The Problem With Personalized Medicine 216
gManZboy writes "Talk of individually tailored medical treatment isn't pie in the sky. This approach eventually will help us address risk factors even before a disease can invade our cells, and detect preclinical disease before it gets out of hand. What role will medical informatics play in this brave new world? Hint: Little data projects may be as important as big data projects such as gene sequencing. At a recent symposium on personalized medicine, Ezekiel J. Emanuel, MD, chairman of the Department of Medical Ethics and Health at the University of Pennsylvania, questioned whether it would make more sense to target all the lifestyle mistakes that patients make rather than analyze genetic defects. His view: 'Personalized medicine misses the most important fact about modern society--little ill health and premature death is genetic, much more is lifestyle and social.' Is Emanuel a dinosaur or a pragmatist?"
Excuses sell better than solutions (Score:2, Insightful)
Everybody knows this, but medicine is a business first. Excuses sell better than solutions. End of story.
Sane (Score:2)
Re: (Score:2)
The preclinical diagnostic power suck (Score:2)
The preclinical diagnostic power suck.
That is why this is not a good route.
Diagnostics even in the clinical stage is not often very well founded, unless you have a broken leg or something to that effect. Psychological disorders are really, really difficult to diagnose with decent accuracy, and therefore should never be treated a preclinical stage.
A can of worms or a jar of pills?
Re: (Score:2)
Pragmatic, Somewhat. Maybe: (Score:2)
Part of the question is CAN it really be effectively changed by lifestyle changes over a whole population?
It's easy to say "eat less fat, and fewer calories and it will be better". We hear that all the time. Exercise more. No alcohol to excess.
But, actually getting people to follow it in a sustainable way hasn't happened in many cases.
When you have a method that well work, but you can't get people to follow, it's not very effective.
In some cases, drug interventions are more likely to be followed. Take a loo
Re: (Score:2)
Re: (Score:2)
Because though there is an illusion of freedom in the wild, lions are strictyly hemmed in by mother nature in terms of calories.
They have to compete with other predators whose territories surround theirs and the reality that they can only harvest so much food and not deplete their territory. That's why there hasn't evolved such a strong ability to limit intake. It's mandated by the physical environment in animal societies.
Do you really want a society where caloric intake is strictly regulated by physics (or
Re: (Score:2)
Re: (Score:2)
Indeed. It worked. What worked was one of the most effective ways of changing behavior there is. Fear.
But, as I mentioned in another post, just relying on fear is limited. We've been getting out the word on obesity for decades. But, it's not producing fear in sufficient amounts to broadly change behavior. Our minds adapt to the situation, and we have an amazing ability to rationalize. Those traits served well in an animal environment where calories were limited by the environment. If there was excess food,
Re: (Score:2)
First, the normally accepted definition of "obese" is stupid to begin with. This is what is considered obese by our government/medical/insurance industries: http://www.schwarzenegger.it/mro/schwarzenegger.html [schwarzenegger.it]
That's right. 100% of the time that
Go get Ayds and live (Score:2)
You can get people to take a pill a day more easily than giving up the cheeseburgers.
Then why not bring back Ayds? Unlike AIDS, Ayds was a safe and effective appetite suppressant candy that one would eat before a meal to decrease one's desire to "has cheezburger".
Re: (Score:2)
If it worked that well, it's hard to believe they deep-sixed the product rather than just change to a new name (Gee, going from "Ayds" to "Diet Ayds" didn't break the memetic connection to AIDS? SHOCKER!).
Even if true, some won't believe it: (Score:2)
"Their air will still be toxic"
In some places. Certainly better than Gary Indiana was in the early 70s. I can vouch personally for that.
"Their water will still be polluted"
In some places. But I'll take my chances with small amounts of runoff related chemicals as opposed to the old style pollutants like sewage, cholera, shigella, etc.
"Their food will still be processed with chemicals"
I'm still waiting to see this food with no chemicals. Every bit that I've seen has chemicals like sodium chloride, dihydrogen
Well... (Score:3)
I'd be inclined to say that Emanuel is neither a dinosaur(he isn't rejecting the new-and-shiny out of hand, just pointing out that much of it offers questionable bang-for-buck compared to the low hanging fruit offered by seriously boring lifestyle stuff), nor a pragmatist(y'know why people like to ignore lifestyle factors and focus on genetic whiz-bangs and hypothetical personalized super-pills? Because lifestyle intervention lies dead at the center of the intersection of "really boring", "really hard", and "lousy patient compliance".
