5 ms·

Here's the crux point... """ ...clinicians are now able to successfully cure at least 95% of patients with the chronic condition with oral medications that hav

Here's the crux point... """ ...clinicians are now able to successfully cure at least 95% of patients with the chronic condition with oral medications that have little or no side effects. "With such an effective means for cure, it only makes sense to universally screen patients," Cheung said. "Implementation of universal screening will also decrease the likelihood of primary care physicians forgetting who does or does not need screening -- and it avoids the sometimes uncomfortable discussion with the patient about why they have been labeled as high risk and needing further screening." """ I think the fact that high risk populations rock the medical boat so globally already makes medicine awkward regardless of avoiding uncomfortable discussions. All these blanket treatments and tests just paper over the fact that there are wide impacting subpopulations with poor health in our populous driving the need for these things in the first place. It's the next immediate question that gets raised when you evaluate 'why do I need another HIV test' or whatever other blood test it is that medicine pushes on you. Eventually it dawned on me that these blind blanket decisions are simply because these doctors don't know anything about a patient's personal life and what risky subpopulations they may or may not belong to. But from the patient who knows what virtue they live or don't live some of these tests just come off as absurd knowing your own life history and the absolute absence of risks you deliberately avoid in life. One step of indirection is not much to jump over for one who naturally asks the next immediate question.

DoofusOfDeath 7y ago
This seems related to the political question of how much healthcare costs should be socialized, i.e. spread across a group rather than shouldered by individuals. As someone who doesn't smoke, barely drinks alcohol, doesn't take illegal drugs, and (I hope) is in a lifelong-monogamous relationship, I hate having to cover healthcare costs specific to those problems. On the other hand, as someone with chronic mild obesity, I'm grateful for government-funded research for treatments of hypertension, stroke, idiopathic cancer, etc. And to some extent I could, if motivated enough, keep my bodyweight down. I guess there are two issues then. The politics of shared costs/benefits, and attending my personal struggles with only being empathetic to problems that I myself experience.
- tripzilch 7y ago
  > As someone who doesn't smoke, barely drinks alcohol, doesn't take illegal drugs, and (I hope) is in a lifelong-monogamous relationship, I hate having to cover healthcare costs specific to those problems. You should try some compassion--they say it's also a healthy life choice. And, that must be pretty convenient, how the legality of drugs just happens to line up exactly with how you judge people on whether they're worthy and deserve health or not.
- sorokod 7y ago
  "This seems related to the political question of how much healthcare costs should be socialized, i.e. spread across a group rather than shouldered by individuals" It's a moral question, not a political one. Food for thought: "Rough sleeper gives birth to twins outside wealthiest Cambridge college" - https://www.theguardian.com/society/2019/dec/26/rough-sleeper-gives-birth-to-twins-outside-cambridge-university https://www.theguardian.com/society/2019/dec/26/rough-sleepe...
  - timthorn 7y ago
    But that story isn't about costs of healthcare - the NHS will treat her for free precisely because the costs are socialised. The social care system will also ramp up rapidly given she's a vulnerable new mother who has now been admitted to the local maternity hospital.
- vsef 7y ago
  High prevalence of hcv isn't just due to lifestyle factors. Baby boomer age group for example have a very high prevalence primarily due to spread by unsafe medical practices before the medical community knew about hcv: https://www.healthline.com/health/hepatitis-c/why-do-baby-boomers#connection https://www.healthline.com/health/hepatitis-c/why-do-baby-bo... Detection/treatment/control of infectious diseases has an additional intrinsically social dimension beyond the individual.
- somewhereoutth 7y ago
  On the subject of shared costs/benefits: The wealth that allows us modern healthcare is not so much the wealth we are producing today, but overwhelmingly more the wealth that the countless generations before us have created. That one person should benefit disproportionately from this wealth, just because by some narrow financial measure their small contribution is slightly less small than another's, is surely against natural justice. Healthcare is our birthright, part of the Universal Basic Stake that we each inherit simply by being born.
joe_the_user 7y ago
All these blanket treatments and tests just paper over the fact that there are wide impacting subpopulations with poor health in our populous driving the need for these things in the first place. Sure, some portion of people in distress contribute overall very disproportionately to health care cost. This includes people who make poor health choices (over-consumption of sugary beverages, unhealthy drug and similar things), people who are homeless and people who chronic health problems (through work-related injuries, random chance or actual poor decisions). There seem to be two reaction: "OK, then just don't allow them health care, problem solved" or "we need to prevent people from getting into that position in the first place." I would say the first reaction is counter-productive, poorly thought-through and morally indefensible. Obviously, I think the second approach is crucial (obviously requiring quite a bit of effort). The first position is very common, however and it's kind of sad, for both the people who think this way but much more for the consequence. I think the only reason people jump to the first position is: A. The situation is presented in isolation and these people aren't considering the consequences. B. There's a human tendency to jump to a belief without fully exploring the evidence. C. Defending a belief often just makes the defender more defensive, especially since changing would make them admit they holding a fairly cruel and immoral position. I think the article from a couple days ago about human belief formation is very relevant for this discussion. see: https://www.youtube.com/watch?v=bvebjL48f-w&feature=youtu.be https://www.youtube.com/watch?v=bvebjL48f-w&feature=youtu.be
wtallis 7y ago
> Eventually it dawned on me that these blind blanket decisions are simply because these doctors don't know anything about a patient's personal life and what risky subpopulations they may or may not belong to. The question is not which subpopulations the patient may belong to, but which ones they may have had contact with. It doesn't matter how well-off you are if you ate dinner last night in a restaurant where the staff cannot afford to be screened and treated for hepatitis. That particular transmission vector is more relevant to Hep A than Hep C, but the general point for public health policy at a high level is sound: you cannot ignore under-served populations that live amongst you, because people you don't care about can still get you sick. Yes, there are some nasty diseases that for now appear to be limited to only sexual and needle transmission, but we shouldn't shape our entire approach to public health around blaming the victims of those particular diseases.

