He argues that since so many things can go wrong in a hospital (you could get sick from someone else, mistakes could be made, etc), only go if the benefits outweigh the risks. And so if you have cancer, it's probably worth the risk. But if you have something that could just go away naturally, that's got a higher expected v…

People are _really_ bad at self diagnosing. So who's to say that the risks of going to the doctor are greater than the risks of self diagnosing? Off the top of my head I know three family members who now suffer some disability because they didn't go to the doctor for symptoms they thought were non-threatening.

Doctors are _really_ bad at aligning the interests of their patient and their employer. So who's to say that the risks of going to the doctor are less than the risks of self diagnosing?

Off the top of my head I know two family members who were murdered because they did go to the doctor for symptoms that were non-threatening, and instead received an opioid addiction and premature death.

Re: Unnecessary medical care is harming patients physically and financially (2015)

#195

Post by emodendroket » Fri, Mar 02, 2018, 5:09 PM UTC

walshemj wrote: post #78

emodendroket wrote: post #56

Earlier quoted context omitted.

Me too, but it seems like there's a hierarchy depending on what your complaint is. When I needed to schedule a follow-up post-hospital discharge they had no problem getting me in, but when I had other complaints it was see an NP or wait months.

Yes as they say that's what the receptionist is to triage patients so that the worried well or those with a cold who want antibiotics dont get seen as quickly as those of with chronic conditions

I think it's not quite the same as what Gawande describes, but a similar enough idea.

Re: Unnecessary medical care is harming patients physically and financially (2015)

#196

Post by michaelmrose » Fri, Mar 02, 2018, 5:10 PM UTC

kent13304 wrote: post #18

Sumaso wrote: post #10

Earlier quoted context omitted.

Yeah lets get rid of laws and regulations, that will fix health care prices!!! /s

It actually would. No need for sarcasm on that comment.

People seem to believe that a system is a fuction of a set of rules and initial conditions and you can modify such and arrive at different results. For example you think a free market enonomy results in a functional health care system and therefore if you institute it you get the desired result.

A system isn't a blank slate it has all sorts of existing issues and players who benefit from the way things are. Currently lots of players are profiting from the way things are.

If you removed all regulations things would start out mostly the same and players would naturally tilt things so they could give out less money and take more in.

There is no reason whatsoever to believe that individual actors would act to ensure the greater good for society even if in the large scale this would be beneficial to society as a whole including them.

A manager at a firm thinks first of what benefits himself, then his firm, then his customers, then society as a whole.

People that put aside profits for the greater profit of humanity are actually selected against by the economic principles you adore.

The health care insurance model exists to help people pool and save expenses for rare misadventures like breaking your leg.

Its unclear how in any rational world this applies to people that are signifigantly ill and need ongoing treatment with known values.

If you knew you were going to crash twice this year and every year thereafter what would your expected insurance rate be and how would the insurance model help you pay for that?

Re: Unnecessary medical care is harming patients physically and financially (2015)

#197

Post by astura » Fri, Mar 02, 2018, 5:12 PM UTC

oftenwrong wrote: post #158

This article came to mind this morning when I made my second visit to the orthopaedics department at a local hospital. The department schedules all patients for pre-appointment x-rays. That is, before the patient is even seen, before the doctor can determine if an x-ray would even be useful. On my first visit, I missed my x-ray appointment. The doctor I saw that day later said that was no problem. According to him, a…

Same thing with me when I was referred to orthopedic surgeon for a lump in the soft tissue. Before even seeing me they called me in for a pre-appointment x-ray. It was never explained to be why a lump in the soft tissue would need an x-ray. I kinda went with it because it was such a surprise but I really wish I questioned it, seems like such a waste. Especially since the doctor ordered an MRI after seeing me.

Re: Unnecessary medical care is harming patients physically and financially (2015)

#198

Post by hestipod » Fri, Mar 02, 2018, 5:16 PM UTC

maccard wrote: post #153

hestipod wrote: post #131

Earlier quoted context omitted.

