5 ms·

“Cancer treatment is expensive.” “Kill the patient” Problem practically solved? Much more affordable, sure, but not better in any other measure.

ethbr1 3y ago
Vets don't put down animals needlessly, but they do practice medicine closer to engineering. There's always a cost-benefit calculation, and the answer should never be 'Whatever the cost.'
- naikrovek 3y ago
  > There's always a cost-benefit calculation, and the answer should never be 'Whatever the cost.' You think like an insurance company: completely detached from reality.
  - deleted 3y ago
    [deleted]
  - dgacmu 3y ago
    No, there literally is always a tradeoff, even in human medicine. I was at my doctor's office yesterday because I'm an idiot and injured myself. I asked about the diagnostic advantages of getting an MRI vs an x-ray for the injury (sciatic pain, probably from an injury to my piriformis; don't snowboard on the east coast). The MRI might have provided better diagnostics, but the x-ray (much faster, at lower cost, but at some radiation exposure to me) ruled out the really serious stuff, and the treatment plan was the same regardless. So: Tradeoff. It was, IMO, both financially and ethically better to use the low-resource diagnostic modality instead of tying up the rare and expensive one, even though it gave me a bit of radiation that in an ideal case I wouldn't have had.
    - wpietri 3y ago
      For sure. During my mom's cancer treatment, these things came up too. E.g., In going through some options, her neuro-oncologist mentioned one drug, Avastin I think, which would have been something like $100k. In his estimation was unlikely to make any difference in her prognosis, and at best would have been a difference of days of lifespan. She was on Medicare, so it was no cost to us either way, but we all felt like it would have been a waste of money. At some point during this process it became clear to me that a "whatever the cost" approach is understandable but wrong. We're all going to die. If an intervention can restore somebody to health, to give them years of a good life, that's great. But an awful lot of money is spent on what seemed to me like prolonging the misery. That's not something I want for myself, and it's definitely not something my mom wanted. So as long as there was some hope of more good time, we fought and fought hard. But when hope ran out, we were off to hospice with no regrets. She died peacefully, surrounded by loved ones. It was a much better death than having a lot of futile last-minute interventions. Speaking of which, if this makes sense to you, make sure your loved ones know your preferences. We had all done living wills years before, and it was such a balm to know exactly what she wanted. I've used Five Wishes for this, and I'm told there are other, possibly better options now too.
      - vba616 3y ago
        >It was a much better death than having a lot of futile last-minute interventions. It's easy to say that sort of thing, so everyone does. It makes plenty of sense. People don't want to die in the hospital or go through hell in their last days or weeks. But nobody wants to die right now, ever. No matter what they said before or what papers they signed. The standard picture, the logic, makes perfect crystalline sense up until there is a choice between going to the hospital right now and living an undefined amount of time, maybe only a day or a week, but longer than the next few minutes.
        wpietri 3y ago
        Sorry, but this is incorrect: > But nobody wants to die right now, ever. No matter what they said before or what papers they signed. Plenty of people recognize when it's time. When my mom was diagnosed with glioblastoma, her surgeon said, "This is what you will die from." That's hard to hear, but people can definitely take it on board. To realize that it's not a choice of whether, just how. Take, Brittany Maynard, who had the same thing my mom did: https://en.wikipedia.org/wiki/Brittany_Maynard https://en.wikipedia.org/wiki/Brittany_Maynard I can go as far as agreeing that American culture has a lot of collective anxiety about death, and a consequent refusal to deal with is calmly. But there are plenty of other approaches to that. Like the European movement known as Death Cafe: https://en.wikipedia.org/wiki/Death_Cafe https://en.wikipedia.org/wiki/Death_Cafe Or the (sadly now defunct) Zen Hospice here in SF: https://www.businessinsider.com/photos-of-zen-hospice-project-sf-2017-8 https://www.businessinsider.com/photos-of-zen-hospice-projec... Many things in our lives can be scary. But we can shape our relationships to them. And given that death comes to all of us, I think it's worth taking the time to get on good terms with it.
    - deleted 3y ago
      [deleted]
  - pjerem 3y ago
    You are interpreting this wrongly. It’s not because there is a cost-benefit that the cost for a high benefit can’t be high. Healthcare budget is not infinite but in most countries, it’s high enough per operation that, for a given individual, it’s virtually infinite. Insurance companies don’t care about the benefit, they just want the cost to be low, it’s not the same thing.
    - ethbr1 3y ago
      > Insurance companies don’t care about the benefit, they just want the cost to be low, it’s not the same thing. Also underappreciated, at the end of the day: {insurance premiums} >= {average cost of care} The actuarial calculations don't change because they're concealed behind group-blended risk. If cost of care increases, premiums must increase as well.
