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> there are a lot of assertions here without sources or context. I don't have time to build the full case. The nutshell version is that modern medicine is dom

> there are a lot of assertions here without sources or context. I don't have time to build the full case. The nutshell version is that modern medicine is dominated by pharmaceuticals. Doctors are largely in the pill dispensing business. Problem is, the pills don't work. Spend more than fifteen minutes reading about the cholesterol and statin racket for just one example, and this is a huge billion dollar thing. It's a big chunk of what doctors do to earn a living. My familiarity with the business comes from the software side of pharma sales. For another example read about long term efficacy of many kinds of chemo and heart surgery. The stuff just doesn't really work, but it sure costs a lot. Doctors are something like the fifth leading cause of death. Malpractice is rife. Modern medicine is great for trauma, injuries, and various acute diseases. But the financial reality of health care is that most of the spending and most of what doctors do is about lifestyle diseases, and the treatments are useless. They give pills and order tons of tests for people who should really just be told that there's nothing to be done other than better diet and exercise, or maybe bed rest. They also blow millions on people who are simply in the process of dying, mostly of old age, and the treatments are empirically known to do nothing.

arn 18y ago
"Doctors are largely in the pill dispensing business." You do realize that doctors don't make any more money based on medications they prescribe. "Problem is, the pills don't work. ..... and the treatments are empirically known to do nothing." I don't really want to get into a big discussion about it because I know I won't be able to convince you. But this is just wrong. Many pills do work. Modern medicine is based on the scientific method and millions on dollars are spent on studies to prove that therapies work. Strnagely enough, insurance companies are part of the gatekeepers for this, since they don't want to pay out of their pockets to provide expensive care for things that don't work. On the other hand, much of "natural" medicine and homeopathic medicine are based in anectodal evidence and not on any large scale scientific evidence.
- kingkongrevenge 18y ago
  > Modern medicine is based on the scientific method and millions on dollars are spent on studies to prove that therapies work. Sure. Take Ambien, for example. The studies show it works! People who take it fall asleep a whole 15 minutes sooner than placebo! For thousands of dollars and unquantified long term consequences you can have something pathetically less effective than lifestyle changes or some cognitive therapy sessions, so ask your doctor about Ambien. Same for the cholesterol statins. They work! They really do lower serum cholesterol, just as advertised. However, they have absolutely no affect on mortality rates in the typically prescribed case, and are implicated in serious neurological disease... This kind of nonsense is pervasive in the medical industrial complex. Doctors, for the most part, dispense treatments pushed on them. But the stuff is largely a waste of money. With a whole lot of these cancer therapies you statistically buy an extra year of life. But the person who took the therapies felt like shit for four years and blew all their savings. The person who just let it be died a year earlier but spent a lot more time feeling ok and saved a lot of money. You can just go on and on with stuff like this. The medical industrial complex is deeply dysfunctional, and at the end of the day there are way too many doctors and they do too much. This is why health care spending and number of doctors per capita is uncorrelated to lifespan and health across regions of the US.
  - arn 18y ago
    "[statins] have absolutely no affect on mortality rates in the typically prescribed case" http://www.ncbi.nlm.nih.gov/pubmed/12114036 http://www.ncbi.nlm.nih.gov/pubmed/12114036 The Heart Protection Study (HPS) randomly assigned 20,536 subjects to simvastatin (40 mg/day) or placebo After an average follow-up of 5.5 years, the following significant benefits with simvastatin were observed: - A 13 percent reduction in all-cause mortality (12.9 versus 14.7 percent for placebo). - An 18 percent reduction in deaths from heart disease or related blood vessel disease (5.7 versus 6.9 percent). - A 24 percent reduction in major cardiovascular events (19.8 versus 25.2 percent) - A 25 percent reduction in the first event rate for stroke (4.3 versus 5.7 percent) reflecting a 28 percent decrease in ischemic strokes and no reduction in hemorrhagic strokes - Among 3982 diabetics without prior cardiovascular disease, a 28 percent reduction in the incidence of MI and stroke (14 versus 18.7 percent).
- dividendium 18y ago
  "Strnagely enough, insurance companies are part of the gatekeepers for this, since they don't want to pay out of their pockets to provide expensive care for things that don't work." Consider the economics here. If something is not expensive, you don't need insurance. So it's in the insurance companies' interests to inflate the prices so more people will need health insurance and can't pay for procedures out of pocket. The insurance companies just have to raise their premiums to compensate, and the larger the amounts of money passing through their hands, the easier it is for them to keep some of it. I'm not attacking insurance companies, just pointing out that it's not entirely logical to assume that their interests are aligned with yours.
  - arn 18y ago
    I'm not saying they are the only gatekeeper. But point is, pharmaceudical companies can't just create a medication and claim it "does xyz" and expect that people will pay for it. These medications are reviewed before being "covered" by insurance companies or medicare (goverenment), so it's not a free for all, as implied in the original poster's comment.
nradov 18y ago
You have mischaracterized modern medicine. However, preventable medical errors were recently estimated to cause somewhere between 44K - 98K deaths per year in the US. For anyone interested in the details I highly recommend reading the Institute of Medicine report "To Err is Human". http://www.nap.edu/openbook.php?record_id=9728&page=1 http://www.nap.edu/openbook.php?record_id=9728&page=1 There are good potential business opportunities in building automation to reduce errors, however it's still tough to get funding and find customers since the reimbursement system generally isn't structured to pay for error prevention. There was one positive step recently when CMS set a new policy to not pay for fixing preventable care problems. http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=3041&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&srchOpt=0&srchData=&keywordType=All&chkNewsType=1%2C+2%2C+3%2C+4%2C+5&intPage=&showAll http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=...

