The OP posted on that thread, so he knew this was a repost. Interesting article, but i fear for HN if reposting an old and interesting link you remember becomes a way of getting easy karma.
I suppose if the goal was karma farming then to be complete you would first repost a highly ranked story and then you would repost the highest ranked comment on your repost. And presumably if the same people read it again and voted again then you would capture the most possible re-karma points :-)
Oddly, I didn't know this was a repost. I came across the article again, I knew I'd read it before, but hadn't recalled that it had been on HN. It was posted long enough ago that the duplicate-catcher didn't alert me.
While the karma was a pleasant addition to an otherwise rough day, my intent was simply to pass on a thoughtful article to people I hoped would enjoy it. Perhaps an exponential decay on reposts would prevent abuse?
As a 26 year old American, my experiences with the US hospital system have been so abysmal that I would consider not even seeking treatment for many serious conditions unless I knew the solution would be straightforward.
Abysmal in terms of having good medical outcomes, and being treated respectfully by hospital staff (who tend to be extremely overworked).
Plus, it's degrading to have no control over how much you will be charged, and whether insurance will cover it.
I personally have had one relatively minor medical issue, so the above comes more from experiences with family members in the hospital.
I wonder how much stress over money affects the health of patients. It's just the last thing you want to worry about when your body is failing.
I also think the system puts too much stress on relatives and the patient when it comes to choices and bureaucracy. Coming from Sweden, just having to choose between 7-8 different insurance plans is headache enough, but to have to choose your doctor, your hospital etc is just too much. I don't want to have to think about it. Americans seem to value choice and being able to shop around much more highly than I do. "Being a good consumer". I can intellectually understand why, but making choices all the time for everything is very taxing and energy consuming, and at some point I just want to be taken care of.
I'm an American who typically values choice and being able to shop around, but I agree that it ends up creating this sort of unpleasant situation in healthcare. Lots of reasons, but two big ones are: 1) lots of buyers who cannot say no, e.g. someone in an ambulance on a way to a hospital is not in a strong negotiating position; and 2) the insurance model doesn't work that well, because incidents are strongly correlated within an individual's lifetime (hence the notion of "preexisting conditions" and the need for employer-tied group plans to pool risk without adverse selection), not independently insurable.
I live in Denmark currently, and I do find the healthcare system here a lot more sane. I have some choice; for example, I can choose a doctor. On that angle I actually have more choice: I can choose any doctor, and keep him/her, whereas in the U.S. I had to give up the doctor I liked when I was a kid, because my dad's company changed insurance plans and my doctor wasn't covered by the new one. And I don't have a huge bureaucratic mess of insurances and plans and bills to deal with, or worry about how changes in my employment will affect my coverage.
I disagree; government regulatory practice is mainly taking some of the worse edges off the inherently broken model of "healthcare as insurance". I'm thinking particularly of major conditions. I think regular office visits could probably be paid for out of pocket, but the real money is going towards hospitals, and that's also where free-market solutions don't work at all.
In particular, I don't see how an unregulated system would solve the correlation-across-lifetime problems. A friend of mine was born with a congenital heart defect, a "preexisting condition" since birth. In a free market, it actuarially makes little sense to sell him insurance at any kind of affordable rate, because the uncertain event already happened (he lost a particular lottery at birth). And in a really free market, that would apply to many more people, because rational insurance companies would require genetic screening before allowing coverage (which they currently can't), allowing them to uncover all sorts of less obvious genetic lottery losers. Put differently, the random risk being insured is, in large part, entire lifetimes, which the insurance market cannot handle, particularly if you think individuals should have some kind of choice (vs. some kind of setup where parents have to buy their offspring's lifetime health insurance pre-conception).
Risk pooling across a large corporation's employees is sort of a hack to approximate the needed across-population risk pooling, in the absence of a true socialized risk pool. That hack has let he U.S. hobble through much of the post-WW2 era, since a large percentage of Americans had employment-for-life at large companies, but it's poorly suited to a world of freelancers and job-hopping.
>I disagree; government regulatory practice is mainly taking some of the worse edges off the inherently broken model of "healthcare as insurance".
But the government put some of those edges there in the first place. The biggest reason you have to have insurance in the US now is without it you're going to pay 5x what the insurance company pays for the same procedure. Because they're buying medical care in bulk and you're not.
