5 ms·

Here's a simple algorithm that would help millions, yet it is not accessible to most patients: Ordering A1C, remembering to actually check the results, and tel

by gleb 10y ago

Here's a simple algorithm that would help millions, yet it is not accessible to most patients: Ordering A1C, remembering to actually check the results, and telling patient to stop eating sugar - well before they are symptomatic for diabetes.

chimeracoder 10y ago
> Ordering A1C, remembering to actually check the results, and telling patient to stop eating sugar - well before they are symptomatic for diabetes. Yeah, it's that last part ("telling patient to stop eating sugar" [and getting them to actually change their behavior]) that's the hard part. This is the holy grail of medicine and has been for decades. We've done billions of dollars of research over the last century, and the one clear thing we've found is that we do not know of any cost-effective way to get patients to change their behavior at large[0]. Seriously, if you really have the answer to that question, you could be a multi-billionaire. [0] That is, we can change behavior of some patients, but they're generally the patients who would have changed their behavior anyway. And we can change the behavior of some of the rest, but they're not cost-effective.
- TeMPOraL 10y ago
  If you knew how to do that, you could also solve the climate change / global warming problem, as well as host of other big social issues at the same time. As it is, people simply follow the incentive gradient, and most of the time there's damn little you can do about it.
  - neffy 10y ago
    And so it turns out once again, in every field, people really are the problem ...
  - lliamander 10y ago
    There is, of course, the (unintended?) side-effect that if there was a cost-effective way for controlling peoples' behavior then we would be effectively under the tyranny of whomever possessed those means. Sometimes we just have to let other people live with the consequences of their actions; which is hard, because often we also have to live with those consequences. Whatever we say about "other people", we should also remember that we are "other people" to somebody.
- maxerickson 10y ago
  Taxes? Like, what might be the huge negative cost of tobacco taxes? (There's an argument to be made for freedom, but you are making an economic argument about costs, not a moral one)
  - deleted 10y ago
    [deleted]
  - xapata 10y ago
    Unfortunately, taxes don't always make significant reductions of usage for addictive substances and may shift commerce towards illegal markets.
- gleb 10y ago
  Right. Patient compliance is a hard problem. But doctor compliance with basic protocols is also very bad, and seems fixable with computers.
carbocation 10y ago
That is already done at a population level, and when I was in primary care I would get notifications about patients whose A1c was overdue.
- gleb 10y ago
  Some hospitals do it, some don't. My wild guess - at best 50% of patients get it. And maybe 25% of those get it interpreted as well as you would for your family.
- Broken_Hippo 10y ago
  I've had exactly one of these tests, and that was only because the insurance I had required all employees to get a battery of blood tests drawn (or pay more each month for insurance). They planned on requiring this yearly, with plans to force folks to start meeting the metrics or pay more for insurance. I'm not sure how this panned out for them. Anyhow, if it wasn't for this, I would have never had such a test. I'm in my late 30's. My father was diabetic at my age, actually, and it runs in the family. I'm a prime candidate for preventive measures, but still nothing. Now, I understand that I go to the doctor rarely but at any one of these I could have been asked about a physical and stuff like that.
Broken_Hippo 10y ago
This would be great for diabetes patients. It might be a good early intervention measure for folks that are prone to be diabetic. But does such a test actually provide benefit to the general public? Would an otherwise heatlhy 30-year old with a bad diet fail this test - or would it only show that despite his bad diet, that his blood glucose levels have been pretty stable the last 3 months? I'm thinking that in an ordinary person with a working pancreas, it wouldn't show the spikes of diabetes. That said, I do think these sorts of things work, especially when paired with labor protection policies that allow folks to miss work to go to the doctor (or be sick). For example, once I was in the Norwegian health system, I got a letter encouraging me to see the doctor for my cancer screening (I'm female). Turns out, they want folks to get one every 3 years and keep a database to keep track of who has gotten it and who hasn't. I don't know how well this sort of thing would work in a fragmented system like the US has, though.

by gleb 10y ago

chimeracoder 10y ago

> Ordering A1C, remembering to actually check the results, and telling patient to stop eating sugar - well before they are symptomatic for diabetes. Yeah, it's that last part ("telling patient to stop eating sugar" [and getting them to actually change their behavior]) that's the hard part. This is the holy grail of medicine and has been for decades. We've done billions of dollars of research over the last century, and the one clear thing we've found is that we do not know of any cost-effective way to get patients to change their behavior at large[0]. Seriously, if you really have the answer to that question, you could be a multi-billionaire. [0] That is, we can change behavior of some patients, but they're generally the patients who would have changed their behavior anyway. And we can change the behavior of some of the rest, but they're not cost-effective.

TeMPOraL 10y ago
If you knew how to do that, you could also solve the climate change / global warming problem, as well as host of other big social issues at the same time. As it is, people simply follow the incentive gradient, and most of the time there's damn little you can do about it.
- neffy 10y ago
  And so it turns out once again, in every field, people really are the problem ...
- lliamander 10y ago
  There is, of course, the (unintended?) side-effect that if there was a cost-effective way for controlling peoples' behavior then we would be effectively under the tyranny of whomever possessed those means. Sometimes we just have to let other people live with the consequences of their actions; which is hard, because often we also have to live with those consequences. Whatever we say about "other people", we should also remember that we are "other people" to somebody.
maxerickson 10y ago
Taxes? Like, what might be the huge negative cost of tobacco taxes? (There's an argument to be made for freedom, but you are making an economic argument about costs, not a moral one)
- deleted 10y ago
  [deleted]
- xapata 10y ago
  Unfortunately, taxes don't always make significant reductions of usage for addictive substances and may shift commerce towards illegal markets.
gleb 10y ago
Right. Patient compliance is a hard problem. But doctor compliance with basic protocols is also very bad, and seems fixable with computers.

carbocation 10y ago

That is already done at a population level, and when I was in primary care I would get notifications about patients whose A1c was overdue.

gleb 10y ago
Some hospitals do it, some don't. My wild guess - at best 50% of patients get it. And maybe 25% of those get it interpreted as well as you would for your family.
Broken_Hippo 10y ago
I've had exactly one of these tests, and that was only because the insurance I had required all employees to get a battery of blood tests drawn (or pay more each month for insurance). They planned on requiring this yearly, with plans to force folks to start meeting the metrics or pay more for insurance. I'm not sure how this panned out for them. Anyhow, if it wasn't for this, I would have never had such a test. I'm in my late 30's. My father was diabetic at my age, actually, and it runs in the family. I'm a prime candidate for preventive measures, but still nothing. Now, I understand that I go to the doctor rarely but at any one of these I could have been asked about a physical and stuff like that.

Broken_Hippo 10y ago

This would be great for diabetes patients. It might be a good early intervention measure for folks that are prone to be diabetic. But does such a test actually provide benefit to the general public? Would an otherwise heatlhy 30-year old with a bad diet fail this test - or would it only show that despite his bad diet, that his blood glucose levels have been pretty stable the last 3 months? I'm thinking that in an ordinary person with a working pancreas, it wouldn't show the spikes of diabetes. That said, I do think these sorts of things work, especially when paired with labor protection policies that allow folks to miss work to go to the doctor (or be sick). For example, once I was in the Norwegian health system, I got a letter encouraging me to see the doctor for my cancer screening (I'm female). Turns out, they want folks to get one every 3 years and keep a database to keep track of who has gotten it and who hasn't. I don't know how well this sort of thing would work in a fragmented system like the US has, though.