    - deleted 3y ago
      [deleted]
    - refurb 3y ago
      I work in healthcare economics and this is false. There are no healthcare system in the world where the budget is “high enough to be virtually infinite”. All health systems are all heavily, heavily constrained by budget. The US system is the least constrained (i.e. if you want the latest cancer care paid for, the US is the place with the highest probability it’ll happen), but since there are thousands of insurance plans it’s not even and any two patients may have plans that make different trade offs. And governments do the very similar math as the insurance companies when it comes to cost-benefit analyses - that’s how they design their benefit offerings. The difference between systems like Canada (with universal care) and the US is that in Canada the end user doesnt see how the sausage is made. That’s because the trade offs are the same for everyone and doctors know a given trade off has been made and the technology that is not paid for is just not even brought up to the patient.
  - neon5077 3y ago
    No, the reality is that an animal is usually an asset. It costs X to feed and maintain an animal over its life to achieve Y amount of profit from its sale or the sale of its products. If X plus medical costs is greater than Y, you're losing money on this animal. Tripling the amount you pay the vet does not increase the final profit margin of the animal, so you simply do not. If basic treatment costs more than the animal will generate in its life, you don't treat the animal. Thinking that any random farm animal is worth infinite medical resources is completely detached from reality. The animal is not worth it. There's not one single reason to pay more to maintain an animal than the money you get out of it. Not in this context.
- aebtebeten 3y ago
  Vets have an elevated suicide rate, which I ascribe to three factors: - they can self-prescribe - they commonly use, unlike human doctors, euthanasia to end suffering - they became vets because they really like animals, but many owners seem more concerned with their pocketbooks Lagniappe: https://www.youtube.com/watch?v=JChwFoCxVC8 https://www.youtube.com/watch?v=JChwFoCxVC8
  - ethbr1 3y ago
    Self-prescription is definitely part of it, but farmers have brutal suicide rates too. Social isolation + a business where the business often runs counter to your moral preferences = a tough life for both The "maybe next year" line gets me every time: https://m.youtube.com/watch?v=ZRDaPEaDJ7E https://m.youtube.com/watch?v=ZRDaPEaDJ7E
  - AnotherGoodName 3y ago
    From experience with a vet in the family it's very much a 'who the fuck in their right mind would do this?!' type of career to anyone that has the ability to ask a vet their honest opinion about their career choice. It's literally a medical science degree with a speciality. The same degree that can get you a very highly paid jobs elsewhere yet it doesn't pay that well. You'll likely end up in a poorly paid 24hour live-in clinic with horrible pay and hours surrounded by euthanasia and the associated grief non-stop all the while with those same drugs sitting there. The mortality rate is so horrific that news of another suicide from the graduating year becomes a 'we've lost yet another one' type of statistic. It's not often you ask someone to give a late teen thoughts on their upcoming career choice and have them rightfully say 'Don't! It's not worth it!' but this literally happened with vet science in my family.
    - peterleiser 3y ago
      I had the same experience when doing a career report in junior highschool. I spoke to a vet who had graduated from UC Davis a few years prior and they did everything in their power to talk me out of becoming one.
    - GlenTheMachine 3y ago
_heimdall 3y ago
That's not a great analogy. There are plenty of alternative treatments for cancer, and speaking of cattle there were actually Mayo Clinic doctors in the early 1900s using raw milk diets to treat serious conditions including cancer. A more apt comparison here would be vets throwing pharmaceuticals and radiation at cows who ingested metals rather than a more simple solution intervention.
non-chalad 3y ago
Might we interest you in M.A.I.D? (1) 1. https://www.theatlantic.com/magazine/archive/2023/06/canada-legalized-medical-assisted-suicide-euthanasia-death-maid/673790/ https://www.theatlantic.com/magazine/archive/2023/06/canada-...
- ethbr1 3y ago
  Full-disclosure: personally I'm a big supporter of an individual's right to choose to end their own life in a medically-facilitated manner. There's something weird about letting people who are happy with life (read: society) choose to force someone who isn't to continue living, against their wishes.
  - non-chalad 3y ago
    Governmemt should not be involved in ending someone's life; Not at their own choosing, nor at forcing them to continue living.
    - ninjanomnom 3y ago
      The alternatives then are self service, or private businesses providing assistance? If we want to endorse the former then educating people on the best way to painlessly end their life might be a good idea, the latter though seems like a bad idea with some very badly aligned incentives.
hoseja 3y ago
"Cancer is terminal." "Bankrupt and undignify the patient and their family with needless, hopeless treatment." Humane, functional american healthcare.

