3 ms·

We could also fix the way medicine works so pre-diabetics are put on an appropriate, low carb diet so they don't end up with diabetes and all of the horrible co

We could also fix the way medicine works so pre-diabetics are put on an appropriate, low carb diet so they don't end up with diabetes and all of the horrible complications in the first place. Medicine as a whole will be looked back upon very poorly with how it handled diet, sleep, sunlight exposure, etc.

gumby 8y ago
It's not like doctors and actuaries don't know this. For reasons poorly understood (though there are many theories) most people have a difficult time changing whatever lifestyle was hurting them in the first place. People also have a poor model of how health care works (most people seem to think it's like getting your car fixed: go to "mechanic" and have problem fixed). Finally the educational level that needs to be addressed is quite low (e.g. the FDA requires that medical labeling assume a fifth grade eduction; since most people take two headache tablets, most are set at a level where two is not dangerous, etc). Thus, for example, the ADA diet advice recommends you have a "small" amount of carbs ("have a smaller slice of cake, or have an orange instead") in the hope that at least they can reduce the severity of the symptoms. Too large a goal might lead to no compliance at all. And the actuaries at the insurance companies have figured out the lifetime cost of putting someone on maintenance therapy vs more aggressive treatment that in most cases people won't follow. A case in point: I was diagnosed with prediabetes and my endocrinologist would only prescribe mainline treatment without additional investigation. Legally she could order any test she wanted but not only would the insurance company bounce anything nonstandard (by their standards) but the hospital management would hassle her as well. I was lucky: I had the money and the education to find and work with a different doctor and found an underlying illness. Once treated, a bunch of symptoms (of which diabetes was just one) went away. The system is not set up to help people like me (though sadly it's not clear how it could even with infinite funding).
- freedomben 8y ago
  Do you mind if I ask what the underlying illness was? Or maybe some of the testing you did?
  - gumby 8y ago
    I had an underlying autoimmune disorder (diabetes can be an autoimmune disorder and isome common comorbidities are too, like Hashimoto’s).

gumby 8y ago

It's not like doctors and actuaries don't know this. For reasons poorly understood (though there are many theories) most people have a difficult time changing whatever lifestyle was hurting them in the first place. People also have a poor model of how health care works (most people seem to think it's like getting your car fixed: go to "mechanic" and have problem fixed). Finally the educational level that needs to be addressed is quite low (e.g. the FDA requires that medical labeling assume a fifth grade eduction; since most people take two headache tablets, most are set at a level where two is not dangerous, etc). Thus, for example, the ADA diet advice recommends you have a "small" amount of carbs ("have a smaller slice of cake, or have an orange instead") in the hope that at least they can reduce the severity of the symptoms. Too large a goal might lead to no compliance at all. And the actuaries at the insurance companies have figured out the lifetime cost of putting someone on maintenance therapy vs more aggressive treatment that in most cases people won't follow. A case in point: I was diagnosed with prediabetes and my endocrinologist would only prescribe mainline treatment without additional investigation. Legally she could order any test she wanted but not only would the insurance company bounce anything nonstandard (by their standards) but the hospital management would hassle her as well. I was lucky: I had the money and the education to find and work with a different doctor and found an underlying illness. Once treated, a bunch of symptoms (of which diabetes was just one) went away. The system is not set up to help people like me (though sadly it's not clear how it could even with infinite funding).

freedomben 8y ago
Do you mind if I ask what the underlying illness was? Or maybe some of the testing you did?
- gumby 8y ago
  I had an underlying autoimmune disorder (diabetes can be an autoimmune disorder and isome common comorbidities are too, like Hashimoto’s).