We’re a Lot Better at Fighting Cancer Than We Realized • Hacker News Board

Re: We’re a Lot Better at Fighting Cancer Than We Realized

#61

Post by petra » Sat, Aug 01, 2020, 7:08 PM UTC

ghufran_syed wrote: post #57

sacred_numbers wrote: post #47

Earlier quoted context omitted.

The incentive for all parties (except the patients) is to increase revenue, rather than decrease costs. Insurance companies may want to reduce costs on a case by case basis, but on a macro level they want to spend more, since they are required to spend 80% of premiums received on treatment. More treatment means higher premiums, which means the 20% not spent on treatment is higher. Hospitals have similar incentives, s…

It's worth noting that Kaiser is a nonprofit that is both "payer" (insurance company) and "provider" (hospitals and clinics) in the US - so I would argue that they have exactly the right incentives that you outline - maximize patient outcomes for minimal cost. So I don't think you necessarily need the government involved.

This begs the question: Why are for-profits winning over Kaiser, Why isn't the Kaiser model everywhere ?

Re: We’re a Lot Better at Fighting Cancer Than We Realized

#62

Post by petra » Sat, Aug 01, 2020, 7:13 PM UTC

inspector-g wrote: post #29

trynewideas wrote: post #5

From a science and pharmaceutical perspective, maybe. As the partner of someone in the US dealing with stage 4 cancer in their 40s, who has two hospitals fighting with each other over whether to keep using a chemo drug that's sent them into anaphylactic shock twice in two rounds of chemo because it's _more convenient_ for the infusion clinic to administer, and all of that currently held up by pre-approval from a rela…

The last bit of your comment, regarding misdiagnosis, reminds me of a recent episode of Peter Attia’s podcast The Drive, wherein he interviews an experienced oncologist. Her opinion was strong in that we are overspending in treatment research and underspending in (early) diagnosis research. Her case, as described in the interview, made sense to me and gave me some hope that at least others could benefit in the future…

The misdiagnosis problem isn't just a problem in the US, here in Israel, there's also a problem with misdiagnosis.

And our healthcare system is considered very good, and uses Single payer, etc.

Re: We’re a Lot Better at Fighting Cancer Than We Realized

#63

Post by minerjoe » Sat, Aug 01, 2020, 7:14 PM UTC

arcticbull wrote: post #43

DanBC wrote: post #31

Earlier quoted context omitted.

> Specifically, the U.S. has the best cancer survival rates in the world. This is a misunderstanding of what "5 year survival rate" means. You're missing "lead time bias", and "over diagnosis bias". From Risk Savvy by Gerd Gigerenzer --begin quote While running for president of the United States, former New York City mayor Rudy Giuliani said in a 2007 campaign advertisement:1 "I had prostate cancer, 5, 6 years ago. M…

Thank you for sharing this quote, I learned about this a long time ago and have been looking for a compelling way to make the case. People are often surprised at how ineffective early and frequent screenings can be -- depending on the disease of course. The risk of unnecessary exploratory surgery and other adverse effects of a false positive can actually add to aggregate patient risk, not reduce it.

One of my mentors was recently diagnosed with prostate cancer due to an elevated PSA test. He is 76 years old. No symptoms. His father died of prostate cancer at the age of 96. The doctors scared him into treatment (the ol' if you don't do this you might die trick) and proceeded to irradiate his abdomen damaging his nerves and causing his legs to atrophe and his outcome on life to plummet. He's just now getting around to realizing that the doctors are the ones that hurt him and he has no intention of listening to them again.

Re: We’re a Lot Better at Fighting Cancer Than We Realized

#64

Post by tstrimple » Sat, Aug 01, 2020, 7:14 PM UTC

petra wrote: post #61

ghufran_syed wrote: post #57

Earlier quoted context omitted.

It's worth noting that Kaiser is a nonprofit that is both "payer" (insurance company) and "provider" (hospitals and clinics) in the US - so I would argue that they have exactly the right incentives that you outline - maximize patient outcomes for minimal cost. So I don't think you necessarily need the government involved.

This begs the question: Why are for-profits winning over Kaiser, Why isn't the Kaiser model everywhere ?

Because healthcare isn't an elastic good with markets that observes the overly simplistic supply and demand model. It's the entire reason why pro-market capitalists are really bad at trying to solve this problem.

Re: We’re a Lot Better at Fighting Cancer Than We Realized

#65

Post by arcticbull » Sat, Aug 01, 2020, 7:15 PM UTC

minerjoe wrote: post #55

deergomoo wrote: post #30

Earlier quoted context omitted.

