2:45 PM yesterday
David Wright commented on Is Your Teen Out of Control... And Smoking Hot?.
Charles, quit using Dan's handle. Analyzing photographs of female body parts, wholly unwarrented and speculative generalizations about others' psycology, vague philosophical allusions, more sentences ending in question marks than periods. We know it's really you.
Nov 22
David Wright commented on The Cost (and Fear) of Dying.
The quoted doctor is using outrage to avoid the question. He actual answer would appear to be "yes, I do believe we should pull the plug on grandma, because we have better uses for those resources." If that's what he believes, he needs to give that answer and be prepared to defend it.
If we didn't insist on socializing medicide, we wouldn't have to "collectively come to terms" with any of this. Have a lot of money and want to spend every last dime of it buying every possible extra breath? Fine, it's your money. Your kids don't just get to decide that it would be better spent on them, and society at large certainly shouldn't. Only to the extend that we spend collective monies on health care do we need to have collective health care priorities.
If we didn't insist on socializing medicide, we wouldn't have to "collectively come to terms" with any of this. Have a lot of money and want to spend every last dime of it buying every possible extra breath? Fine, it's your money. Your kids don't just get to decide that it would be better spent on them, and society at large certainly shouldn't. Only to the extend that we spend collective monies on health care do we need to have collective health care priorities.
Nov 21
David Wright commented on The Panic Over Mammograms.
The post and several commenters overstate the "objetivity" of the mamogram recommendation.
There are a couple ways that such a recommendation could be truely objective. It could be that studies show no measurable difference in mortality between 40-50 year-olds who get mamograms and those who don't. Or it could even be that studies show increased mortality in 40-50 year-olds who get mamograms (because, e.g. of the dangers of treating false positives).
In fact, studies show neither. They show that mamograms yield about the same decrease in mortality in 40-50 year-olds as they do in 50-60 year-olds: around 15%. So why not recommend mamograms for 40-50 year-olds? Because the baseline mortality due to breast cancer in 40-50 year-olds is so low that the panel judged the small increased risk of death from this group not getting mamograms to be outweighed by the benefits of less stress and inconvenience due to the procedure, false positives, and unnecessary treatments.
But there is no scientifically objective rule about how much stress reduction is worth how much increased risk of death. By picking a different value for this "price," the panel could have concluded that 50-60 year-olds shouldn't get mamograms, or that 20-30 year-olds should.
I am not saying that the panel's pick was unreasonable, or influenced by political pressure to cuts costs. But it wasn't "scientifically objective" either, and it probably way influenced by the general feeling in the public health community that we over-treat and need to move in the other direction.
By the way, one of the things that "evidence-based medicine" can state objectively is that breast self-exams don't appear to be useful in the general population. There is no measurable difference in mortality between those who do self-exams and those who don't.
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There are a couple ways that such a recommendation could be truely objective. It could be that studies show no measurable difference in mortality between 40-50 year-olds who get mamograms and those who don't. Or it could even be that studies show increased mortality in 40-50 year-olds who get mamograms (because, e.g. of the dangers of treating false positives).
In fact, studies show neither. They show that mamograms yield about the same decrease in mortality in 40-50 year-olds as they do in 50-60 year-olds: around 15%. So why not recommend mamograms for 40-50 year-olds? Because the baseline mortality due to breast cancer in 40-50 year-olds is so low that the panel judged the small increased risk of death from this group not getting mamograms to be outweighed by the benefits of less stress and inconvenience due to the procedure, false positives, and unnecessary treatments.
But there is no scientifically objective rule about how much stress reduction is worth how much increased risk of death. By picking a different value for this "price," the panel could have concluded that 50-60 year-olds shouldn't get mamograms, or that 20-30 year-olds should.
I am not saying that the panel's pick was unreasonable, or influenced by political pressure to cuts costs. But it wasn't "scientifically objective" either, and it probably way influenced by the general feeling in the public health community that we over-treat and need to move in the other direction.
By the way, one of the things that "evidence-based medicine" can state objectively is that breast self-exams don't appear to be useful in the general population. There is no measurable difference in mortality between those who do self-exams and those who don't.
Nov 20
David Wright commented on Gov. Gregoire's Budget Speech.
There are couple innacuracies in the speech.
Hypothetically, shutting down higher education would close the gap. The state spends $5.9B on higher ed, more than twice the gap.