We already have plenty of good advice to go around(by no means perfect knowledge; but we know much better than we do), largely unheeded and often coexisting with social conditions that actively work against heeding it. We don't actually have personalized genetic-super-pills(with limited but important exceptions: oncology, for instance, has a number of genetic markers that have proved tractable to test for and highly useful to know. Some rare hereditary disorders have also been well worked up. Much of the rest of it remains in the "yeah, it sure does appear to run in families; and we made this mouse model by tweaking the genes like so; but that doesn't help you very much...); but we could probably get people to take them fairly regularly if we did...
The use (Score:3)
One of the things 'personalized' medicine addresses is the 'well that's not me' factor that is in may people mind.
The reality is that a percentage of people in the population will never need to worry about cholesterol problems and the knowledge that such people exist allow others to live in the illusion that they may not have to worry about it either.
Personalized medicine will allow the Dr, to tell a person YOU need to not 'X' or you will have 'Y' happen.
The problem however is that it is always a percentage game. Some of the genes we have found so far increase a persons chances of developing a certain type of cancer by 1 or 2 %. So is that enough to warrant changers in behavior.
People who work in computers for a living already know that their carrier choice raises their cancer risk by something like 20% ( how many of them left their careers because of it though).
Part of the problem is understanding the risk ... and them excepting the consequences if they show up.
( are we allowed to do that anymore !!)
Practical advice is not what people want (Score:5, Insightful)
Emanuel is right, but experience tells us that people don't want straight-forward advice about not eating deep-fried butter or exercising more. They want to do it anyways and be saved by medicine when it catches up to them.
Pragmatically speaking (Score:2)
Now: for a quick assessment of his chances: how many of us are sitting around on our butts reading /. instead of getting some exercise?
Yeah, I thought so. Maybe the genetic screening is worth doing after all.
Re: (Score:2)
Bingo. I already commented or you'd get modded up.
Human Nature (Score:2)
It is easier to "sell" (as in commercial, or even simply convincing) some treatment against a silent potential killer in your gene, than asking you to change your habit (stop smoking, drink less, ...) for an actual killer in your lifestyle. Same thing happen for about anything: people are scared of terrorists, but do not driving or even go boozing in high criminality area.
People do not give a shit when they are in charge, so in practice, short of making lifestyle change mandatory by law, you can only rea
Orwellian Phrase (Score:2)
...targeting lifestyle "mistakes"
Doesn't that sound like a conveniently vague catch all for justifying corporate or governmental control over people?
Re: (Score:2)
...targeting lifestyle "mistakes"
Doesn't that sound like a conveniently vague catch all for justifying corporate or governmental control over people?
I'm sorry Citizen, but your statement fails to inspire happy-happy, joy-joy feelings in everyone around you.
Please remain at your present location and await a Protect-Serve patrol that will assist you by transporting you to the nearest Community Adjustment Center to modify your outlook and behavior so as to inspire happy-happy, joy-joy thoughts in yourself and those around you.
Failure to comply may result in a minimum 70 year stay at the nearest cryo-prison facility where you will be subliminally re-educat
What Personalized Medicine Is For (Score:5, Insightful)
This field is for dealing with the little ugly gaps that neither broad pharmacology nor lifestyle adjustment can correct. Take the case of antidepressants, for example: they're extremely finicky (not all work in all people) and have a huge cost in side-effects before the benefits arise. It is an extremely high cost to both the patient's health and the support system to cope with a bad choice of antidepressant. The basis of this fickleness is genetic, and running the right test in advance can prevent bad combinations.
Personalized medicine is not a cure-all, it's a very precise tool in drug design and selection. I'm sure that won't stop lazy physicians and marketers from calling the regular diagnostic process "personalized," though.