One way you could deal with that is form a co-op to negotiate prices the same way insurance companies do, but without the insurance part. But you can't, because it's illegal.
Risk pooling is supposed to happen at the insurance company level, not at, e.g., the corporate level. i.e. the insurance company is pooling risk across a lot of individual clients. That this only sort of happens now is an offshoot of the regulatory system. Of course, a large company will always be able to negotiate slightly better rates.
In a free market, whenever it is financially rational to insure someone, it would happen. So, someone probably couldn't get insurace that covers their preexisting condition (which wouldn't be fair to the insurer), but they could get coverage for other things.
And that's the way it should be. Nobody should force someone else to take care of them. People are not owed anything by the universe.
Having been denied insurance because of a procedure that I underwent to make me considerably more healthy, I call bullshit. How do you "not cover" the result of a procedure that impacted every aspect of my life while covering everything else?
Naked capitalism and healthcare can't work together (and this coming from somebody who strongly believes the government has way too many fingers in way too many pies). The priorities are too far out of whack; but that doesn't mean capitalism shouldn't have a significant role to play.
I do think government regulation (in particular, the tax benefit for companies providing insurance) have made the situation far worse than it needs to be. I talked to an insurance broker after the Obamacare vote. He told me every insurance company in my state was dropping policies for 19 year olds, since they had no say who they covered. Talk about incentivizing good behavior...
In the end, it's an incredibly complex problem that should not be handled in at the Federal level, if for no other reason than there are too many competing needs.
I do think government regulation (in particular, the tax benefit for companies providing insurance) have made the situation far worse than it needs to be.
In the end, it's an incredibly complex problem that should not be handled in at the Federal level
Then you are arguing on the wrong side.
You are like the Republican Party. You argue that one thing is practical, but another thing is moral. You cede the moral high ground to the other party. Ironic, since the moral high ground ought to be yours.
How do you "not cover" the result of a procedure that impacted every aspect of my life while covering everything else
If it's that important, why don't you just pay for it? Why do you point a gun at me and force me to pay for your procedure? If our medical system were free, it would be as efficient as the veterinary system, and the cost reduction would be commensurate. So, you see, the moral is the practical.
Naked capitalism and healthcare can't work together
Neither can capitalism and clothing, consumer electronics, toothpaste, food, transportation. I mean, everywhere we have tried capitalism, it has failed. Everywhere we have tried socialization and regulation, it has worked. Why don't we apply the model of the Soviet Union to our healthcare system? That is obviously a pro-healthy choice. </friendly_sarcasm>
I'm not "arguing on the wrong side". When you have 300 million people, you have a choice: rule by fiat or slice things into smaller pieces, because 300M people are never going to agree. State populations, on the other hand, are much more closely aligned, making an intractable problem at the federal level tractable at the state level (like many other problems). I'll get back to the government regulation in a minute, but first...
I'm not asking "you" to cover my procedure. I'm asking to be allowed into a shared risk pool at any cost due to having had a procedure. Regardless, when you buy into a shared risk pool, guess what, you have to share the risk. You can't say "I'm not sick, so I shouldn't have to pay for sick people." Your option is to buy in or not. As a personal insurance companies have smiled upon, a person has their choice to not buy in or not; for those of us they frown at, we don't have choice to buy in (short of being part of a corporate plan).
And that gets back to where the regulation has caused problems: it's set the entire industry up to have insurance companies be the customers of medical care instead of individuals, leading to all kinds of weird incentives.
For healthy people and relatively rich people, naked capitalism would be fine for healthcare. However, government is (well, should be;) about more than just building roads and bombers. It should be an embodiment of a shared responsibility we have to each other. I put reasonable[1] levels of healthcare in that shared responsibility.
I think a single-payer system, especially in the US, would fail horribly. I think we need more competition and not less. I think, most importantly, the customer for medical care (ie the person who ultimately sees the bill) should be the individual (failure of any price consciousness is another part of what got us into this situation).
But I also think everybody should have access to good quality care at prices they can afford. Today, there is an entire middle-class (not "The Middle-class") that makes too much for medicaid and too little for insurance that are just screwed. Have cancer? Too bad if you want to fight it, because one dose of the medication costs more than you make in a day. That is just inhumane and pure capitalism doesn't care. So the alternative is to quit your job so you can qualify for medicaid, but even that sucks (for bureaucratic, lack of competition, and lack of price sensitivity reasons) and is worse for the patient and our economy both.
