The other Awards Obama will will this year...

[Bun-Bun]

"Hailing from Liverpool, Kenneth now lives in Welwyn garden city with his adoring wife after retiring from British rail. He has suffered from knee pains since long due to bow legs.
He had been placed on a British waiting list for knee replacements for the last couple of years. This year, after turning 81, he felt that he deserved better and wanted to enjoy a better quality of life. He was not keen on surgery in NHS hospitals. His daughter located a Knee surgeon in Chennai on the internet in her search for “Knee replacement surgery in India”.
Do you think it it false? Do you think it is unusual for people to wait two or three years for this type of "non-critical" surgery?

I have no knowledge one way or another. I assume you provide your link to support these contentions, but after reading it, I can give it little credence, and therefore still don't know. I do know you have abysmally low standards for what you'll take as evidence, at least if it supports your position.:P

[--Pete]

Hi,

Age is a perfectly relevant medical criterion, especially for prognosis. When deciding how to treat patients, prognosis is important. An organ transplant for a 20-year old could lead to half a century or more of increased lifespan. An organ transplant for an 85-year old is, most likely, not going to lead to more than a decade at the outside, accompanied by a significant QOL decrease. That's important.

To expand on this point, there are other related age factors. It is well known that with increasing age, the body's ability to endure stress and to recover from medical insult decreases. So, in your example, in addition to the reduced benefits to the older patient is the increased risks of dying during the operation, of not being able to tolerate the anti-rejection medication, and of not recovering from the surgery. The cost-benefit relationship must include these dangers as costs.

One thing that is important, though, is to have flexibility. I don't know how flexible a state run system would be. I do know, from personal experience, that there is some flexibility in our system. When I was first diagnosed with leukemia, I was told that I only qualified for a mini-transplant because of my age. However, the resistance of my leukemia to chemo removed the possibility of the mini-transplant. On the other hand, my resilience to three major rounds of chemo convinced the doctors at the Seattle Cancer Care Alliance that I was strong enough to risk a myeloablative transplant. Had they not re-evaluated the situation, the Lounge would be one grumpy old fart less.:)

--Pete

[Jester]

To expand on this point, there are other related age factors. It is well known that with increasing age, the body's ability to endure stress and to recover from medical insult decreases. So, in your example, in addition to the reduced benefits to the older patient is the increased risks of dying during the operation, of not being able to tolerate the anti-rejection medication, and of not recovering from the surgery. The cost-benefit relationship must include these dangers as costs.

Indeed. On a related note, some studies have shown that, even for perfectly healthy people, moderate waiting times can actually reduce mortality. Both doctors and patients have a propensity to want too much treatment too quickly (than is statistically optimal), and that slight delays can actually prevent more deaths due to errors and complications than immediate surgeries. Treatment is always to be judged vs. the alternatives - there is no panacea, only different states of being with different survival rates and quality of life. Sometimes, the disease is more gentle than the cure. Often times not, but it's not always easy to tell.

One thing that is important, though, is to have flexibility. I don't know how flexible a state run system would be. I do know, from personal experience, that there is some flexibility in our system. When I was first diagnosed with leukemia, I was told that I only qualified for a mini-transplant because of my age. However, the resistance of my leukemia to chemo removed the possibility of the mini-transplant. On the other hand, my resilience to three major rounds of chemo convinced the doctors at the Seattle Cancer Care Alliance that I was strong enough to risk a myeloablative transplant. Had they not re-evaluated the situation, the Lounge would be one grumpy old fart less.:)

I'm really not sure. I've seen plenty of people, both elderly and young, make it through various types of cancer in the Canadian system - and some deaths as well. Cancer doctors in Canada seem more or less like doctors anywhere - concerned primarily with finding treatments for their patients that work. I don't see anything inherent about doctors whose paycheque eventually comes from the state being less flexible about the types of treatment one receives. Without comprehensive statistics and good case studies, it would be hard to tell if this is a problem. Would your experience have been different in Canada, or the UK, or Sweden? I hope not, and I don't see any immediate reason to presume it would have been. But it is certainly a legitimate concern.

And I'm happy to still have everyone's favourite curmudgeon lounging around. Maybe someone took a peek at your "contribution" and decided that brilliant people should be kept around.:)

-Jester

[kandrathe]

Indeed. On a related note, some studies have shown that, even for perfectly healthy people, moderate waiting times can actually reduce mortality. Both doctors and patients have a propensity to want too much treatment too quickly (than is statistically optimal), and that slight delays can actually prevent more deaths due to errors and complications than immediate surgeries. Treatment is always to be judged vs. the alternatives - there is no panacea, only different states of being with different survival rates and quality of life. Sometimes, the disease is more gentle than the cure. Often times not, but it's not always easy to tell.

