Medical Anarchy • Hacker News Board

Re: Medical Anarchy

#71

Post by dllthomas » Fri, Mar 14, 2014, 1:15 AM UTC

kevingadd wrote: post #70

dllthomas wrote: post #65

Earlier quoted context omitted.

Given how frequently public schooling fails children, I think we should probably be somewhat liberal about permitting other options.

Liberal is great, as long as we don't completely fail the children. Going too far in the other direction and failing the children worse is a pretty shameful response. I can understand the desire to do the complete opposite of the public school system if you believe it is the source of all your woes, but it kind of defies rational logic to abandon things like objective measurements, professional training, etc.

In many areas, you're also abandoning drug dealers and metal detectors. I'm not convinced that - for some schools - simply keeping children out of those schools mightn't do more good than harm even before you start trying to educate. At which point, professional training is kind of irrelevant. Of course, for most of the children in those schools, their parents aren't very able to home-school either. Regarding objective measurements, measure away - I've no objection to measurement.

Re: Medical Anarchy

#72

Post by mattchew » Fri, Mar 14, 2014, 2:14 AM UTC

kevingadd wrote: post #69

mattchew wrote: post #63

Earlier quoted context omitted.

> And yes, there are some parents who do a great job homeschooling; I'm sure of it. I've just never met them, and I was extensively involved in local homeschooling programs back in my home town, so I interacted with dozens of homeschooling families, hundreds of homeschooled kids, and visited some of the organized conventions and programs that involved thousands more. If you have interacted with this many homeschooler…

You can bust out lazy indirect ad-hominems all you like, but we're not talking about me here, we're talking about parents failing to educate their children, which is kind of a big deal. Your hurt feelings or personal religious faith can't really justify ruining other people's futures. We're not talking about perfection here either; if someone decides to apply a different teaching style, or is okay with being relaxed…

I was talking about you, and the credibility of your views. There's lots of yelling on the internet, but most of it you shouldn't take seriously.

I do apologize to HN for helping hijack the thread.

Re: Medical Anarchy

#73

Post by eurleif » Fri, Mar 14, 2014, 2:16 AM UTC

kevingadd wrote: post #33

eurleif wrote: post #30

Earlier quoted context omitted.

>Just because they're largely minors doesn't, to me, mean that their parents have the right to deny them a future in favor of whatever their personal reasons may be. Yes, this is an infringement on the 'rights' of parents, but I don't think parents have the right to treat children like property in the first place. So the issue is that the parents are forcing a decision on the child, in violation of the child's rights…

That would be fine with me, but we have precedents establishing that minors are not well-equipped to make important decisions for themselves (at least until they're older). So I don't know if they can actually make that choice. I know a couple kids who preferred homeschooling, but mostly because it was easier than going to school. That was to their detriment later on when they started college. I don't know if that ma…

Anecdote time: I was not just homeschooled, but unschooled. Unschooling basically means that instead of my parents teaching me, I was expected to learn on my own. They provided some direction and assistance, but they weren't especially well-equipped to teach, and I was always free to choose not to learn something, which I absolutely did do out of laziness sometimes.

I got very into programming, and when I was 18, I launched a Web site which succeeded wildly, and has been paying my bills ever since. I did fine on the SAT, and I had a 4.0 GPA during the year I spent in college. (I left after that to run my company.)

My feelings on unschooling are complicated. Knowing how it turned out, there is no way I would go back in time and make my parents send me to school. But I can easily imagine alternative outcomes where I end up dying in a ditch instead of starting a company. I don't think I would ever unschool a child myself.

But since I'm happy with how unschooling turned out for me, how can I support a law denying those potential benefits to everyone else? That's essentially a law against what caused me to be who I am. I'm fairly certain that if I'd been sent to school, I wouldn't have started my company. It was the result of endless hours of tinkering -- time I wouldn't have had if I'd been busy with homework.

It's a bit like doing a startup versus working a normal job. If you do the startup, you might lose all your cash and fail; but you also have a small chance of winning big. High risk, high reward. The job will give you consistent pay, with no chance of losing your hat; but also with no chance of a big win. Low risk, low reward.

High risk certainly isn't for everyone, but imagine a world where no one ever took risks.