So I believe capitalism plays a very important role in this, but I don't think, by itself, it can solve it. My perspective on this shifted a lot after going to work for myself and not being able to provide healthcare for my children after my COBRA ran out.
1. Being kept alive for years on a ventilator is nowhere near reasonable.
Ah, well that's where we disagree. I can't control what genes I'm born with, and I don't think there's anything wrong with socializing those risks across the population. Let's say there's a 1% risk of me being born with some condition. I think it's perfectly fair for me to pay 1% of the cost of treating that condition, whether I'm born with it or not. I don't see why I should pay 100% the cost if I get unlucky in the genetic lottery, or 0% if I get lucky. That's just upping the ante on a bet I wasn't even around to make. And that's the kind of pooling insurance usually does, but the mechanics of this particular risk are very hard for insurance to pool, because it happens to take place before I'm sentient enough to purchase insurance, unlike a tree falling on my house.
If anything, it strikes me as exceptionally petty and greedy for people who have the misfortune not to need to undergo surgery for a congenital heart disease to be angry about having to pay for their 1/risk chance of it.
I mean, I'm not even arguing anything particularly leftist here: F.A. Hayek made basically this argument.
I can't control what genes I'm born with, and I don't think there's anything wrong with socializing those risks across the population.
What's wrong with it is that you're initiating force against me, and making my life manifestly worse.
I mean, as someone who can pay for my own healthcare, this is what I get out of socialized medicine in the US:
(1) Less money to spend on my own healthcare issues
(2) Regulations that prevent my doctors from taking care of me in the best possible way
(3) Regulations that prevent me from getting the best medicine
(4) Anything medical is done in an extremely expensive and wasteful way
That's what you're doing to me, in order to instill your notion of what is "perfectly fair."
The U.S. medical system does not work effectively for the same reasons that the Soviet economy did not.
It's likely only going to keep getting worse with Obamacare.
You know, these posts sound a lot like "I've got mine, screw you."
Am I rare in that I wouldn't mind paying a little more if it'd mean that the country would be legitimately happier/healthier? Whether that be socialized healthcare, single-payer, or any combination.
Then just do it. It is unfortunate that Obamacare is forcing you to get insurance, but I'm sure you can find a medical plan with a ridiculously high deductible (specifically for people who are wealthy[1]) that will cost you next to nothing[2] and, similar to life insurance, protect you and your assets if something catastrophic happens.
1. I'm making no judgement about whether you are wealthy or just choose to pursue no healthcare.
You cover a lot of ground here -- socialized medicine, Obama, government regulation, "initiation of force", the fall of the Soviet Union. But just to select one:
"...as someone who can pay for my own healthcare..."
What should be done about the people who cannot?
Your profile reveals that you're an Ayn Rand fan; I don't believe Rand provided an answer to this question, other than to posit that harnessing the collective resources of society to address it, in any way, destroys essential freedom. Do you propose that "The Virtue of Selfishness" would be an effective and moral organizing principle for modern society?
In a free market, whenever it is financially rational to insure someone, it would happen.
Which is why healthcare-as-insurance is so perverse.
So, someone probably couldn't get insurace that covers their preexisting condition (which wouldn't be fair to the insurer), but they could get coverage for other things.
Would you perhaps like to volunteer at a hospital some time? Maybe you could explain objectivist principles to parents with children born with 'pre-existing conditions' like spina bifida or taysach's syndrome? Explain that they'll have to deal with a child's debilitating illness without financial aid? Maybe you could read Atlas Shrugged during storytime at a children's cancer ward? You could explain to all of those little 'Takers' how unfair their treatment is to their parent's insurance companies?
If you want to make an intellectual point, don't say something mocking and hyperbolic. Be honest about what you really believe. Be willing to defend it.
Say, "I demand that you practice altruism. I am going to force you to be good, by my definition of good, at the point of a gun."
I would want to help someone with spina bifida, but I would not want to do it because you force me to at gunpoint, while simultaneously creating a system where I myself can't get the healthcare I can actually pay for.