Not only that (Score:2)
But maybe it can lead to better knowledge of what lifestyle factors matter to an individual. This idea that there is the One True Lifestyle is just as silly as the idea that one drug works for all. Different people have different things they need and so on. This would be why there are those people who can drink and smoke and not exercise all their life, and yet live to a ripe old age (my grandpa is one of those). For most people, those choices are harmful, for some that matter little to not at all.
Or things
Re: (Score:2)
He's a pragmatic dinosaur? (Score:3)
Bottom line, DNA is the source code of how our bodies work. Some may think it is pretty useless at this point, but we will only truly understand its value once we understand it. Most of science works like this . . .
Re: (Score:2)
the big problem with DNA = Source code for person = Absolute Gospel on That Person is one of those simple/complex things
Even if you have source code delivered as a set of QRcodes engraved on Gold tablets by Angels you still need to worry about
1 the developers "stack"
2 the System it is run on
3 what other programs are running on The System
4 versions of various system libs installed
5 Power and other Environmental concerns
Hitlers Own Superman would still drop dead at 13 if he was not fed correctly and given a d
all jobs needs paid sick days as some places (Score:2)
all jobs needs paid sick days as some places make sick people come in to work and even with paid sick days to many boss have the suck it up idea and that just get's the full office sick. In foodservice this get's others sick as well.
Wrong question but right answer (Score:4, Insightful)
The goal of personalized medicine is to identify which genomic pattern in a population will respond to a given drug, or identify which drug will work for a given person's genome. It has nothing to do with improving public health policy and only tangentially with reducing health care costs. It has a lot to do with reducing time-to-treatment and making drugs more efficacious.
Emanuel is right that it's nuts to waste money on gene-based treatments which target only the symptoms of disease, when fixing the disease itself necessarily requires a change in lifestyle, which is something that technology cannot and will not fix. Once we accept this, the next step is simply, "How"?
All western countries are healthier than the US. Let's start by looking at what they're doing and then reward americans for doing more of that.
Deadlines (Score:2)
Dr. Emanuel's thinking seems right on this; there's evidence that "genetics only account for approximately 20 to 30 percent of an individual's chance of surviving to age 85." (see Scientific American [scientificamerican.com]) Maybe rather than provide cures, personalized medicine could be used to give people a more accurate estimate of how long they're going to live, based off various lifestyle decisions. Nothing motivates like a deadline.
False Dichotomy (Score:2)
Is Emanuel a dinosaur or a pragmatist?
Of course, the submitter left off the fact that he might be neither a dinosaur nor a pragmatist. Rather, he could be quite correct in his assessment.
Bad lifestyle is a choice, bad genes isn't (Score:2)
Honestly, if you do the things you do you've decided that the perks outweigh the disadvantages. If you decide that gorging at McDonald's is better than eating a salad, that's a choice. If you decide a night out on the down getting seriously drunk or high is worth it, it's a choice. As long as I've paid plenty money in beer taxes and you can probably chop a year or two off my pensions relative to the healthy guys to cover any alcohol related injury or illness, what business is it to anyone else if I choose t
Personalized medicin is NOT just genetics (Score:2)
I am constantly bombarded by idiots telling me things like "eat less carbs", but my personal medical issues makes eating more protien worse for my body than eating carbs.
ALL medicine should be personalized - not just for your genes, but for your particular conditions.
Re:There would be no healthcare crisis in the U.S. (Score:4, Informative)
So ban HFCS (High Fructose Corn Syrup). It's a vicious cycle - HFCS suppresses the hormone that tells you you're full, so you keep on eating more food with HFCS, further suppressing the "Hey Dummy, Stoppppp!" signal.
Pigs eat corn to fatten up. It has the same long-term effects on humans.
Re:There would be no healthcare crisis in the U.S. (Score:5, Interesting)
True, though I don't think it's just that. Any high GI food supplies you energy faster than you can use it. So your body starts storing that excess blood sugar as fat as fast as it can. And then in a little while you're craving energy again, hungry and/or tired. Basically you get sugar withdrawals.
When I tried coming off carbs out of interest, I started in the evening. I felt incredibly tired the next morning. I went out for a walk (probably a mile or two in total) and was really worried I was going to fall asleep on my feet at one point.. but then by the end of the walk I felt good. Basically I think that was because if you exercise for 30 minutes or so you start burning fat for energy rather than relying on stuffing your face. Now I only eat "whole" carbs like brown rice and wholemeal bread/pasta/noodles/whatever. They don't give you the same sugar rushes and cravings that put your body on a chemical rollercoaster.
