zadig

Yeah, the advantage of PP is that (1) they are specialized and (2) they have a large patient volume that allows them to negotiate medical products in bulk. That allows them to provide reproductive health care cheaper and more efficiently with just as good if not better patient outcomes than any other service.

You can't seriously think that US doctors want to keep their patients sick.

That's because people in general, probably you too, are willing to take the tradeoff for resolution of acute problem over long term consequences. Most people are willing to pay for expensive cancer treatments even with the socioeconomic consequences because the alternative is death. Now whether they should or not is a different discussion altogether. Every medical intervention has associated risks and side effects - from the most routine blood draw to a simple laparoscopic hysterectomy to the antipsychotic to treat your schizophrenia. We are willing to take those risks because we decide that it is worth it.

And I would be careful to not make sweeping generalizations about how mainstream medicine makes chronic problems worse. First, most chronic problems are due to population and socioeconomic determinants of health that are often well out of the scope of healthcare providers at least in the inpatient setting. Second, even with chronic problems we have made advances: think about insulin for diabetes, antihypertensives for blood pressure, or statins for heart disease.

All this talk of 35 vs 45 hours a week makes me sad that medical residents are clocking 80 hours.

> But how often does that occur? And is it worth the economic cost of not having doctors available, or doctors overworked? Individual human life is cheap.

As someone currently in medical school, I'm going to have to agree w/ the previous comment that often "simple" cases are not so simple. For dealing with something as simple as diarrhea, you have to understand the anatomy of the GI tract, the physiology of nutrient absorption, pathophysiology of different diseases, important details about infectious causes (i.e. toxins, mech of transmission, etc.), labs, clinical presentation, associated phys/pathophys like neurological, immunological, and hematological features, associated symptoms, common patient histories, drugs and their mechanisms of actions, etc. etc. etc. The sheer volume of knowledge that you need to know and how everything fits together is something I hadn't realized before coming to med school. Plus, you have to learn clinical skills like how to take a patient history, do a physical exam, etc. all of which is only for treatment of diarrhea. Now imagine learning all of this for topics as wide ranging as all the different cancers, heart failure, emphysema, diabetes, all the different congenital defects, etc. You also have to know how to read radiology, how to intubate, draw blood, perform disease-specific tests, maybe learn how to do surgery, etc. Anyway, the point is it takes a lot of skills and concepts for a fully trained doctor to work up simple things.

What I find funny about this example is that at first I thought the "it happened" argument was going to be used in defense of the person doing the stabbing. Which, of course, it could.

While it is true that end-of-life care costs are indeed out of control, to say that there is a "strong profit motive" for keeping terminally-ill patients alive seems to me a very, very cynical view.

I think the point the previous commentator was trying to make is the distinction between the 'tech industry' a la Silicon Valley versus other industries - and it would be unfair to credit the former with any innovation in the latter. Pretty much every industry since we have invented fire has grown through advances in 'tech'. So what makes a firm a 'tech' firm - in this day and age it's hard to say, and I'm not sure if it's a useful exercise.

I'm feeling incredibly bearish on this one. The central nervous system is not meant to be trifled with.

There are way too many questions here. What's the evidence for this? Two papers by two of his collaborators? How are neurons that have already degenerated in the brainstem due to the Werdnig-Hoffmann Disease going to be rescued? How is he going to reconnect different pathways between the brain and spinal cord if they have a different spatial distribution? So is the patient going to have the immune system of the donor body - if so, what does that mean for the head? What evidence is there that the visceral organs are going to be correctly modulated by the brain? What's going to happen to his collaborator's monkeys in a couple years?

The problem with self-administration though is misinterpretation. Not to mention that the logic of cheapness/convenience -> more data -> better health doesn't always hold. The more features you screen for the higher the chance of false positives, and most people don't know how to put correct readings into medical context.

There is actually now a LOT of interest in the biomedical community for circulating tumor DNA - a quick Pubmed search yields 3317 results and Illumina is practically throwing money at the field. You have to keep in mind that the sequencing technology has only recently become cheap and sophisticated enough for this kind of highly sensitive testing to be possible.

I think you might want to take a closer look at the developments in cancer over the past five years. Ipilimumab alone reduced the risk of death in metastatic melanoma patients by 32% - scientists used to not even want to touch the disease because it was such a death sentence. For all its faults, medical research does make progress.