When I read things like this, it makes me so glad I live in the UK and don't have to endure any of this free market bullshit when it comes to health. The system you describe is just so chillingly brutal and callous.
The NHS is not perfect (as some of your tales of woe cherry-picked from right-wing newspapers suggest), but its core mission is essentially that of compassion and fairness: to provide medical care to each member of the population regardless of their financial circumstances.
Any health care system that does not aspire to that ideal is by its very nature horrendously biased against the poor.
(By the way, you should be more careful with the articles you choose to believe. For example, the research cited in the one titled "NHS death rates four times higher than US" did not show any such thing - it was a comparison between one UK and one US hospital, on a relatively tiny cohort of 1000 patients, showing a mere 7.5% difference in post-operative death rate. It is ridiculous to extrapolate this data to the entire health care systems of two countries.
This is typical of Daily Mail spin on such research - you'd be much better off not citing that newspaper at all due to its inherent bias against the NHS.)
I don't think one could conceive a metaphor more archetypal of the US than "done at the point of a gun" -- but what do you mean by that, in terms of the UK health system?
I'd say that the biggest problem is that insurance... isn't. People want to pay for it like insurance but have it act like: a shared cost equalization system, a tax feee medical saving/spending system, a group buy (collective bargaining) discount system, a network referral system, an emergency care guarantee, oh and every once in a while, a standard insurance policy.
Can you explain this more please? I am under the impression that it's almost entirely the product of a bloated insurance industry and wouldn't mind some evidence set me right.
What happens in Sweden? Does the state assign a doctor to you? What happens if you don't like that doctor and want a different one?
I wouldn't want to do away with the freedom of choice, convenient as it may be to have a default. Besides, once you've chosen all those things you can just stick with them for years on end.
I'm sure you can choose if you really really want to, but there are sensible default options. The way it should be in my opinion:
1. Go to nearest hospital, no need to worry about insurance or whether it's a "preferred" hospital for your insurance company.
2. Get assigned doctor(s) based on your needs.
3. Get treatment. No need to check what treatments are covered and if your doctor is trying to screw you over with unnecessary expensive tests.
3. Relax. No paperwork because there is a unified information system. No insurance paperwork because it's all covered.
I think it's difficult to imagine how much easier it can be, when you're used to dealing with heavy bureaucracy and insurance companies. I can't explain how much less stressed I was in that system. Then again, I'm even stressed about owning a car with all that entails in terms of check-ups, oil changes, repairs, insurance, expiring licenses, parking etc. Perhaps other people are better at dealing with this crap than I am.
For regular doctor's appointments, I don't go to the hospital, I just go to my doctor's office.
I can imagine pretty well. When things are set up with good insurance coverage, it's hardly any different than what you described, maybe with the exception of preferred networks, but in my city I've never had any doctor fall outside of the preferred network for my insurance anyway. Everything is either covered from the insurance or you get a straightforward bill, and even then you can get an HSA to cover your out-of-pocket expenses with some insurance plans. I've never had to deal with insurance paperwork either, aside from collecting my insurance card from the mail and presenting it at the doctor's office. It can easily be much, much worse though.
Well, obviously there are exceptions, but I wouldn't measure or defend a system based on the best case, but the average and standard deviation. Unfortunately, a huge amount of people are falling through the cracks. Sweden's system might be worse for rich/upper middle class people, but the average case is more than acceptable and the deviation is small. For instance, if you come in with a non life threatening condition, you will have to wait. That could mean waiting months for a specific surgery that you might get instantly in the US if you had good insurance. That kinda sucks when you have to wait and you're in pain, but is understandable unless you want to spend 50% of GDP on health care, or prioritize people based on how much they earn.
Historically, rich people from countries with socialized medicine would fly to the United States for medical treatment.
We could stand to improve the quality of care for the poor in the US, but there's lots of room to do that in the existing system. For people who have health insurance benefits from their work, I think having a little bit more paperwork is better than waiting for months for surgery.
Again, it's completely irrelevant what amazing treatment rich people get. And please, find me any evidence that American health care is in any way better or that anyone is flying there to get treatment. I can only find evidence of the contrary. If I ever get seriously sick, I'll be on the first plane out of here.
Look, your hobbyhorse is obviously this notion that there are absolutely no redeeming characteristics to the US health care system, so there's obviously no point getting into a nuanced conversation with you. It's rather off topic anyway. I regret ever thinking you were capable of a reasonable conversation.
