6 ms·

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 t

by 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.
    - vba616 3y ago
      >Plenty of people recognize when it's time. Thank you for being relatively polite. All of the replies to my original comment have veered off from what I tried to express with the phrase "right now". I was alluding to a situation with rapid terminal cancer much later than diagnosis, but earlier than morphine + the end of communication. The fentanyl or oxycontin stage, as I recall it. I think most likely if you are ever so slightly insulated from such a situation, you might not realize it. Having a parent die of cancer when you are ~7 may not prepare you for having a parent die of cancer when you are ~37. That is how I see it now.
- extraduder_ire 3y ago
  I have vanishingly little experience, but I don't think there's a strong correlation between the cost of a medicine or treatment and its effect on health outcomes. I think it's more of a function of how rare, difficult, new (not generic or out of patent), or experimental it is. I can see going for a more costly treatment seeming more appealing psychologically though.
deleted 3y ago
[deleted]

by dgacmu 3y ago

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.
  - vba616 3y ago
    >Plenty of people recognize when it's time. Thank you for being relatively polite. All of the replies to my original comment have veered off from what I tried to express with the phrase "right now". I was alluding to a situation with rapid terminal cancer much later than diagnosis, but earlier than morphine + the end of communication. The fentanyl or oxycontin stage, as I recall it. I think most likely if you are ever so slightly insulated from such a situation, you might not realize it. Having a parent die of cancer when you are ~7 may not prepare you for having a parent die of cancer when you are ~37. That is how I see it now.
extraduder_ire 3y ago
I have vanishingly little experience, but I don't think there's a strong correlation between the cost of a medicine or treatment and its effect on health outcomes. I think it's more of a function of how rare, difficult, new (not generic or out of patent), or experimental it is. I can see going for a more costly treatment seeming more appealing psychologically though.

deleted 3y ago

[deleted]