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

#91

Post by twunde » Sat, Aug 01, 2020, 8:20 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 ?

This is actually two questions:

Why do we have for-profit vs non-profit healthcare providers in the US and does that affect how they're run? The main difference is that non-profits tend to be more profitable since they don't pay taxes, but otherwise they're pretty much the same including the high bills. They are required provide some threshold of charity care, but the forms you need to fill out differ from provider to provider.

The 2nd question is why aren't there more dual payer-provider systems? There are two big barriers, firstly you need a large amount of capital to start up either a provider or a payer system, to do both you need even more money. Secondly you need expertise in running both a provider and a payer. Over the past decade a number of providers tried adding insurance arms. Many failed. In NY, both Northwell Healthcare and Crystal Run's insurance arms were started and closed (and these are both well-run healthcare systems) [1]. What's been going on recently in healthcare is that insurance companies have been starting joint ventures with providers. Even Kaiser has struggled when expanding in new markets, especially on the east coast (they're mainly on the West Coast where they were started as a way to provide healthcare to workers at Kaiser enterprises)

[1] https://www.recordonline.com/news/20190329/crystal-run-to-pu...

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

#92

Post by libraryatnight » Sat, Aug 01, 2020, 8:21 PM UTC

arcticbull wrote: post #41

callmeal wrote: post #27

Earlier quoted context omitted.

>I'm curious about what kind of cancer masquerades as iron deficiency, an infection, and a benign tumor? The kind of cancer where the patient can be easily dismissed by the doctor because of course they know best.

"...doctor because of course they know best" is a really strange thing to say. I don't mean to invoke paternalism here -- but between a patient with Google and a doctor with years of medical training, residency and practice, they more than likely do know best. At least, better than the patient. They won't always be right, and you can ask for a second opinion, but they do know better. If they didn't, you could practic…

In some ways I do practice my own medicine and doctors are just QA. I know when I need antibiotics, or I have a strong hunch, I just need them to confirm and write the script (They do this over apps now). My GP wasn't much help with a problem I was having, so I had to track down a specialist who would listen, eventually I was found to be RIGHT, and again just needed the doctor to write the script.

Not saying they don't know more than me about the body, naming its parts and what they do, but I know best when something isn't right and the amount of doctors you have to go through to get them to admit "OK, you feel bad, something is wrong, let's have a look" and actually do something other than go through the motions is astounding.

Edit: Leaving this but kind of wish I hadn't left this comment. I had a point to make, and maybe its in here, but this just comes off stupid. Sorry.

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

#93

Post by dstick » Sat, Aug 01, 2020, 8:22 PM UTC

iskander wrote: post #26

dstick wrote: post #3

So if I summarize correctly they re-evaluated already “FDA passed” but abandoned substances for anti-cancer workings using new techniques (CRISPR) and got 50 hits. That’s amazing! Would this work in other fields as well?

That's a good summary but it's missing the context that these kinds of "hits" will most likely fail clinical trials. Many drugs look good at this stage in preclinical development and almost none of them show both safety (ph1 trial) and efficacy (ph3 trial). There aren't actually that many low hanging therapeutic fruit out there, mostly we have to actually do the work to discover new mechanisms and make new compounds…

It read like that would be different here, using the new method, wouldn’t it? Or did I misunderstand that?

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

#94

Post by pilsetnieks » Sat, Aug 01, 2020, 8:23 PM UTC

namenotrequired wrote: post #88

xenospn wrote: post #69

Earlier quoted context omitted.

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

He said some

Which? Because without specifics it's just casting aspersions on the whole concept of universal healthcare. Especially since a major part of OP's point was about costs and insurers.

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

#95

Post by romanoderoma » Sat, Aug 01, 2020, 8:26 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…

the state of healthcare in US is absolutely horrifyng

How is that even possible that there's a place on earth where middle level engineers are paid 6 figures salaries but as a society they don't care if someone dies in a hospital bed over insurance legalities is completely maddening to me

it's one of those things that I will never understand and accept as normal

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

#96

Post by dstick » Sat, Aug 01, 2020, 8:27 PM UTC

_jahh wrote: post #25

ne01 wrote: post #23

There is a tendency to fight our way out of every problem. But what we truly need is to accept the problem, take responsibility and look for the root cause. That is true “fighting”. But most try to destroy the symptoms so they can continue their path and usually continue the root cause. Of course finding the root cause is not easy and it takes one to study oneself I highly recommend the following book to everyone (in…

while I'd be the last to say root approach should be discounted (diet, lack of exercise, smokes, and bad sleep contributing more to bad outcomes that just about anything else), I worry that the thinking in this post can be used to judge people who have cancer for their actions when unfortunately the true root cause for many people is actions taken long before they're born because of environmental exposure. So while y…

Agreed, and even then, doesn’t cancer “just happen”? There’s a BRCA2 gene defect in my family (that I’m lucky enough not to have inherited) and that increases the likelyhood of developing breast cancer to 80% for women and prostate cancer to ~20% for men. But to the best of my knowledge, everyone has an innate %, just by virtue of being alive.