That's one way to make lemonade from a bad situation. So not only do you have to wait, its a good thing since your doctors don't always make the right decisions. Where do I sign up?

And I'm happy to still have everyone's favourite curmudgeon lounging around. Maybe someone took a peek at your "contribution" and decided that brilliant people should be kept around.:)

Ditto. Verbal fencing on the lounge would hardly be as fun without the old master.

[Jester]

That's one way to make lemonade from a bad situation. So not only do you have to wait, its a good thing since your doctors don't always make the right decisions. Where do I sign up?

You would prefer more people to die, maybe? This isn't a rhetorical trick, or a "silver lining", or whatever. It's a straight up calculation: X people will die without immediate treatment, but X+Y people will die *with* immediate treatment. I'd sign up for the thing that kills me less often. In fact, ceteris paribus, I'd consider it an ethical obligation. You may prefer otherwise.

-Jester

Afterthought: This is not to say that *all* wait times save lives, far from it. But moderate wait times may in fact be an overall benefit to health, rather than a detriment.

[kandrathe]

Afterthought: This is not to say that *all* wait times save lives, far from it. But moderate wait times may in fact be an overall benefit to health, rather than a detriment.

You'd need to show me the study. Intuitively, people die from their maladies, and lack of treatment. Even the example of joint replacements, where the lack of mobility results in deteriorating health, or uncertain mobility leads to a fall. Now, if you think that having a wait list of many months actually saves lives, then I'd need some evidence of that. Generally, I'd say that poor health leads to more poor health. For example, an extended injury can lead to a lack of mobility and exercise, which leads to obesity, depression, and other health problems.

Sometimes individuals are too frail for the procedure that they need, and then yes, waiting to get healthy enough to have the "operation" may save the individuals life if their malady can wait. But, I think more often than not, people are healthy enough and would be better off being treated sooner.

[eppie]

Indeed. On a related note, some studies have shown that, even for perfectly healthy people, moderate waiting times can actually reduce mortality. Both doctors and patients have a propensity to want too much treatment too quickly (than is statistically optimal), and that slight delays can actually prevent more deaths due to errors and complications than immediate surgeries. Treatment is always to be judged vs. the alternatives - there is no panacea, only different states of being with different survival rates and quality of life. Sometimes, the disease is more gentle than the cure. Often times not, but it's not always easy to tell.

-Jester

A slightly related topic. Medical treatment is also very culturally driven. In europe you can see big differences between the countries. If in the south somebody goes to the doctor and leaves without a prescription for some kind of drug, they thing the doctor is a moron. In the north doctors are more likely to prescripe some rest/vitamines/asperine, they have the idea that if you don't need to put all kind of drugs in a human body, it is better not to do it.
(of course I am talking about light illnesses, not cancer)

[Jester]

You'd need to show me the study. Intuitively, people die from their maladies, and lack of treatment. Even the example of joint replacements, where the lack of mobility results in deteriorating health, or uncertain mobility leads to a fall. Now, if you think that having a wait list of many months actually saves lives, then I'd need some evidence of that. Generally, I'd say that poor health leads to more poor health. For example, an extended injury can lead to a lack of mobility and exercise, which leads to obesity, depression, and other health problems.

Hm. Scratch the "study" part - the link from the wikipedia article appeared in the footnote to be a journal article, but it is clearly a magazine article, and not a scientific study. While I find its argument to be generally persuasive but outdated, it is clearly opinion supported with numbers, not objective evidence. Nor is it as helpful with its comparisons as it was cited to be - so don't bother looking at that as any kind of authority. However, the basic argument still makes sense, as follows.

The intuition is this - medical treatment is not risk free. Surgeries (and all treatments) lead to complications, infections, medical accidents, and so on, and those things account for nontrivial fatalities. If you treat everyone immediately, some %X is going to die from these things, and more will have less serious problems.

When one waits a couple weeks for surgery, some people will find out they didn't need treatment - their diagnosis was wrong, or their illness is not as severe as it appeared. Doctors (and especially patients) often jump the gun with treatment, because nobody likes to feel that they're not doing what's necessary. And with a "patient-as-customer" approach, patients who want a treatment tend to get it, if they can pay - even if that is not the medically optimal course of action. But those people who don't need treatment who are made to wait a few weeks will be spared the risk of medical complications - and some %X will have their lives "saved" by non-intervention. This is especially true if doctors have skill at sorting out urgent from borderline cases, and can shuffle the list accordingly.

Now, the question then becomes - are there net lives saved from avoiding unnecessary treatment, or are they outnumbered by the lives lost in delayed treatment? There's an optimum there, and at least for many conditions, the optimum is not zero wait time. (Now, it's probably not three months either.) A system that prioritizes medical criteria can, so long as it is funded appropriately, find that optimum. A private system is almost certain to overshoot it on the side of performing too many surgeries too quickly - patients and patience are surprisingly incompatible.