arn 18y ago

"Doctors are largely in the pill dispensing business." You do realize that doctors don't make any more money based on medications they prescribe. "Problem is, the pills don't work. ..... and the treatments are empirically known to do nothing." I don't really want to get into a big discussion about it because I know I won't be able to convince you. But this is just wrong. Many pills do work. Modern medicine is based on the scientific method and millions on dollars are spent on studies to prove that therapies work. Strnagely enough, insurance companies are part of the gatekeepers for this, since they don't want to pay out of their pockets to provide expensive care for things that don't work. On the other hand, much of "natural" medicine and homeopathic medicine are based in anectodal evidence and not on any large scale scientific evidence.

kingkongrevenge 18y ago
> Modern medicine is based on the scientific method and millions on dollars are spent on studies to prove that therapies work. Sure. Take Ambien, for example. The studies show it works! People who take it fall asleep a whole 15 minutes sooner than placebo! For thousands of dollars and unquantified long term consequences you can have something pathetically less effective than lifestyle changes or some cognitive therapy sessions, so ask your doctor about Ambien. Same for the cholesterol statins. They work! They really do lower serum cholesterol, just as advertised. However, they have absolutely no affect on mortality rates in the typically prescribed case, and are implicated in serious neurological disease... This kind of nonsense is pervasive in the medical industrial complex. Doctors, for the most part, dispense treatments pushed on them. But the stuff is largely a waste of money. With a whole lot of these cancer therapies you statistically buy an extra year of life. But the person who took the therapies felt like shit for four years and blew all their savings. The person who just let it be died a year earlier but spent a lot more time feeling ok and saved a lot of money. You can just go on and on with stuff like this. The medical industrial complex is deeply dysfunctional, and at the end of the day there are way too many doctors and they do too much. This is why health care spending and number of doctors per capita is uncorrelated to lifespan and health across regions of the US.
- arn 18y ago
  "[statins] have absolutely no affect on mortality rates in the typically prescribed case" http://www.ncbi.nlm.nih.gov/pubmed/12114036 http://www.ncbi.nlm.nih.gov/pubmed/12114036 The Heart Protection Study (HPS) randomly assigned 20,536 subjects to simvastatin (40 mg/day) or placebo After an average follow-up of 5.5 years, the following significant benefits with simvastatin were observed: - A 13 percent reduction in all-cause mortality (12.9 versus 14.7 percent for placebo). - An 18 percent reduction in deaths from heart disease or related blood vessel disease (5.7 versus 6.9 percent). - A 24 percent reduction in major cardiovascular events (19.8 versus 25.2 percent) - A 25 percent reduction in the first event rate for stroke (4.3 versus 5.7 percent) reflecting a 28 percent decrease in ischemic strokes and no reduction in hemorrhagic strokes - Among 3982 diabetics without prior cardiovascular disease, a 28 percent reduction in the incidence of MI and stroke (14 versus 18.7 percent).
dividendium 18y ago
"Strnagely enough, insurance companies are part of the gatekeepers for this, since they don't want to pay out of their pockets to provide expensive care for things that don't work." Consider the economics here. If something is not expensive, you don't need insurance. So it's in the insurance companies' interests to inflate the prices so more people will need health insurance and can't pay for procedures out of pocket. The insurance companies just have to raise their premiums to compensate, and the larger the amounts of money passing through their hands, the easier it is for them to keep some of it. I'm not attacking insurance companies, just pointing out that it's not entirely logical to assume that their interests are aligned with yours.
- arn 18y ago
  I'm not saying they are the only gatekeeper. But point is, pharmaceudical companies can't just create a medication and claim it "does xyz" and expect that people will pay for it. These medications are reviewed before being "covered" by insurance companies or medicare (goverenment), so it's not a free for all, as implied in the original poster's comment.

nradov 18y ago

You have mischaracterized modern medicine. However, preventable medical errors were recently estimated to cause somewhere between 44K - 98K deaths per year in the US. For anyone interested in the details I highly recommend reading the Institute of Medicine report "To Err is Human". http://www.nap.edu/openbook.php?record_id=9728&page=1 http://www.nap.edu/openbook.php?record_id=9728&page=1 There are good potential business opportunities in building automation to reduce errors, however it's still tough to get funding and find customers since the reimbursement system generally isn't structured to pay for error prevention. There was one positive step recently when CMS set a new policy to not pay for fixing preventable care problems. http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=3041&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&srchOpt=0&srchData=&keywordType=All&chkNewsType=1%2C+2%2C+3%2C+4%2C+5&intPage=&showAll http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=...