What an absurd and dangerous notion. It's bad enough to imply that someone dealing with the physical and emotional debilitations caused by both the disease and the treatment, not to mention secondary concerns like the effect on employment and finances, essentially isn't trying hard enough. But suggesting pseudoscience that could very well make things worse is deplorable. I'm truly glad it worked out for you, but as s…

Naturopathic medicin is not "pseudoscience". I've seen first hand friends that trusted main-stream cancer doctors and were hurt almost to the point of death. It wasn't until they turned to alternatives that they improved and survived. It doesn't take much of a history lesson to find many many examples of Allelopathic medicine causing much more harm than good. The OP details that they found out that the mechanism at w…

(1) Naturopathic medicine by and large is pseudoscience and confirmation bias. Some people with cancer spontaneously go into remission. One study found 22% of breast cancers undergo spontaneous regression. [1] This includes people taking pseudoscientific treatments. People then point to the naturopathic medicines are the proximate cure, but in reality, it would have gone away with or without. This is why we have double-blind studies that account for this, and for the placebo effect -- which is super strong, and growing stronger as our faith in medicine grows.

(2) 'You embrasing the status quo, which is demonstrably killing people daily with poisons, and calling everything else "pseudoscience" is truly a deplorable stance.'

Chemotherapies are toxic treatments, and they are toxic in no small part because we are looking to kill off specific tissue. Unfortunately few chemotherapies are totally specific, and work is being done to improve them, including delivery mechanisms. Radiation treatments obviously also destroy tissue, but again, every effort is made to improve target specificity.

(3) "...we've ever forced onto people in the chase for the god mighty dollar."

In many countries, doctors are public servants, and the government run programs negotiate hard with pharma companies to knock down prices, instead of, you know, passing them on to the "customer."

(4) "The financial incentives of the pharmaceutical companies and the medical profession do not make them work for our benefit. A cure would be a huge loss of one of the largest money making schemes ever devised."

Far be it from me to support the crazy profiteering of big pharma, however, I think you'll see them finding ways to profit from one-off cures for chronic conditions like Sofosbuvir for Hep C. They'll just charge medical systems what its 'worth' in terms of how much a lifetime supply of Hep C treatments would cost -- minus a little so the system benefits over the status quo too. In this case, $84,000. Not to mention the company that developed it was acquired for $11 billion dollars by Gilead. [2] But of course quickly after others will follow. [3] This is why patents last 20 years.

(5) "There has been good research on cancer treatements that do not destroy the immune system, nor require poisoning. A cursory scan on sci-hub for medicinal mushrooms and cancer yeild a hundred hits [0] with much to learn from. Studies from 20 years ago showing how taking certain mushrooms while undergoing chemo and/or radiation can greatly reduce side effects and improve survival rates."

So does fasting, no mushrooms needed. [4] But in both your studies and mine it was the "poison" chemotherapy that was treating the cancer, not the mushrooms.

The really ingenious work being done these days is finding ways to point our immune system at cancer and letting it do the hard work for us.

[1] https://en.wikipedia.org/wiki/Spontaneous_remission

[2] https://www.scientificamerican.com/article/we-now-have-the-c...

[3] https://www.theguardian.com/science/2018/apr/12/non-profits-...

[4] https://osher.ucsf.edu/patient-care/integrative-medicine-res...

Re: We’re a Lot Better at Fighting Cancer Than We Realized

#66

Post by DanBC » Sat, Aug 01, 2020, 7:16 PM UTC

arcticbull wrote: post #43

DanBC wrote: post #31

Earlier quoted context omitted.

> Specifically, the U.S. has the best cancer survival rates in the world. This is a misunderstanding of what "5 year survival rate" means. You're missing "lead time bias", and "over diagnosis bias". From Risk Savvy by Gerd Gigerenzer --begin quote While running for president of the United States, former New York City mayor Rudy Giuliani said in a 2007 campaign advertisement:1 "I had prostate cancer, 5, 6 years ago. M…

Thank you for sharing this quote, I learned about this a long time ago and have been looking for a compelling way to make the case. People are often surprised at how ineffective early and frequent screenings can be -- depending on the disease of course. The risk of unnecessary exploratory surgery and other adverse effects of a false positive can actually add to aggregate patient risk, not reduce it.

Gerd Gigerenzer is pretty good, and he has a few books.

There are also the "fact boxes" and "icon arrays" on this site: https://www.hardingcenter.de/en/early-detection-prostate-can...