-Jester

[kandrathe]

Now, the question then becomes - are there net lives saved from avoiding unnecessary treatment, or are they outnumbered by the lives lost in delayed treatment?

Right.

I know of some personal anecdotes in my family where delay "has / would have" resulted in death. Not scientific. I still believe in that old adage, "get a second opinion". However, in this cost conscious world, who can afford to get one, let alone two specialists to diagnose a problem. I would surmise that the type of malady would dictate the parameters for speed of treatment. One family member wasn't feeling well, so he went to his GP, who started to run tests. He was on the treadmill and started having a heart attack, and the GP gave him nitroglycerin, and called the ambulance to take him to the hospital where they performed a quintuple bypass within a 8 hours. And, it is an interesting counter point to the article you linked. That couple did end up paying some money out of pocket for the treatment, but that was 25 years ago. That family member worked with his GP over the next few years, and with some modern drugs totally turned around his health and is now well into his late seventies with no recurrence of that health issue. After retirement, he volunteers to drive a school bus for the local school district. I would attribute his recovery and longevity to a medical system that reacted quickly to his problem, and then worked to resolve it.

I know many other tales just in my family where speedy diagnoses of acute issues and prompt action saved their life.

I'm sure there are those times when due to a bad diagnosis or due to the lack of urgency that some delay would correct an issue, or allow the patient time to be better prepared for the treatment.

I did a quick google (scholar) for "treatment+delay+mortality" and found quite a few studies where mortality and morbidity was directly linked to delays before treatment, which also includes diagnostic delay. I'm sure you are talking about the delay after diagnosis, however in misdiagnosis the delay may also be fatal.

[DeeBye]

However, in this cost conscious world, who can afford to get one, let alone two specialists to diagnose a problem.

I can! But I live in Canada so I guess I'm excluded from your poll.

I would surmise that the type of malady would dictate the parameters for speed of treatment. One family member wasn't feeling well, so he went to his GP, who started to run tests. He was on the treadmill and started having a heart attack, and the GP gave him nitroglycerin, and called the ambulance to take him to the hospital where they performed a quintuple bypass within a 8 hours.

Your family member would have received the same treatment under a universal health care system, in just as timely a manner. Also, universal health care systems have better preventative care so maybe your family member might not have had the heart attack in the first place. The follow-up care would also be better. I'm not just talking out of my ass here because my dad had a heart attack a couple of years ago and went into surgery to fix a faulty heart valve, and my wife's grandmother had a quad bypass at the age of 77. These are just anecdotes though.

[kandrathe]

Also, universal health care systems have better preventative care so maybe your family member might not have had the heart attack in the first place.

Not likely. He was foolish, thinking he could eat whatever he wanted because he worked hard. After his near death experience he traded in the fried foods, for fruits and veggies. He didn't seem like the type of guy who cared about getting his cholesterol levels checked either.

[eppie]

Not likely. He was foolish, thinking he could eat whatever he wanted because he worked hard. After his near death experience he traded in the fried foods, for fruits and veggies. He didn't seem like the type of guy who cared about getting his cholesterol levels checked either.

The problem in many western countries is that prevention by a healthy life style pattern is not seen as one of the more important things in life.....I would thus go for trying to make your health-care system work.

By the way, you do have a lot of cool 'hospital series' on TV....so it is possible.

[kandrathe]

The problem in many western countries is that prevention by a healthy life style pattern is not seen as one of the more important things in life.....I would thus go for trying to make your health-care system work.

By the way, you do have a lot of cool 'hospital series' on TV....so it is possible.

Being health conscious is occasionally fashionable, but most of the time its considered square. When you are young, you believe you are immortal, so you get addicted to soda pop, french fries, and sugary snacks. Then, when you are 30ish you get this wake up call when you suddenly discover your metabolism has slowed down and you can't work it off like you did before. I made this point before. We could save a trillion or so in health care costs, if we just spent some time and money encouraging a preventative lifestyle.

[eppie]

Being health conscious is occasionally fashionable, but most of the time its considered square. When you are young, you believe you are immortal, so you get addicted to soda pop, french fries, and sugary snacks. Then, when you are 30ish you get this wake up call when you suddenly discover your metabolism has slowed down and you can't work it off like you did before. I made this point before. We could save a trillion or so in health care costs, if we just spent some time and money encouraging a preventative lifestyle.

Probelm is that especially in the US but also in other countries, your consuming lifestyle is what keeps the economy running. Many big multinationals live of the fact the people eat too much and too much crap.
However also people that lead healthy lifes need medical care, so spending add-campaign money or changing regulations for fast food restaurant will only get you so far.