Re: (Score:2)
Re: (Score:2)
Re: (Score:2)
Well that's interesting about the GI of HFCS, but protein makes you feel much more full compared to carbs, certainly when comparing calorie-for-calorie. And since whole carbs, protein and fat takes longer to digest and absorb than refined carbs, they leave you feeling fuller for longer, without any rapid changes in blood sugar (which results in mood swings.. and more "comfort eating", rinse, repeat..).
Re: (Score:2)
You don't have to drink pop. There are plenty of beverage choices that do not involve any form of sugar. We as people decided that we like pop so we drink it and companies cater to our whims. If YOU don't want to drink HFCS, then don't. Don't ask the government to force me to conform to what works for you. If there was one lifestyle and diet that worked for everyone, there would not be thousands of "lose weight fast and stay healthy on this brand sparkly new diet/pill/workout!" products.
My mother-in-la
Re: (Score:2)
It's government intervention that has put HFCS into so many different products. Corn growing in the US can be done below cost because of government support, this keeps the cost down and that means that it gets stuffed into almost anything. Just about anywhere outside the US the idea of using corn syrup instead of sugar (cane or beat) would be crazy. If the government intervened less in farming then you'd see HFCS (and corn farming in gene
Re: (Score:2)
Re: (Score:3)
Re: (Score:3)
yup, but you are not alone.
Sucrose is a glocose and fructose molecules stuck together. It is rapidly decomposed in the body into.... Glucose and Fructose. So... your body turns sucrose into HFCS. In fact, HFCS was formulated to be similar to sugar that way...on purpose.
So... HFCS is exactly the same as sucrose for most purposes.
However, GI is not the whole story. I highly recomend Lustig's talk on fructose as a poison for a more in-depth discussion (find it on youtube).
Short version.... carbs mostly degrade
Re:There would be no healthcare crisis in the U.S. (Score:4, Insightful)
Re: (Score:2)
The flipside is the high import tariff on cane sugar, which has it's roots in politics, and trade protectionism.
It's astounding how politicians go on about the invisible hand of the market solving everything*, and then putting it in handcuffs. Sugar import tariffs being one of those things. If the domestic price of sugar in the USA wasn't double the global price, HFCS wouldn't have ever gained the foothold that it has, and perhaps corn farming might have been replaced by some more productive use of the land
Re: (Score:3)
Just to throw a little fat into the fire, many of those politicians you mentioned crank about renewable energy subsidies as being "market-distorting", and had them high on the chopping block during budget negotiations. At the same time, we also subsidize the hugely profitable petrochemical industries to the tune of more than an order of magnitude greater. Yet that subsidy is "essential" and apparently not at all market distorting.
Specifically, the numbers I've heard were $13e9 for alternative/renewable en
This is just nonsense (Score:2)
This is just nonsense. You guys talk about HFCS and chemicals and hormones the way that tribal peoples talk about evil spirits. If you just say the right words and eat the "clean" foods, you'll be protected from the evil spirits and the sorcerers and the witches lurking out in the darkness.
Fructose is just fruit sugar. It's abundant in apples and pears and other fruits. Also in honey. It's not magic. It's not evil. It's sugar. Too much is bad for you, just like any other sugar or starch.
Please try t
Re: (Score:2)
In other words, take your own advice - either be rational or STFU.
Re: (Score:2)
There is a big difference between being rational and being informed. Clearly you don't understand that, as you told me to get educated and stop pushing lies, elsewhere, leading me to think that you feel there is some sort of choice to be ignorant at work here.
You have better information...fine, good, thanks for the link. Is this the one you were pointing me at because I will go read it now, but to accuse people of being irrational for not being as informed as you like to claim to be is hardly helpful.
Re: (Score:3)
Re: (Score:2)
Not true.... Cane sugar is sucrose. Sucrose is rapidly decomposed into fructose and glucose in the body. So sugar is equivalent to HFCS in every way.
Re: (Score:2)
Re: (Score:2)
Yes. Absolutely. Siege Hiel!