ethbr1 3y ago

Vets don't put down animals needlessly, but they do practice medicine closer to engineering. There's always a cost-benefit calculation, and the answer should never be 'Whatever the cost.'

naikrovek 3y ago
> There's always a cost-benefit calculation, and the answer should never be 'Whatever the cost.' You think like an insurance company: completely detached from reality.
- deleted 3y ago
  [deleted]
- dgacmu 3y ago
  No, there literally is always a tradeoff, even in human medicine. I was at my doctor's office yesterday because I'm an idiot and injured myself. I asked about the diagnostic advantages of getting an MRI vs an x-ray for the injury (sciatic pain, probably from an injury to my piriformis; don't snowboard on the east coast). The MRI might have provided better diagnostics, but the x-ray (much faster, at lower cost, but at some radiation exposure to me) ruled out the really serious stuff, and the treatment plan was the same regardless. So: Tradeoff. It was, IMO, both financially and ethically better to use the low-resource diagnostic modality instead of tying up the rare and expensive one, even though it gave me a bit of radiation that in an ideal case I wouldn't have had.
  - wpietri 3y ago
    For sure. During my mom's cancer treatment, these things came up too. E.g., In going through some options, her neuro-oncologist mentioned one drug, Avastin I think, which would have been something like $100k. In his estimation was unlikely to make any difference in her prognosis, and at best would have been a difference of days of lifespan. She was on Medicare, so it was no cost to us either way, but we all felt like it would have been a waste of money. At some point during this process it became clear to me that a "whatever the cost" approach is understandable but wrong. We're all going to die. If an intervention can restore somebody to health, to give them years of a good life, that's great. But an awful lot of money is spent on what seemed to me like prolonging the misery. That's not something I want for myself, and it's definitely not something my mom wanted. So as long as there was some hope of more good time, we fought and fought hard. But when hope ran out, we were off to hospice with no regrets. She died peacefully, surrounded by loved ones. It was a much better death than having a lot of futile last-minute interventions. Speaking of which, if this makes sense to you, make sure your loved ones know your preferences. We had all done living wills years before, and it was such a balm to know exactly what she wanted. I've used Five Wishes for this, and I'm told there are other, possibly better options now too.
    - vba616 3y ago
      >It was a much better death than having a lot of futile last-minute interventions. It's easy to say that sort of thing, so everyone does. It makes plenty of sense. People don't want to die in the hospital or go through hell in their last days or weeks. But nobody wants to die right now, ever. No matter what they said before or what papers they signed. The standard picture, the logic, makes perfect crystalline sense up until there is a choice between going to the hospital right now and living an undefined amount of time, maybe only a day or a week, but longer than the next few minutes.
      - wpietri 3y ago
        Sorry, but this is incorrect: > But nobody wants to die right now, ever. No matter what they said before or what papers they signed. Plenty of people recognize when it's time. When my mom was diagnosed with glioblastoma, her surgeon said, "This is what you will die from." That's hard to hear, but people can definitely take it on board. To realize that it's not a choice of whether, just how. Take, Brittany Maynard, who had the same thing my mom did: https://en.wikipedia.org/wiki/Brittany_Maynard https://en.wikipedia.org/wiki/Brittany_Maynard I can go as far as agreeing that American culture has a lot of collective anxiety about death, and a consequent refusal to deal with is calmly. But there are plenty of other approaches to that. Like the European movement known as Death Cafe: https://en.wikipedia.org/wiki/Death_Cafe https://en.wikipedia.org/wiki/Death_Cafe Or the (sadly now defunct) Zen Hospice here in SF: https://www.businessinsider.com/photos-of-zen-hospice-project-sf-2017-8 https://www.businessinsider.com/photos-of-zen-hospice-projec... Many things in our lives can be scary. But we can shape our relationships to them. And given that death comes to all of us, I think it's worth taking the time to get on good terms with it.
  - deleted 3y ago
    [deleted]
- pjerem 3y ago
  You are interpreting this wrongly. It’s not because there is a cost-benefit that the cost for a high benefit can’t be high. Healthcare budget is not infinite but in most countries, it’s high enough per operation that, for a given individual, it’s virtually infinite. Insurance companies don’t care about the benefit, they just want the cost to be low, it’s not the same thing.
  - ethbr1 3y ago
    > Insurance companies don’t care about the benefit, they just want the cost to be low, it’s not the same thing. Also underappreciated, at the end of the day: {insurance premiums} >= {average cost of care} The actuarial calculations don't change because they're concealed behind group-blended risk. If cost of care increases, premiums must increase as well.
  - deleted 3y ago
    [deleted]
  - refurb 3y ago
    I work in healthcare economics and this is false. There are no healthcare system in the world where the budget is “high enough to be virtually infinite”. All health systems are all heavily, heavily constrained by budget. The US system is the least constrained (i.e. if you want the latest cancer care paid for, the US is the place with the highest probability it’ll happen), but since there are thousands of insurance plans it’s not even and any two patients may have plans that make different trade offs. And governments do the very similar math as the insurance companies when it comes to cost-benefit analyses - that’s how they design their benefit offerings. The difference between systems like Canada (with universal care) and the US is that in Canada the end user doesnt see how the sausage is made. That’s because the trade offs are the same for everyone and doctors know a given trade off has been made and the technology that is not paid for is just not even brought up to the patient.
- neon5077 3y ago
  No, the reality is that an animal is usually an asset. It costs X to feed and maintain an animal over its life to achieve Y amount of profit from its sale or the sale of its products. If X plus medical costs is greater than Y, you're losing money on this animal. Tripling the amount you pay the vet does not increase the final profit margin of the animal, so you simply do not. If basic treatment costs more than the animal will generate in its life, you don't treat the animal. Thinking that any random farm animal is worth infinite medical resources is completely detached from reality. The animal is not worth it. There's not one single reason to pay more to maintain an animal than the money you get out of it. Not in this context.
aebtebeten 3y ago
Vets have an elevated suicide rate, which I ascribe to three factors: - they can self-prescribe - they commonly use, unlike human doctors, euthanasia to end suffering - they became vets because they really like animals, but many owners seem more concerned with their pocketbooks Lagniappe: https://www.youtube.com/watch?v=JChwFoCxVC8 https://www.youtube.com/watch?v=JChwFoCxVC8
- ethbr1 3y ago
  Self-prescription is definitely part of it, but farmers have brutal suicide rates too. Social isolation + a business where the business often runs counter to your moral preferences = a tough life for both The "maybe next year" line gets me every time: https://m.youtube.com/watch?v=ZRDaPEaDJ7E https://m.youtube.com/watch?v=ZRDaPEaDJ7E
- AnotherGoodName 3y ago
  From experience with a vet in the family it's very much a 'who the fuck in their right mind would do this?!' type of career to anyone that has the ability to ask a vet their honest opinion about their career choice. It's literally a medical science degree with a speciality. The same degree that can get you a very highly paid jobs elsewhere yet it doesn't pay that well. You'll likely end up in a poorly paid 24hour live-in clinic with horrible pay and hours surrounded by euthanasia and the associated grief non-stop all the while with those same drugs sitting there. The mortality rate is so horrific that news of another suicide from the graduating year becomes a 'we've lost yet another one' type of statistic. It's not often you ask someone to give a late teen thoughts on their upcoming career choice and have them rightfully say 'Don't! It's not worth it!' but this literally happened with vet science in my family.
  - peterleiser 3y ago
    I had the same experience when doing a career report in junior highschool. I spoke to a vet who had graduated from UC Davis a few years prior and they did everything in their power to talk me out of becoming one.
  - GlenTheMachine 3y ago