DoofusOfDeath 7y ago

This seems related to the political question of how much healthcare costs should be socialized, i.e. spread across a group rather than shouldered by individuals. As someone who doesn't smoke, barely drinks alcohol, doesn't take illegal drugs, and (I hope) is in a lifelong-monogamous relationship, I hate having to cover healthcare costs specific to those problems. On the other hand, as someone with chronic mild obesity, I'm grateful for government-funded research for treatments of hypertension, stroke, idiopathic cancer, etc. And to some extent I could, if motivated enough, keep my bodyweight down. I guess there are two issues then. The politics of shared costs/benefits, and attending my personal struggles with only being empathetic to problems that I myself experience.

tripzilch 7y ago
> As someone who doesn't smoke, barely drinks alcohol, doesn't take illegal drugs, and (I hope) is in a lifelong-monogamous relationship, I hate having to cover healthcare costs specific to those problems. You should try some compassion--they say it's also a healthy life choice. And, that must be pretty convenient, how the legality of drugs just happens to line up exactly with how you judge people on whether they're worthy and deserve health or not.
sorokod 7y ago
"This seems related to the political question of how much healthcare costs should be socialized, i.e. spread across a group rather than shouldered by individuals" It's a moral question, not a political one. Food for thought: "Rough sleeper gives birth to twins outside wealthiest Cambridge college" - https://www.theguardian.com/society/2019/dec/26/rough-sleeper-gives-birth-to-twins-outside-cambridge-university https://www.theguardian.com/society/2019/dec/26/rough-sleepe...
- timthorn 7y ago
  But that story isn't about costs of healthcare - the NHS will treat her for free precisely because the costs are socialised. The social care system will also ramp up rapidly given she's a vulnerable new mother who has now been admitted to the local maternity hospital.
vsef 7y ago
High prevalence of hcv isn't just due to lifestyle factors. Baby boomer age group for example have a very high prevalence primarily due to spread by unsafe medical practices before the medical community knew about hcv: https://www.healthline.com/health/hepatitis-c/why-do-baby-boomers#connection https://www.healthline.com/health/hepatitis-c/why-do-baby-bo... Detection/treatment/control of infectious diseases has an additional intrinsically social dimension beyond the individual.
somewhereoutth 7y ago
On the subject of shared costs/benefits: The wealth that allows us modern healthcare is not so much the wealth we are producing today, but overwhelmingly more the wealth that the countless generations before us have created. That one person should benefit disproportionately from this wealth, just because by some narrow financial measure their small contribution is slightly less small than another's, is surely against natural justice. Healthcare is our birthright, part of the Universal Basic Stake that we each inherit simply by being born.

joe_the_user 7y ago

All these blanket treatments and tests just paper over the fact that there are wide impacting subpopulations with poor health in our populous driving the need for these things in the first place. Sure, some portion of people in distress contribute overall very disproportionately to health care cost. This includes people who make poor health choices (over-consumption of sugary beverages, unhealthy drug and similar things), people who are homeless and people who chronic health problems (through work-related injuries, random chance or actual poor decisions). There seem to be two reaction: "OK, then just don't allow them health care, problem solved" or "we need to prevent people from getting into that position in the first place." I would say the first reaction is counter-productive, poorly thought-through and morally indefensible. Obviously, I think the second approach is crucial (obviously requiring quite a bit of effort). The first position is very common, however and it's kind of sad, for both the people who think this way but much more for the consequence. I think the only reason people jump to the first position is: A. The situation is presented in isolation and these people aren't considering the consequences. B. There's a human tendency to jump to a belief without fully exploring the evidence. C. Defending a belief often just makes the defender more defensive, especially since changing would make them admit they holding a fairly cruel and immoral position. I think the article from a couple days ago about human belief formation is very relevant for this discussion. see: https://www.youtube.com/watch?v=bvebjL48f-w&feature=youtu.be https://www.youtube.com/watch?v=bvebjL48f-w&feature=youtu.be

wtallis 7y ago

> Eventually it dawned on me that these blind blanket decisions are simply because these doctors don't know anything about a patient's personal life and what risky subpopulations they may or may not belong to. The question is not which subpopulations the patient may belong to, but which ones they may have had contact with. It doesn't matter how well-off you are if you ate dinner last night in a restaurant where the staff cannot afford to be screened and treated for hepatitis. That particular transmission vector is more relevant to Hep A than Hep C, but the general point for public health policy at a high level is sound: you cannot ignore under-served populations that live amongst you, because people you don't care about can still get you sick. Yes, there are some nasty diseases that for now appear to be limited to only sexual and needle transmission, but we shouldn't shape our entire approach to public health around blaming the victims of those particular diseases.