There is no problem that can't be solved by the heavy hand and jack booted heel of government. Fuck educating people....just ban it all. Thats totally going to work this time. Just like it did for alcohol and drugs.
Re: (Score:3)
A ban on all ingredients associated with and linked to obesity should be law.
You are proposing to outlaw almost all foods with calories in them. You can become obese eating almost any energy-dense food -- about 90% of all foods.
Re: (Score:3)
Indeed. Back in the 50s they started telling the world that all fat was unhealthy. People started eating low fat foods, and instead going nuts with sugary drinks/foods, refined carbs and fries. I hate when something says "low fat!" on the front, but it's like 50% sugar. Who cares about the fat content then?
Read up on Ancel [healthimpactnews.com] Keys [proteinpower.com] and the Seven Countries Study if you want to see where the idea that fat is bad came from.
Re: (Score:3)
Indeed. Back in the 50s they started telling the world that all fat was unhealthy. People started eating low fat foods, and instead going nuts with sugary drinks/foods, refined carbs and fries. I hate when something says "low fat!" on the front, but it's like 50% sugar. Who cares about the fat content then?
Yogurt is perhaps the biggest offender on that list. Real natural yogurt usually has a fat content somewhere between 4.5% and 6%. It may be higher, but it is difficult to actually make the yogurt with lower fat content, because it doesn't have the critical mass needed to thicken into something you can eat with a spoon. When you see a yogurt with 2% or lower fat, it's thickened by adding corn starch after the fermentation is completed.
And as others have pointed out, the corn starch and related sugars don't t
Re: (Score:2)
There's a saying for that: (Score:3)
"If a frog had shock absorbers, it wouldn't bump its butt when it hopped."
Easy to say. It's proved more difficult to actually get people to lose weight.
Re: (Score:3)
Lets distill it down even more. Fear is often what motivates.
Not surprising. That's how we evolved. Fear kicks in and we move.
But, as I mentioned in another post, slowly changing things like weight and lifestyle don't raise fear in and of themselves.
Regardless of how much it makes sense, you have to find a way of getting people to actually go along with the lifestyle changes. And that's not always easy to do in a way they won't consciously or subconsciously rebel against.
Having everyone get diagnosed with l
Re: (Score:2)
Should be "certainly not implying".
Gah, mornings.
Re: (Score:2)
Not surprising. That's how we evolved. Fear kicks in and we move.
But, as I mentioned in another post, slowly changing things like weight and lifestyle don't raise fear in and of themselves.
It's funny looking at it that way. I recently started exercising regularly; and by recently, I started "exercising" by taking daily walks with my girlfriend in October, about a mile or so, but they got longer as time went on. As it gradually grew Too Fucking Cold(TM) to walk outside at any time of day (yay, Ohio!), we began following exercise videos. I'm between 3-4 days a week, but I'm trying to bring myself to 6. My goal is to be in good enough shape to start P90X by March. It's a shitty realization
Because we'd all live forever? (Score:5, Interesting)
1) People who can't afford it and therefore suffer. This includes accidents, communicable diseases, etc. that aren't much dependent on obesity.
2) Huge amounts of resources spent (about half of all healthcare spending) on dragging out the process of dying for people who are, one way or another, going to die soon anyway. Most of them are geriatric patients with incurable progressive conditions: metastatic cancer, congestive heart disease, Alzheimer's, etc.
Better lifestyle practices will give us longer, healthier, and for many of us happier lives. They won't make us invulnerable nor immortal. They won't keep our families from bankrupting themseves trying to add one more week of misery in ICU when our time comes.
Re:Because we'd all live forever? (Score:5, Insightful)
2) Huge amounts of resources spent (about half of all healthcare spending) on dragging out the process of dying for people who are, one way or another, going to die soon anyway. Most of them are geriatric patients with incurable progressive conditions: metastatic cancer, congestive heart disease, Alzheimer's, etc.
Better lifestyle practices will give us longer, healthier, and for many of us happier lives. They won't make us invulnerable nor immortal. They won't keep our families from bankrupting themseves trying to add one more week of misery in ICU when our time comes.