The nutshell is don't ever have foot surgery unless it's to repair a catastrophic injury/trauma and there is no choice if you want to save the foot. The risk/failure rates are so high and not honestly explained. I was left with ruined joints, damaged tendons, nerve damage, and RSD that spread up my legs and affects my whole body to a degree. I was misinformed and flat out lied to and have never met someone to this da…

While I'm sorry that this has happened to you, it's not fair to pin it on foot surgery. The same can be said for the majority of surgeries. I'm not in the US, FWIW. I've a family member who has had 3 surgeries on their hand (the last 2 to repair the damage done by the first one). Meanwhile, I have multiple friends who have had various surgeries for small sports injuries that are fully recovered. The risks and failure…

I don't recall receiving any forms explaining risks at all let alone the outcomes I experienced, just consent for "the procedure", HIPPA, and "guarantee to pay them" forms etc while I had an IV in my arm and was being wheeled down the hall. I was explicitly told beforehand it was a low risk procedure and I quote "I can't promise it will improve things much but it can't make it worse and if we dont do this you will be crippled by 50." I spent years stalling and getting second opinions and got agreement with him and suggestions for other surgeries as well. NOBODY told me what could happen.

The same family and people who preached about "trusting the professionals" then turned to victim blaming (which is all too common I have learned) when things went bad and said "Why did you trust them? Take responsibility for your choices!" This was not a time when it was as easy to research doctors reputations online either and frankly it wouldn't matter because they are like Amazon reviews. People tend to look back in time and put it on the patient and say they should have been smarter, known better etc.

Re: Unnecessary medical care is harming patients physically and financially (2015)

#199

Post by dsfyu404ed » Fri, Mar 02, 2018, 5:19 PM UTC

HarryHirsch wrote: post #60

whb07 wrote: post #8

Earlier quoted context omitted.

More like, “what happens when the patient does not directly feel the financial bill and the doctor tries to charge/do unnecessary things to make more money”. This is a direct result of the laws and regulations distorting the market.

Have you heard of the high-complexity drug testing scam? It works like this: at the intake visit the physician has the patient piss in a cup and it gets sent off to a drug testing company somewhere. They run a GC/MS, and then a very substantial bill (~5 kUSD) shows up a few weeks later. It's a stroke of genius, no one is responsible. The physician says "you peed in the cup", the drug testing company says "services we…

>How is such behaviour encouraged by laws and regulations?

Because the laws and regulations create an environment where there is so tons of complexity and little transparency.

A piss test is routine. The cost does not vary and can be forecast wit 100% accuracy.

You wouldn't agree to let a mechanic charge $500 for a $25 oil change. Only a very careless person would fall for that. The current situation in medical is such that the proportion of the population who would/wouldn't fall for that scam is flipped.

Re: Unnecessary medical care is harming patients physically and financially (2015)

#200

Post by Retric » Fri, Mar 02, 2018, 5:24 PM UTC

tinokid wrote: post #191

Retric wrote: post #119

Earlier quoted context omitted.

That's demonstrably false. Early screening is useful, but that's also a medical procedure. Really what we care about is cancer deaths at a specific age AKA what % of 15 year old people die of cancer and that really has dropped. Even beyond that the absolute rate of cancer deaths in the US peaked in 1990 216 per 100k vs 2015 at 158 per 100k. Which is a massive drop even over 1950's pre screening and younger population…

> Even beyond that the absolute rate of cancer deaths in the US peaked in 1990 216 per 100k vs 2015 at 158 per 100k. Which is a massive drop even over 1950's pre screening and younger population numbers of 193 per 100k. Hmmm... Apply a 25 year lag. https://www.cdc.gov/mmwr/preview/mmwrhtml/figures/m4843a2f1.... >PS: Stomach cancer is flat out much less common because we understand a major cause now. Cervical cancer r…

Lung cancer has not changed overall numbers all that much from 1990. https://seer.cancer.gov/statfacts/html/lungb.html So, no it's not responsible for the massive drop in cancer deaths by age group.

I included HPV and Stomach cancer in a PS specifically because they are minor changes to overall numbers. Sunscreen also impacts the rates people get cancer, but it's a very minor effect.