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

#97

Post by TaupeRanger » Sat, Aug 01, 2020, 8:27 PM UTC

Frankly, the title is absolutely idiotic. This article describes a way of studying drugs that have already been approved by the FDA for other indications as potential cancer drugs. A vast majority of these drugs will fail or do no better than current treatments which involve butchery and poison. The article is basically worthless and I have no idea why it has even a single upvote from this community. None of this has been shown to do anything for patients.

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

#98

Post by TaupeRanger » Sat, Aug 01, 2020, 8:28 PM UTC

iskander wrote: post #21

Drug repurposing for cancer is a neat and vaguely plausible idea that's been eating up attention and grant funding for a decade now, without any successes in clinical trials.

Precisely. The title is frankly appalling.

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

#99

Post by raffraffraff » Sat, Aug 01, 2020, 8:32 PM UTC

xenospn wrote: post #69

bserge wrote: post #67

Earlier quoted context omitted.

> 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.

It's not that simple. Sometimes you go to two or even three doctors and they don't take your symptoms seriously. "A mild cough is nothing to worry about, lots of people have mild asthma and don't realise it, have an inhaler", "Everybody gets headaches, it's not abnormal", "Your blood results are perfect", "The X-Ray came up clear". You end up feeling like a hypochondriac. Most of the time the doctors are right. Twice in my life I was convinced that something was very wrong (and thankfully it wasn't)

Of course, sometimes the doctors are wrong.

In the last year I lost my sister and our dog to cancer. In both situations, cancer want diagnosed at first. In the case of my sister, the doctor assumed "women's problems" - irregular bleeding, bloating, cramping etc. But the diagnosis came pretty quickly afterwards because it was a very aggressive cancer that soon triggered blood clots, fluid on the lungs and a bunch of other stuff. They could do nothing for her, and catching it earlier wouldn't have helped. It ate through her in about 6 months. The oncologist was up to date on the latest treatments and was discussing her case with the world's best (because she was only 44 and had just had a kid, they did everything they could).

With our dog, there wasn't a diagnosis for weeks, while he gradually deteriorated. We have an amazing vet, but nothing showed up in tests (blood work, x-rays, physical exams). The only hunch we had was that pain killers seemed to ease his breathing issues - so we took him to get an MRI and found it. We choose to spare him from the pain (he had a very happy 10 years, and wasn't the type that could handle chemo and operations - it would have been incredibly selfish to put him through it for... What, maybe 12 months of health before it comes back?)

Thing about cancer: sometimes it's treatable and sometimes it's not. I have a whole new respect (read: "fear of") cancer since last year.

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

#100

Post by trynewideas » Sat, Aug 01, 2020, 8:37 PM UTC

cmrdporcupine wrote: post #79

trynewideas wrote: post #60

Earlier quoted context omitted.

Internal squamous cell carcinoma originating on an ovary. It never "masqueraded", it was just the kind of thing that causes a person to complain about uterine pain, which in turn causes every doctor they seek help from to apparently turn their brains completely off and blame it on either a UTI or menstruation. The more detailed misdiagnoses: heavy but otherwise normal periods from enlarged fibroids causing anemia, a…

Oh man, this is terrifying, and here's the thing... how many of us or our partners start having erratic or 'strange' periods in the pre-menopausal, mid-40s, etc. points of their life? It's happening for my wife -- extremely short cycles, sudden intense periods, etc. and the doctors are kind of like "well this is within the bounds of normal"; not the exact same set of problems as you describe, but some overlap... but…

> Do you have any advice on the kind of testing that _could_ have diagnosed your partner's situation earlier?

I'm not a doctor, but in our case squamous cell-specific antigen tests. And they won't be effective unless the tumor is already relatively advanced.

Barring that, abdominal imaging and an ovariectomy, which is what we eventually got ordered -- as noted the challenge was getting my partner's uterine pain taken seriously enough to warrant a referral for imaging, then fighting the insurance company to get prior approval in a timely manner.

Toward that point, it would help to measure the amount of bleeding as best as you can, just to have a baseline, and also to frame as precisely as you can how erratic her cycles have become. My partner used period tracking apps to collect frequency and length data, and kept their own log to measure relative intensity and the amount of blood. A menstrual cup was key to the latter, and it was a big adjustment to switch to one, but wound up being the empirical data needed to take the pain complaints seriously.

If you want to dive into some literature, a 2014 study [1] does a good job describing the relationship between ovarian cysts and ovarian squamous cell carcinomas. I can't stress enough that my partner's condition is rare (in this study, 4 out of 6,260 MCT patients), but not unheard of, and I can say at least from personal experience that this six-year-old assessment of it hasn't really changed:

> Since there is no definite symptom or sign, even in radiologic imaging, it is challenging to preoperatively diagnose ovarian SCC arising from MCT unless the tumors are advanced-stage. Thus, most cases reported to date seem to be diagnosed by postoperative histopathologic analysis. However, an unexpected diagnosis of tumor malignancy during surgery may interrupt performing complete surgical management at that time, which can adversely affect prognosis. Moreover, it is well recognized that SCC-MCT has a poor prognosis, and no standard treatment is available because of its rarity. ... More evidence supporting these strategies for the management of SCC-MCT by large, multicenter studies is required.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4124088/