4 ms·

I would refer you to this recent review in the Nature - "Tracing the US opioid crisis to its roots" - https://www.nature.com/articles/d41586-019-02686-2 https:/

I would refer you to this recent review in the Nature - "Tracing the US opioid crisis to its roots" - https://www.nature.com/articles/d41586-019-02686-2 https://www.nature.com/articles/d41586-019-02686-2 And outlook https://www.nature.com/collections/wcbsjcwqng https://www.nature.com/collections/wcbsjcwqng At least to me, it seems like that crisis was created, primarily because of misalignment of the system towards maximizing executive compensation instead of public health.

deleted 6y ago
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oliwarner 6y ago
No. I mean that on many levels —including your reading of that article— but I'm not going to engage there. You are once again pointing at opioids a some unassailable argument that doctors are only in it for the cash and cannot be trusted. If anything, doctors are trying to keep people off ventilation. They have to, they have dramatically more C19 patients than vents. Here, patients over 60 with co-mobidities are actively disqualified. Beside this global conspiracy amongst physicians to over-prescribe ventilation, you're also suggesting that neither they nor the hundreds of public health bodies are looking at the results of their actions and adapting treatment, despite taking extreme care to collate data. Guidelines here are emergent, but you can't placebo people with resting SpO2s of 80. They die. Again, "Look, opioids!" is not an argument. It's a harmful comparison.
- dchichkov 6y ago
  It is not, "Look, opioids!". It is: "Look, wrong incentives in the health-care system in the United States". The parallel seems interesting to me, as just like with opioid epidemic, some doctors were resisting in providing the painkiller therapy. While the mainstream was to use the opioid therapy. The structure of the health-care system in the United States also contributed to the over-prescription of opioids. Because many doctors are in private practice, they can benefit financially by increasing the volume of patients that they see, as well as by ensuring patient satisfaction, which can incentivize the over-prescription of pain medication. Prescription opioids are also cheap in the short term. Patients’ health-insurance plans often covered pain medication but not pain-management approaches such as physical therapy. “The incentives were there for people to prescribe more and more, particularly when they had already been convinced it was the right thing to do — the compassionate thing to do,” Humphreys says. This might help to explain why Canada is also experiencing an opioid crisis, with 10,337 opioid-related deaths between January 2016 and September 2018. Most European countries, however, have so far been insulated from the epidemic. Doctors in Europe are not motivated financially to make prescriptions. - from this article in Nature -. And by the way, yours "nothing compared" - this is just plain wrong. The level of the prescription-induced crisis, in numbers, was about the same as the current level. And users funneled to non-prescription since the prescription channel is now blocked. As to the current decision-making. I'm not sure what is a right and efficient solution. Probably it is in the area of developing antivirals as fast as possible. And actively fighting the coefficient in the exponent. Like people wearing masks in Walmart. And allowing doctors to wear masks in hospitals, instead of hospital management making statements like: "THERES NO MORE WUHAN VIRUS IN THE HALLS AT THE HOSPITAL THAN WALMART". See: https://www.nytimes.com/2020/03/31/health/hospitals-coronavirus-face-masks.html https://www.nytimes.com/2020/03/31/health/hospitals-coronavi... But, putting people on ventilators seems like inefficient use of efforts. Yes, if you don't put late-stage patients on ventilators, they'd die. But it looks like, there is 80% chance they'd die, if you'd put on ventilators. And fewer people may die overall, if efforts were not spend on the whole ventilators affair. And instead something else was done.

deleted 6y ago

[deleted]

oliwarner 6y ago

No. I mean that on many levels —including your reading of that article— but I'm not going to engage there. You are once again pointing at opioids a some unassailable argument that doctors are only in it for the cash and cannot be trusted. If anything, doctors are trying to keep people off ventilation. They have to, they have dramatically more C19 patients than vents. Here, patients over 60 with co-mobidities are actively disqualified. Beside this global conspiracy amongst physicians to over-prescribe ventilation, you're also suggesting that neither they nor the hundreds of public health bodies are looking at the results of their actions and adapting treatment, despite taking extreme care to collate data. Guidelines here are emergent, but you can't placebo people with resting SpO2s of 80. They die. Again, "Look, opioids!" is not an argument. It's a harmful comparison.

dchichkov 6y ago
It is not, "Look, opioids!". It is: "Look, wrong incentives in the health-care system in the United States". The parallel seems interesting to me, as just like with opioid epidemic, some doctors were resisting in providing the painkiller therapy. While the mainstream was to use the opioid therapy. The structure of the health-care system in the United States also contributed to the over-prescription of opioids. Because many doctors are in private practice, they can benefit financially by increasing the volume of patients that they see, as well as by ensuring patient satisfaction, which can incentivize the over-prescription of pain medication. Prescription opioids are also cheap in the short term. Patients’ health-insurance plans often covered pain medication but not pain-management approaches such as physical therapy. “The incentives were there for people to prescribe more and more, particularly when they had already been convinced it was the right thing to do — the compassionate thing to do,” Humphreys says. This might help to explain why Canada is also experiencing an opioid crisis, with 10,337 opioid-related deaths between January 2016 and September 2018. Most European countries, however, have so far been insulated from the epidemic. Doctors in Europe are not motivated financially to make prescriptions. - from this article in Nature -. And by the way, yours "nothing compared" - this is just plain wrong. The level of the prescription-induced crisis, in numbers, was about the same as the current level. And users funneled to non-prescription since the prescription channel is now blocked. As to the current decision-making. I'm not sure what is a right and efficient solution. Probably it is in the area of developing antivirals as fast as possible. And actively fighting the coefficient in the exponent. Like people wearing masks in Walmart. And allowing doctors to wear masks in hospitals, instead of hospital management making statements like: "THERES NO MORE WUHAN VIRUS IN THE HALLS AT THE HOSPITAL THAN WALMART". See: https://www.nytimes.com/2020/03/31/health/hospitals-coronavirus-face-masks.html https://www.nytimes.com/2020/03/31/health/hospitals-coronavi... But, putting people on ventilators seems like inefficient use of efforts. Yes, if you don't put late-stage patients on ventilators, they'd die. But it looks like, there is 80% chance they'd die, if you'd put on ventilators. And fewer people may die overall, if efforts were not spend on the whole ventilators affair. And instead something else was done.