Re: Medical Anarchy

#74

Post by pak » Fri, Mar 14, 2014, 5:00 AM UTC

thedufer wrote: post #54

pak wrote: post #28

Disclosure: I'm currently attending medical school in New York. It seems incredibly irresponsible for a doctor to prescribe things based on an internet conversation without a physical exam. You can't auscultate (listen to with a stethoscope), visually inspect, run labs, do basic imaging, etc. over an anonymous internet forum, which are basic facilities that anybody should expect a doctor in the US to utilize. It is p…

> You could certainly offer general "advice", but this will never be a substitute for seeing a doctor. No, and I don't think anyone is arguing that. But surely its better than doing nothing, which is the alternative for people who can't afford to visit a doctor?

The increasing inequality in access to care is something that concerns me greatly because I see it all the time (I work for a free clinic that supports local residents without insurance) and I fear that it contributes to growing frustration and distrust of the American healthcare system. It is this very frustration that fuels desperate solutions like CoinMD, sketchily marketed natural remedies and insurance supplements, political bickering over healthcare.gov and the ACA, medical tourism, semi-legal internet stores for prescription drugs, ... it goes on and on.

As a commenter below put it so well, all of these responses are "a symptom of how we think about these kinds of problems being badly broken..."

Furthermore, I disagree that something is necessarily better than nothing. Wrong or incomplete advice can be much worse than no advice. Telling somebody it sounds like they have the common cold while missing out on the possibility of tuberculosis because the doc can't do a chest XRay, a PPD (skin test), run cultures, or listen to the lungs, is downright dangerous to that person and the people that they come in contact with. If a doctor then recommends the wrong drug to somebody based on incomplete information, the long term outcome can reduce or end a life.

This is why (1) medicine is already so heavily regulated (2) malpractice is such a prevalent concern among doctors and (3) it would only confuse healthcare consumers to endorse a second tier of medical care where the advice they receive might be "less right" than that of the first tier.

Here are some reasonable parallels to the dilemma you bring up:

- Plenty of people in the US can't afford to buy a car. Is it surely better to let them all buy cheaper used cars from foreign countries with crappy brakes, no seatbelts and no airbags?

- Plenty of people can't afford to buy meat as often as they'd like. Is it surely better to let them buy cheaper meat from unknown sources which hasn't been USDA approved?

Re: Medical Anarchy

#75

Post by baddox » Fri, Mar 14, 2014, 5:04 AM UTC

kevingadd wrote: post #67

baddox wrote: post #60

Earlier quoted context omitted.

> I think it's reasonable to assume that unless anyone has proven the contrary, which they haven't. I disagree. I think it could go either way, as I have no real scientifically valid evidence either way, but I think the burden of proof is on the party advocating using violence to prevent the other party from doing what it wants. > Many arguments in favor of homeschooling are about parents' religious freedom or about…

Who said anything about violence? I think it's a pretty absurd leap to go from me expressing a negative opinion on homeschooling directly to me seemingly dispatching SWAT teams to round up homeschoolers.

How then would you implement a policy that prohibits parents from homeschooling if they don't meet certain qualifications?

Re: Medical Anarchy

#76

Post by sithu » Fri, Mar 14, 2014, 5:20 PM UTC

pak wrote: post #74

thedufer wrote: post #54

Earlier quoted context omitted.

> You could certainly offer general "advice", but this will never be a substitute for seeing a doctor. No, and I don't think anyone is arguing that. But surely its better than doing nothing, which is the alternative for people who can't afford to visit a doctor?

The increasing inequality in access to care is something that concerns me greatly because I see it all the time (I work for a free clinic that supports local residents without insurance) and I fear that it contributes to growing frustration and distrust of the American healthcare system. It is this very frustration that fuels desperate solutions like CoinMD, sketchily marketed natural remedies and insurance supplemen…

The reality is that there is already, and will always be, wide variation in quality between providers and institutions. No one should expect perfection from an online service, or anywhere for that matter.

It is this kind of thinking, the fear of missing that 0.01% chance of something serious, the fear of colleagues low opinions, the fear of lawyers and persecution- that perpetuates the current culture of doing as much as possible regardless of probability, adverse events or complications of those actions. You can't cough in an ER these days without getting radiated. You can't be a little short of breath without getting a chest CT. Surely there is a line to draw.

I agree with your overall premise that there should be a minimum quality level and regulations on any service. But I am not convinced that an online doctor (or even Watson) would be any more of a 'quack' than seeing a nurse practitioner/PA in a tiny clinic in suburbia.