I can't comment on Sweden, but in Canada, you essentially go to any doctor you want. It was in the US, where the insurance company more-or-less assigned a doctor, that I lacked freedom of choice.
Let me clarify that when I'm sick, I just want to be taken care of, I'm not saying that should apply to everything.
On to choices, having many choices do not make people happier, but rather the opposite, there is plenty of research backing this up. Obviously having no ability to choose makes people unhappy as well. I don't think it's laziness realizing and acting on what makes us happy and what doesn't.
If one doctor or hospital is objectively better than the other, I want to be able to choose the better one, even if having to actually choose is not fun.
I agree, and it's not just end of life treatment. I often tell people, half joking but half serious, that I would rather die than go to the hospital.
Even the simplest visit is an excruciatingly long, bureaucratic, kafkaesque nightmare where your bank account is drained, and the patient has little if any input or control over how they're treated. Hospitals just suck.
As Americans, we seem unable to realize that in many cases the best thing to do is nothing, or just keep an eye on it. We love the thought of "fighting cancer."
You can't just fix this problem at one level; it's pretty endemic. To start with, I'd love to be able to opt-out of unlikely-to-improve-my-outcome procedures, but even with those wishes doctors are likely to still act because of other pressures.
You can make your wishes explicitly known, it's called 'advanced directives' however most people either don't know about this or don't want to have to think about it because it involves facing their own mortality.
IF you really don't want CPR, or heroic measures to be taken on you, then get a DO NOT RECUSSITATE' or DNR tattoo on your chest or side, where the defib pads go (just in case) and carry around a copy of your advanced directives in your wallet.
For everything else, you will be conscious and thus have the ability to tell someone 'no'
The previous HN thread claimed that it's better to have a bracelet or necklace or similar than a tattoo, and in particular that tattoos may not actually be followed as consistently as bracelets etc.
I'm not interested in the debate as to why this is, just trying to inform people.
- a tattoo may be a strong indication that, some time ago, you had an opinion, but it isn't any kind of indication that you still are of that opinion (including a timestamp in your tattoo is an option, but impractical). A signed statement in a bracelet, on the other hand, can be updated regularly, and even if it is not updated, the fact that you still are wearing it can be seen as confirmation that your opinion hasn't changed.
Strongly agree. Last year, I had the misfortune of being sent to the ER for lightheadedness and confusion while hiking. All different doctors ran a battery of very expensive tests, none of which I was in any condition to consent to. They discovered nothing. Most of the time I spent on a bed in the hallway under piercing lights, being ignored, surrounded by such chaos that I had PTSD from it for months. Nobody was able to provide any form of tangible help. I got better on my own just resting for a few days.
That was only the beginning. I received dozens of singleton bills for the co-pay amounts for dozens of separate procedures and tests, which each arrived in my mailbox over a period of seven months. Seven months of surprise bills for various different things they did in a period of a couple of hours. The charges totalled in the thousands. And of course, for each separate charge, I got mail from both the insurance company and the hospital.
The net effect being that I received nothing except doctors saying "we see nothing wrong" and being sent home. But I had to endure finding surprise bills in the mail, and doing the paperwork to pay and file them, randomly for the next seven months. Every one a reminder of how a system took advantage of me while I was down and couldn't answer for myself.
I felt betrayed, like could not one person have the sensitivity and take the time to let me rest somewhere and feed me food and gatorade or something? And no matter how much I wanted to move on from it and get on with my life, I still had to face the bills streaming in like randomized salt rubbed into the wound.
Lesson: Take outstanding care of yourself at all times without fail. Don't have medical problems. If you do, have amazing health insurance.
Well buddy you'd be singing a different tune if the doctors discovered a medical issue and prevented you from dying.
If you were so lightheaded and confused that you were unable to be your own advocate and get yourself some fluids and food then you probably should have gone to the hospital. If you just let doctors talk you into it and you didn't think it was warranted then you have a problem with your assertion skills.
You're ignoring the very lucid point he's making. Why is that?
As a UK citizen I've never had to endure such nonsense around health. I don't know what's weirder, that such a crazy system was allowed to evolve or that people defend it.