Precisely. The biggest reason we spend twice as much [reuters.com] as other countries on healthcare, yet find ourselves in the company of some third-world countries in outcomes, is that we blow horrible amounts of cash on unnecessary (read CYA for lawsuits) tests and ignorant "futile care" that tortures the dying in order to extend their lives a few months. More here: http://zocalopublicsquare.org/thepublicsquare/2011/11/30/how-doctors-die/read/nexus/ [zocalopublicsquare.org]
Re: (Score:2)
we blow horrible amounts of cash on unnecessary (read CYA for lawsuits) tests
And in Texas, we got tort reform and discovered what's really going on is that "we blow horrible amounts of cash on unnecessary (read doctor gets paid per test) tests" http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande [newyorker.com]
Re: (Score:2)
The really sad thing with the heroic medicine at the end is that it often hastens the end and the majority of the time it destroys the quality of life. I would rather have 8 good months at the end than 12 terrible months.
And you're doing -- what? -- about that? (Score:2)
You have, right?
I doubt it (Score:3)
One day, you might be fighting to stay alive too (or maybe you don't think so - but maybe you'll change your mind in 50 years' time).
If I'm still alive at 110, I doubt very much that I'll be all that stressed out about checking out. Plenty of family members have gone peacefully when they got tired of living -- including my maternal (step-)grandmother who basically just withdrew until she shut down and my paternal (step-)grandmother who lived to 97 and got tired of burying children and grandchildren. I think my mother is headed that way soon.
So be it. Give me a good view out over the Rio Grande and some (great-)grandchildren in the h
Bad things (Score:2)
Wow, you're absolutely terrible if you think this is a bad thing.
I obviously wasn't clear. FWIW, I have legally-enforcable advance directives (not to mention some kids and a mistress who have heard me rant about it for years) to make sure that nobody can spend what I've saved for my grandchildren on useless ICU charges.
Not true (Score:5, Insightful)
An insurance model for delivering healthcare works for disasters and a one time end of life expense. It breaks when you're using healthcare for maintenance. The thing anyone without socialized medicine is, unless you're so rich you can drop $10k/mo, you don't really have healthcare. Because as soon as you need it, I'm mean you're really going to use it and use it regularly, your insurance provider is going to take it away. That's why America socialized medicine... for the elderly. But even they're going to lose it soon. Just you wait. You think it's there, but it's not. And by the time you realize it, it'll be too late. Poverty will crush you and you won't matter any more. You'll just fall by the way side.
You're being silly (Score:2)
Re: (Score:2)
Re: (Score:2)
Re: (Score:2)
and the average age could be rolled back as well. Much of the 'crisis' is due to a much older population needing more help to stay healthy.
An effect of the legalization of contraception.
Re: (Score:2)
Not likely. It would probably mean that we'd be spending those dollars on other health care services. The reason why health care is so expensive in the US comes down to a few things. One, for profit entities in the system, that profit does jack shit for patients that can't afford coverage because it's expensive. Two the fact that you could get sick and then have your insurance dropped over a technicality or not renewed. Third the lack of preventative care that has been endemic in the system over the decades
Re: (Score:2)
That would be true if there was a healthcare crisis in the U.S.
But there is a healthcare crisis, pharmaceutical companies, HMO's and political busybodies keep putting their noses where they don't belong. Healthcare for profit is not healthcare for the individual. The Hippocratic oath says,
"Do No Harm',
however, doctors follow the hypocritic oath that says,
"Do No Harm to the profits of corporate pushers and their questionable (at best) drugs".
Forcing mandatory healthcare down the throats of citizens by politicians who are bought and paid for by Big Pharma, is at bes
Re: (Score:2)
It's not unconstitutional otherwise Medicare would have been thrown out by now. If you don't want the healthcare you have options. I bet you could move to Somalia.
I have a seriously hard time imagining how people could view healthcare as a tool of oppression. Very, very few people opt out in any sort of genuine way now, and under the reform law all you have to do is cop a religious exemption or plead poverty and you're out of it. Doesn't sound very mandatory to me. And even if you don't do that, the fine it
Re: (Score:2)
National healthcare gets a better deal on drugs. You know who gets the drugs the cheapest? the VA. do you know why? volume.
SO some drug companies make some money? so what?