_heimdall 3y ago

That's not a great analogy. There are plenty of alternative treatments for cancer, and speaking of cattle there were actually Mayo Clinic doctors in the early 1900s using raw milk diets to treat serious conditions including cancer. A more apt comparison here would be vets throwing pharmaceuticals and radiation at cows who ingested metals rather than a more simple solution intervention.

non-chalad 3y ago

Might we interest you in M.A.I.D? (1) 1. https://www.theatlantic.com/magazine/archive/2023/06/canada-legalized-medical-assisted-suicide-euthanasia-death-maid/673790/ https://www.theatlantic.com/magazine/archive/2023/06/canada-...

ethbr1 3y ago
Full-disclosure: personally I'm a big supporter of an individual's right to choose to end their own life in a medically-facilitated manner. There's something weird about letting people who are happy with life (read: society) choose to force someone who isn't to continue living, against their wishes.
- non-chalad 3y ago
  Governmemt should not be involved in ending someone's life; Not at their own choosing, nor at forcing them to continue living.
  - ninjanomnom 3y ago
    The alternatives then are self service, or private businesses providing assistance? If we want to endorse the former then educating people on the best way to painlessly end their life might be a good idea, the latter though seems like a bad idea with some very badly aligned incentives.

hoseja 3y ago

"Cancer is terminal." "Bankrupt and undignify the patient and their family with needless, hopeless treatment." Humane, functional american healthcare.