I've had plenty of first and second hand experience with the american health care system and I am very aware that it's nowhere near ideal. This applies perhaps even more so in the area of mental health.
Still, I think the post I replied to above warrants criticism. Reading between the lines one might come to the conclusion that he went to the ER because he was out of shape.
I dont know. Its one thing when you are 65 and all your kids are grown up. Its a whole other thing when you are 50 and have young children at home. I have a friend with 4 young kids. He has stage 4 cancer requiring constant chemo and pain, but he is going to fight it with everything they have in order to be there as long as possible with his kids - and maybe beat it.
Even that issue isn't that simple. There is no right answer to the debate between being there as long as you can for them and not wanting to have them experience their parents withering away and dying, entirely helpless. I have been fortunate not to be in this position but I can't imagine the latter being very healthy for the children. It's up to every parent and family to decide this in their own way.
I've known two people in the medical field in this position, late stage cancer with young children at home. Both chose to fight with drug cocktails and experimental treatments (such as sipuleucel-T when it was in trials) but stopped short of life debilitating treatments like chemo, although one was lucky enough to get laser based irradiation therapy (I forgot the technical term, but it uses an accelerator to irradiate a tumor without harming surrounding tissue as much as chemo: http://www.protons.com/protons/index.page). I never asked but I'm guessing that they've seen all too often what the family goes through with a loved one dying from terminal cancer and don't think it's worth the pain or suffering, for the family or for them.
Some people choose to stop fighting, gain a few weeks or months of reduced pain and better (temporary) health, and settle affairs as best they can. Remember, if chemo doesn't work, then it is a longer, more painful demise.
It's a hard tradeoff. Maximize the quality time you have, and prepare for your family's future -- especially before the diagnosis comes.
If, as a US citizen, you're going to have (or need) serious treatment done for which you will have to pay a considerable amount of money it might be an option to go overseas. I can highly recommend going to Thailand. They have great medical centers in Bangkok with very professional and highly skilled doctors and specialists AND you're treated like a patient who needs care.
The following is my point of view. I understand some people have a different point of view, and I don't have a problem if they make it known, and their families and health care providers respect their wishes.
But from where I sit, the dying doctors' point of view, as presented in this article, struck me as irrational.
Axiom: Being dead is better than being alive. Under all circumstances.
I personally believe this axiom, very strongly. I'd rather spit in the eye of death with my last breath than go quietly into the night.
It logically follows, then, that a treatment that has a 1% chance of working is better than doing nothing, if the latter has a 0% chance of working, no matter how extreme the treatment is.
Living longer, even in a state of constant extreme pain, is better than dying. Well, maybe dying peacefully would be less painful for my relatives, but again, I personally place a much higher value on my own life than my family's feelings of sadness or whatever.
The only question which remains is the validity of the Axiom. If this world is all there is, if when you die there isn't an afterlife or reincarnation or whatever...then the Axiom is clearly true.
If you have strong religious belief, then perhaps your afterlife is better. But only a perfect belief that you are headed to a better place makes it rational to give up. If you have a little bit of doubt -- if you're 99% sure you're going to Heaven but 1% of you whispers that maybe there's nothing and you'll turn into dust instead -- you still want to put off rolling that die as long as you can. Ditto if you're 100% sure there's an afterlife and 99% sure you've been good enough to get into Heaven, but 1% of you says that maybe Hell is where you're headed.
If your religion forbids suicide, and there's a chance that the Judge who will weigh your life will interpret not opting for the best available medical treatment as equivalent to suicide, then that affects your decision too. Although, to be fair, this cuts both ways: The suffering you cause your family by lingering beyond your time on Earth might count against you too. Literally "Damned if you do, damned if you don't." It's unclear enough that there should really be a few more commandments or something, to address all the corner cases.
My wife is a doctor. For her, seeing people die horrible deaths is not an abstract possibility. It is something that she's seen far more of than she wants, and is likely to see in the future again more than she wants.
Despite having no particular religious views, she would disagree with your "axiom" in the strongest of possible terms. So would I. I am not religious, but my preferences include not suffering horrible pain. I also am against causing severe emotional and/or financial distress for people I care about. Those preferences lead to there being situations where I am literally better off dead than alive, and I have made sure that my wife is aware of what those situations are so that she can make that decision for me if I am incapacitated and it needs to be made.