Re:There would be no healthcare crisis in the U.S. (Score:5, Insightful)
Give it another few years for Obamacare to come all the way online, and there may well be. ;)
(oblig. "I'll probably get modded down for this.")
Probably. The rest of the modern world all look after the basic medical needs of people, it's pretty much only the US that lets people die because they have no money.
Re: (Score:3, Informative)
Give it another few years for Obamacare to come all the way online, and there may well be. ;)
(oblig. "I'll probably get modded down for this.")
Probably. The rest of the modern world all look after the basic medical needs of people, it's pretty much only the US that lets people die because they have no money.
I came in to say the same thing Tsingi, there already is a healthcare crisis in the US, and anyone who tells themselves otherwise needs to do some research. The US has been behind in healthcare for years.
Re:There would be no healthcare crisis in the U.S. (Score:5, Insightful)
Maybe the point should be that only in the US do sick people undergo a lifetime of indentured servitude due to medical bills if they can't pay for insurance. In most other places, people don't have to bundle the choice to receive necessary medical care with the aftermath of crushing medical debt payments for the rest of their lives.
And yes, this issue does cause people to avoid the hospital until a little problem has become a big problem, in many cases fatal. Please refer back to Tsingi's "letting people die" comment. No medical system is perfect, but from my vantage point the American system is pretty messed up.
Re:There would be no healthcare crisis in the U.S. (Score:5, Insightful)
Furthermore, the ER is not the be all and end all of medical care. Treating chronic medical conditions from the ER isn't very useful nor satisfying to either the ER or patient. US FEDERAL LAW STATES ONLY THAT HOSPITALS HAVE TO TREAT PATIENTS FOR EMERGENCY CONDITIONS. Once the "emergency" is over, they don't have to treat you although it is often illegal to just dump a patient out in the street (those tend to be state laws).
And to continue - just because the ER has to treat you doesn't mean the hospital won't bill you. And try to collect on the bill.
So the stupid meme of the US has a health care for all is valid only for a very narrow definition of health care.
And yes, Virginia, there is a crisis in the US healthcare system. Not only do we NOT cover a significant portion of the population, we DO pay more to do so without any measurable benefit whatsoever.
Re:There would be no healthcare crisis in the U.S. (Score:5, Insightful)
Funnily how people will rabidly fight to preserve every egg that got a sperm in it, right up until the fetus squirts out of a woman's vagina. At that point it's either completely on its own [wordpress.com] or they actively work to kill it. [pbs.org] Right up until it comes down with a terminal illness and wants some "medical lead" to end its suffering. Then it's back to it being immoral and illegal [go.com] again.
Re: (Score:2)
Re: (Score:2)
In the U.S., if you're sick and you can get to a hospital, you will be cared for.
And that care will be based directly on the patients ability to pay. For instance, it may be in the best interests of the patient to reattach a dismembered finger or toe, but if the patient can't afford the surgery, or if their insurance won't cover it, the finger or toe ain't getting reattached, even though it's in their best interests.
It's easy to say people will get help when it's a life or death emergency because to turn people away for that would be ridiculous and inhumane. But when it's a quality of
Re: (Score:2)
I'm missing your point. She had options? Why was going home unacceptable?
Re: (Score:2)
Because her plane ticket was a week later, so her options were to be in crippling pain for a week, pay a bunch of money to move her ticket up and be in pain for a day or two while changing planes multiple times (with a 2 year old in tow), or have the traditional surgery and be bedridden for weeks (while still needing to reschedule her plane ticket, costing her more money, and still needing to figure out what she was gonna do with the two year old while she was convalescent). The option that was in her best
Re: (Score:3)
I know a lot about it because I was the one that had to get up at 2 AM to drive her to the fucking E.R. with her son in tow. I worked a night shift the night before and a morning shift the next day so I had all of two hours sleep in a 36 hour period.
The night made a bit of an impression. Between her screaming and crying, and her son crying, and no fucking sleep, I thought I was going to go fucking crazy.
Believe what you want...