The state is not obligated by federal law to offer services such as medicaid. It is simply highly incentivized to do so by federal matching funds. Hypothetically, if the state were to simply stop participating in medicaid, it would save $3.3B, enough to close the gap.
She is right, by the way, about corrections. Hypothetically shutting down every state prison (releasing not just "nonviolent drug offenders" but all prisoners) would save $1.3B, not enough to close the gap.
Hypothetically, shutting down higher education would close the gap. The state spends $5.9B on higher ed, more than twice the gap.
The state is not obligated by federal law to offer services such as medicaid. It is simply highly incentivized to do so by federal matching funds. Hypothetically, if the state were to simply stop participating in medicaid, it would save $3.3B, enough to close the gap.
She is right, by the way, about corrections. Hypothetically shutting down every state prison (releasing not just "nonviolent drug offenders" but all prisoners) would save $1.3B, not enough to close the gap.
Nov 20
David Wright commented on Gov. Gregoire's Budget Speech.
@6: Yeah, because that what it looked like back in 2006, when the state's real per capita spending was what it will be if it doesn't raise taxes to cover this shortfall.
Nov 20
David Wright commented on Viaduct Park?.
Concert venue?! There is a reason most concert venues are not built as stacks of 40' wide concrete corridors.
Nov 20
David Wright commented on Gov. Gregoire Opposes "All Cuts" Budget.
Wow, with such a deep cut, we must be talking about dialing back spending to what it was 20 or 40 years ago, when Washington was full of starving people dying in the streets, right?
Let's see, $2.6B less than $32B is $29.4B, which with a population of 6.5M is $4.5K per capita. Looking back at historical state spending and adjusting for population and inflation, to find that level of real per capita spending, you have to go back to... 2006-2007.
God forbid that the state have to cut back real per capita spending to what it was 4 years ago. God forbid that anything interfere with the God-given right of government to take ~4% more real dollars out of everyone's pockets every year.
Let's see, $2.6B less than $32B is $29.4B, which with a population of 6.5M is $4.5K per capita. Looking back at historical state spending and adjusting for population and inflation, to find that level of real per capita spending, you have to go back to... 2006-2007.
God forbid that the state have to cut back real per capita spending to what it was 4 years ago. God forbid that anything interfere with the God-given right of government to take ~4% more real dollars out of everyone's pockets every year.
Nov 20
David Wright commented on The Alaskan Stereotype.
You're in Alaska for your OB-GYN rotation in Connecticut?
Nov 20
David Wright commented on Life and Death in a Recliner in South Carolina.
Very poor poster child for health-care reform.
It's one thing to ask the general public to step up and help hard-working people dealt an unforseeable blow by fate. It's another thing entirely to ask the general public to step up and stage interventions for those hell-bent on self-destructive behavior.
To act like there is no such distinction plays into the stereotype of liberals as people who don't believe in personal responsibility. Then again, maybe that's accurate...
It's one thing to ask the general public to step up and help hard-working people dealt an unforseeable blow by fate. It's another thing entirely to ask the general public to step up and stage interventions for those hell-bent on self-destructive behavior.
To act like there is no such distinction plays into the stereotype of liberals as people who don't believe in personal responsibility. Then again, maybe that's accurate...
Nov 20
David Wright commented on Gregoire May Cut Basic Health—Entirely.
We need a different model for indigent health care. Right now we try to buy a few poor people coverage that is nearly as good as what rich people paying for themselves get. Oh, it might have different co-pays or no vision or dental. But it doesn't say "we won't cover the expensive, better cancer treatment, only the 20-year-old cheap one that gives you lower survival odds".
What we need instead is an NHS-like system for indigent care. Given a pot of money, use it to buy as many QUALYs for the indigent as it can. That definitely means shutting out the indigent from the more expensive procedures. But that also frees up dollars that can be used to buy more years of life for more people.
As a bonus, by creating a stark divide between the really great treatments available to those paying their own way and the minimal treatments available to those living on the public dime, it gives people a strong incentive to get off the public plan.
What we need instead is an NHS-like system for indigent care. Given a pot of money, use it to buy as many QUALYs for the indigent as it can. That definitely means shutting out the indigent from the more expensive procedures. But that also frees up dollars that can be used to buy more years of life for more people.
As a bonus, by creating a stark divide between the really great treatments available to those paying their own way and the minimal treatments available to those living on the public dime, it gives people a strong incentive to get off the public plan.
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