Human life is sacred. It is a noble statement. I don't think there is anything wrong with your belief (about spitting in death's eye), except life isn't measured well as a binary option (dead or alive). (dead better than life)
In many circumstances death is by far better than life.
You need to factor in the quality of life. Its really what's important.
Take diseases like Alzheimers and neurodegenerative diseases. If I can't take care of my activities of daily living, and do not mentate - why on earth would I want to spend another day on this earth.
We can keep people alive for a terminally long time with tube feedings, rectal tubes and catheters and IV medications. Doesn't make living better than death. It also doesn't not mean that one decided to go quietly into the night.
Suffering is suffering, sometimes its better to stop suffering.
How old are you? Have you ever been hospitalized? Have you ever had a family member hospitalized?
It's easy to sit back and pontificate that you'd choose heroic medical treatment over whatever the alternative might be if you've never actually seen what that entails. It's a lot harder when you see that for most people, especially older people, it's an experience akin to being imprisoned and then tortured to death. A hospital is an awful place to spend the last moments of your life.
Everybody is entitled to their own opinion, of course, but you would really choose six months in a hospital bed, puking your guts out over three months of a reasonable quality of life? It's one thing if fighting means a 50% or greater chance of making it five years; it's quite another if fighting it means a matter of months.
How about if you were in a lot of pain and were told that you can take a pain killer but it would likely shorten your life (not necessarily a hypothetical choice)?
You speak as if death is not an inevitable destination. You're not immortal, you know. You can't stave off your demise forever. One day your existence will end and your consciousness will be permanently obliterated.
With that in mind, do you really want to be physically and mentally tortured in the last few days, weeks or months of your existence? How about at some time in the middle of your life? It all amounts to the same thing, in the end.
Sometime after that I had conversations with my Grandmother and Mother about their wishes.
I now know their expectations, and they know mine. It's important to think about death, and these situations. It's even more important to express your feelings to those who have the power to impact how you will be treated.
This is very good, but you need more than verbal undertakings. You need paper, in particular you need a Medical Power of Attorney, a notarized document authorizing you to make medical decisions on behalf of your Mother and Grandmother (and your Mother, for the Grandmother) (oh, and mutually reciprocal ones for you and your spouse if any).
Without that paper, hospital personnel may ignore you when you say what she wanted, in fact may feel they are legally required to ignore you.
And the paper needs to be accessible on short notice (not in a bank safety-deposit box). It's a good idea to have a copy filed at her primary care doctor's office.
I've seen two grandfathers of mine on which absurd medical care was given: one was seriously ill and maintained as a living mummy for months (he did look as bad as people who were rescued from extermination camp at the end of WWII) and another who, while in coma, had a leg cut off although everyone knew he wouldn't wake up. Who the heck wants to wake up with only one leg when one know you'll die in the next few hours / days of terrible cancers that spread throughout the whole body?
It's precisely what this article is talking about because it's really what's going on.
People dying in an environment they're not familiar with, experienced things they never experienced during their whole life: broken ribs due to overzealous CPR, one leg cut off, tubes everywhere.
I've had a girlfriend who was a doctor and the sheer number of crazy situation like this she was describing were insane.
Believe me: this is very real and you probably don't want the statistics.
Because the probability that you will notice, the day your day has come, that you're missing one leg while feeling your ribs being broken is very far from zero.
It seems almost purposely designed to bankrupt you as quickly as possible so that the agencies can start passing you around as some sort of billing token.
Guidelines in the US and Europe recommend compressions which are four or five cm deep, and that's a pretty significant percentage of the distance from your sternum to your back. Remember of course that one of the things that your rib cage is supposed to protect against is blows to your heart and lungs, so it shouldn't be too much of a surprise that a procedure that is supposed to compress your heart is also going to cause damage to your ribcage.
Yes this happened to my father. I remember the crunching sound of his ribs to this day. This was at waterloo station in London in 1993. He just keeled over. Fortunately for him, someone had just got stabbed 100 yards away so people were already on hand. The paramedic didn't even blink. Everyone else shit a brick.
He survived though and after a bypass op is fine to this day.
It probably helped as well that St Thomas's is literally within a few hundred yards of Waterloo Station.