Re: (Score:2)
"In the U.S., if you're sick and you can get to a hospital, you will be cared for. And you can probably hitch a ride to the hospital, with the police if no one else. "
And sign away their lives while there're at it. You obviously don't know but medical care is prohibitively expensive for people who are living paycheck to paycheck nevermind the ones already in the hole. Thanks to our current plutocracy and the viewpoint of money is life(capitalism) here in the US, no one is going to wreck their
Re: (Score:2)
My wife and I pay punitive insurance premiums. My mother deals with Medicare weekly. I'm not unaware of the problems.
We are engaging in a discussion not of how to pay for healhcare, but of what role the Federal government should play. Massachusetts did this at the state level. Should we empower our Federal government to do this?
My personal opinion is no, both because the Federal solution is certainly going to be more expensive and questionably sufficient, and it is an unconstitutional exercise. States
Re: (Score:2)
Wrong.
A) We are talking about countries with money and power. IN the group, the us is last.
B) ", if you're sick and you can get to a hospital, you will be cared for"
Wrong. If you are experiencing lige threatening emergency, you can get care for.
C) "And you can probably hitch a ride to the hospital, with the police if no one else."
That's pretty niave.
D) ". Tell people in most of the underdeveloped world that they aren't denied health care because they have no money. And step back, lest they smack you."
this h
Re:There would be no healthcare crisis in the U.S. (Score:4)
The metrics that actually matter to the people making use of the system, how more/less likely you are to die of ailment x in country y, shows quite the opposite. If you are diagnosed with any form of Cancer in the US you are more likely to still be alive after 5 years than anywhere else in the world (in some places, such as the UK, the survival rate is half of what it is in the US) and the numbers for almost every other medical problem shows the same pattern with the US being first or top three.
Total bullshit. US cancer death rates are in the middle of the pack [nationmaster.com] on aggregate statistics. Yes, the US does pretty good [webmd.com] for some cancers (for some people, most notably those with insurance), but not for all.
Nice of you not to buy insurance when you don't need it. Or don't think you need it. Most people I know don't plan on getting ill. It's not something that is on the calendar for "next year". But keep rolling the dice if you like.
Re: (Score:2)
The trouble is most people are not covered not because they can't afford it but because they naively believe it can't happen to them, they are ignorant, or reckless.
Before the affordable care act it was estimated that 25% of the people without coverage already qualified for a federal or state program, that would cover them. They simply were not participating out of ignorance and laziness.
The rest of the folks most likely could get high deductible policies that would in fact cover them if disaster struck for
Re: (Score:3)
Re: (Score:2)
If you are under 60 and not chronically ill you can save thousands every year by making use of a HSA & extremely high deductable policy
Nice of you not to buy insurance when you don't need it. Or don't think you need it. Most people I know don't plan on getting ill. It's not something that is on the calendar for "next year". But keep rolling the dice if you like.
Dude, really? Did you not read what he wrote? Or are you being obtuse on purpose? A health savings account and a cheep policy is hardly uninsured. Granted, it only works if you are emotionally capable of saving a bit of every paycheck (and use some discrimination when picking the policy).
Re: (Score:2)
2 points:
1) Survival based on hospital only counts people who could go to the hospital.
2) The US is mid to low on any real metric.
I suspect that if you count the people who could not get any treatment at all until it became 'life threatening' the US would far much lower.
When people discuss umber about health care in the US, they seem to forget that the vast majority do not account for people who can not go to the hospital or doctor because they have no money. With cancer, want's it gets to the point where y
Re: (Score:2)
If the prices weren't so entirely out of whack, most of us could go with high deductible insurance and just pay out of pocket for the rest. It's noot that people believe insurance should cover routine costs, it's that we have such a crazy scheme of billing (for example, hospitals charge several times more to patients paying out of pocket than they do to insurance companies) that people have to get their insurance involved just to avoid getting completely ripped off.
Re: (Score:2)
False.
Yep.
Re: (Score:2)
It's illegal to deny people health care because they lack insurance in the US
It is illegal to deny EMERGENCY healthcare to people. Once they're stabilized, the emergency is over and they're not required to do anything further.
Re: (Score:3)
Hurting others in their family (Score:2)
In a free society, with free association and free expression, one SHOULD be able to live badly or even kill themselves, provided they aren't hurting anyone else.
People with medical problems might be hurting others in their family. And they might be hurting the general public when they turn to crime to support a way to get healthy again, as dramatized in the 2002 film John Q.