Re: We’re a Lot Better at Fighting Cancer Than We Realized

#67

Post by bserge » Sat, Aug 01, 2020, 7:21 PM UTC

trynewideas wrote: post #5

From a science and pharmaceutical perspective, maybe. As the partner of someone in the US dealing with stage 4 cancer in their 40s, who has two hospitals fighting with each other over whether to keep using a chemo drug that's sent them into anaphylactic shock twice in two rounds of chemo because it's _more convenient_ for the infusion clinic to administer, and all of that currently held up by pre-approval from a rela…

> a cancer that had been misdiagnosed as an infection, an iron deficiency, and a benign tumor for four months prior

It's absolutely maddening that this is not even uncommon. Doctors think they know best, definitely better than you, and will stand by their sometimes quite obviously idiotic conclusions, leaving you helpless. And in some countries with universal healthcare, it's a lot harder to just go find a better doctor. Screw the whole system. I've got more words to say, but I'll stop here.

I am sorry for what you're going through and wish you all the best.

Re: We’re a Lot Better at Fighting Cancer Than We Realized

#68

Post by arcticbull » Sat, Aug 01, 2020, 7:21 PM UTC

Alex3917 wrote: post #58

arcticbull wrote: post #52

Earlier quoted context omitted.

No, they don't. They practice first-aid. There's a big difference between slapping on a band-aid and a DIY hip replacement, or cancer diagnosis. Maybe this is a uniquely American thing and with the self-sufficiency narrative being so at the fore. I don't fix my own car because I'm not a mechanic -- I share the symptoms with a professional. I don't tell my doctor what to prescribe or what's wrong with me because I'm n…

75%+ of American adults take supplements, and that’s just one of many different self-directed medical activities that people practice.

I think you're unintentionally proving my point.

Dietary supplements largely don't work, at all, and some of them are outright harmful. They basically do nothing, at best. So 75% of America probably, er, shouldn't. This is something a medical professional might tell you if you asked them. This visualization should help you understand the magnitude of just how little dietary supplements do -- it came up here on HN a while back as an example of a beautiful visualization [1].

Most multivitamins are totally worthless unless you're eating an incredibly poor diet. There's actually an association between multivitamin use and an increase in all-cause mortality [2] with a more pronounced effect in smokers [3].

So, I re-iterate, there's a reason these people went to school to become doctors.

[1] http://www.informationisbeautiful.net/visualizations/snake-o...

[2] https://jamanetwork.com/journals/jamainternalmedicine/fullar...

[3] https://academic.oup.com/aje/article/152/2/149/87699

Re: We’re a Lot Better at Fighting Cancer Than We Realized

#69

Post by xenospn » Sat, Aug 01, 2020, 7:22 PM UTC

bserge wrote: post #67

trynewideas wrote: post #5

From a science and pharmaceutical perspective, maybe. As the partner of someone in the US dealing with stage 4 cancer in their 40s, who has two hospitals fighting with each other over whether to keep using a chemo drug that's sent them into anaphylactic shock twice in two rounds of chemo because it's _more convenient_ for the infusion clinic to administer, and all of that currently held up by pre-approval from a rela…

> a cancer that had been misdiagnosed as an infection, an iron deficiency, and a benign tumor for four months prior It's absolutely maddening that this is not even uncommon. Doctors think they know best, definitely better than you , and will stand by their sometimes quite obviously idiotic conclusions, leaving you helpless. And in some countries with universal healthcare, it's a lot harder to just go find a better do…

What do you mean? I'm from a country with universal healthcare, and you can just go see another doctor.

Re: We’re a Lot Better at Fighting Cancer Than We Realized

#70

Post by dboreham » Sat, Aug 01, 2020, 7:23 PM UTC

bserge wrote: post #67

trynewideas wrote: post #5

From a science and pharmaceutical perspective, maybe. As the partner of someone in the US dealing with stage 4 cancer in their 40s, who has two hospitals fighting with each other over whether to keep using a chemo drug that's sent them into anaphylactic shock twice in two rounds of chemo because it's _more convenient_ for the infusion clinic to administer, and all of that currently held up by pre-approval from a rela…

> a cancer that had been misdiagnosed as an infection, an iron deficiency, and a benign tumor for four months prior It's absolutely maddening that this is not even uncommon. Doctors think they know best, definitely better than you , and will stand by their sometimes quite obviously idiotic conclusions, leaving you helpless. And in some countries with universal healthcare, it's a lot harder to just go find a better do…

Long ago, I knew someone who had an undiagnosed brain tumor. Multiple Drs told her she was pregnant.