The speed with which you can be in specialist care is absolutely critical when it comes to cardiac problems - which is a large part of the reason why survival rates are far higher in places like Central London where you've got both fast response time for paramedics (for London as a whole, ~75% of 'immediately life-threatening' calls have a response time of under eight minutes) and multiple world class Hospitals with specialist cardiac centres.
Even so, that's one hell of a lucky break your father had and fantastic that he both survived and is fine still!
There's new technology that automates this and the incident of rib-breakage is, as I understand, drastically minimized. (http://en.wikipedia.org/wiki/AutoPulse)
As an anecdote, my 70+ year old dentist (i.e. not the demographic with the strongest bones) had a heart attack (clinically dead). The responding EMTs used the AutoPulse, which saved his life. It pumped his heart for 10+ minutes while 1 EMT gave him air and the other drove to the hospital. No brain damage, no broken ribs.
we won't be able to repair these various cancers until we can do whole cell emulation on the offending cell and contrast/compare it to a healthy equivalent.
We need to understand the mechanics of cells down to the molecular level. Then maybe we can think of a fix. At this stage in society, we know just enough about cancers to do more harm than good in the remaining years of life for the worst forms of cancer.
There are plausible ways to fix cancer, outlined in some detail, but they are so different from the present status quo of cancer research that the community does not pursue them. If it doesn't look a lot like a drug, good luck in obtaining funding for your research.
For example, WILT / OncoSENS. Which is to say turn off all mechanisms for telomere lengthening and work around the issues that will cause by replacing stem cell populations:
Further, even a robust cure for a specific cancer based on targeted cell killing (by surface chemistry or other markers) doesn't require a complete understanding of the cancer cell - you just need to identify a reliable marker, no need to understand why it's a reliable marker.
We won't* fully correctly emulate a single human cell using deterministic computers in any reasonable timeframe. Even if we had a fully characterized model of a healthy cell, what mechanism would we then use to prevent/eliminate cancers? You still have to get something in there in order to kill the cancerous tissue, whether it's drug-based, mechanical, or radioactive. Claiming that attempting prevention/treatment is futile until a probably-not-in-our-lifetime goal is achieved is defeatist at the highest level.
Respectfully I disagree. This level of understanding is not necessary.
Metaphor: if you are fighting a fire, you don't kneed to understand the full composition of th various fuels and the exact molecular characteristics of the fire at every point, it is enough to know that water will quench it.
- I realise that many on HN have an aversion to metaphors so please forgive me and let me continue to elaborate.
Wole cell emulation is certainly not necessary, although it would no doubt be interesting to be able to do this at some long-distant point.
We don't need to do this because it really does seem as though it is enough to understand the mechanisms of unconstrained cellular proliferation through genetic analysis and surface protein characterisation.
This will allow targeted therapies through:
1) Find the genes that are Broken, or allow the final common pathway of cell proliferation to be stuck in the 'on' position, and work out how to block them.
-Initially this will be done by designed drugs following the model of glivec but one day soon (i hope) it seems likely that siRNA technologies will make it a lot easier and faster
2) characterise the surface molecules that are different in the cancerous cells and design targeted therapies for them,
- as with Trastuzamab for HER2 in receptor positive breast cancers; in the future it seems more likely that we will be able to achieve good efficacy with musing camel antibodies (smaller, high affinity), and by combining the antibodies to substances to deliver targeted radiation, chemotherapy and upregulate the immune response against the cells
3) immune system-boosting therapies which prime the immune system against specific cancers
- already shown in proof of concept for various leukemias, see New England Journal of Medicine 'Chimeric Antigen Receptor–Modified T Cells in Chronic Lymphoid Leukemias' , doi://10.1056/NEJMoa1103849
You say we need to understand the mechanics of cells down to a molecular level; in a very many cases we do:'we understand huge areas of cellular biology down to the atomic and molecular level. There are of course many things we don't understand or know yet, but emulation is not necessary for knowing them and it seems quite clear that proliferation pathways are very well characterised indeed, and have been for around 20-25 years; since all cancerous cells must proliferate by this pathway it is simply (I know, it is very difficult, but still, I say again, simply) a matter of determining which pathway is being used and blocking it, whilst also destroying the cell.
Not easy work, but I believe something that we are making good progress on.
- my 2c given a background in molecular biology and as a final year med student
