The BG Health Care Thread: Decreasing the Surplus Population

**Byrthnoth** · 2020-08-23 06:00

I could have picked basically any class of medicine that theoretically acts inside the BBB. IMO the hierarchy is something like:
* Local acting compounds - We know the mechanism of action pretty well.
* Systemic compounds that don't cross the BBB - We are doing okay still but our understanding is dropping. Some we understand (like COX inhibitors) and some we don't (like many antibiotics).
* Interacts with the CNS - Wow, we can really only wave our hands (like tylenol, lithium, etc.)

I'll admit that psychiatry is an easy target due to this, but it isn't so unique in how little the mechanism actually matters for treatment.

This isn't something that I'm whole-cloth proposing here. It is the entire premise of evidence-based medicine.

Originally Posted by David M. Eddy

Eddy first published the term "evidence-based" in March, 1990 in an article in the Journal of the American Medical Association that laid out the principles of evidence-based guidelines and population-level policies, which Eddy described as "explicitly describing the available evidence that pertains to a policy and tying the policy to evidence instead of standard-of-care practices or the beliefs of experts.

Lets look at your example:

Originally Posted by Heavencloud

the other day i hypothetically worked with an experienced PA who came to me and had me see a pt - he was concerned about the pt but hadn't given antibiotics yet because he didn't have a source yet. i saw the patient and had him give abx right away just based on a 30 second encounter and a physical exam. pt died of septic shock later. the 30mins of delay in abx prob didn't make a difference, but if had been a physician see the patient initially i almost guarantee you treatment would have been started faster. unlucky for this patient. my shop is reducing MLP coverage because physicians are faster w/ each patient and sometimes the "fixing" of what the MLPs did is more work than it is worth. and we only have PAs, i can't even imagine how bad it would be with NPs.

In your example, why did the person fail? Did they not do the physical exam, or did they not know what to do after it? We will forever need people to collect signs, do surgery, and react in real time, but the ideal of evidence-based medicine would just be to have a recommendation program with a good interface that gets updated as new evidence comes out. It auto-loads someone's digital health record (if that mess ever gets sorted out) and recommends diagnostics/treatments using the available research. Computers are pretty good at memorizing drug interactions, so that doesn't exactly worry me.

Again, I'm not in favor of my doctors being largely mechanistically ignorant and I would prefer that they all genuinely know their specialty instead of being a poor facsimile of the proposed computer program, but unless I'm in an ER (where the goal is to keep oxygenated blood flowing) or at the orthopedic surgeon, that isn't the situation at the moment.

**Salodin** · 2020-08-23 08:12

Someone's upset that MDs are nothing but car mechanics for the body meanwhile PhDs are the real doctors

Sent from my SM-G975U using Tapatalk

**Byrthnoth** · 2020-08-23 08:20

I'm upset that we can't get more car mechanics of the body because their training is inefficient and artificially limited by the AMA.

We can't wave a wand and get more doctors or make them work twice as long, so anyone that wants M4A also needs to have some kind of plan for increasing the supply of medical care providers and deregulation is pretty clearly the winner imop.

**archibaldcrane** · 2020-08-31 21:20

https://twitter.com/archibaldcrane/s...262310917?s=19

**Ksandra** · 2020-08-31 22:04

Can you fight it since they said nothing to begin with? (I hoep ya can)

These companies are so full of shit and there's always back n' forth. If you push it hard enough they may cave.

Obviously stupid you'd have to fight it to begin with. Best of luck.

**archibaldcrane** · 2020-08-31 22:55

Originally Posted by Ksandra

Can you fight it since they said nothing to begin with? (I hoep ya can)

These companies are so full of shit and there's always back n' forth. If you push it hard enough they may cave.

Obviously stupid you'd have to fight it to begin with. Best of luck.

Well, this isn't the bill, the bill for the remainder will (supposedly) come from the hospital, so I'd have to start there. A long time ago I fought an expensive ER bill because I was unemployed and got the whole thing written off, but I had to demonstrate lack of assets and stuff and I won't be able to claim poverty on this one (despite, again, being unemployed for this one too)

**zoobernut** · 2020-09-01 15:37

The alternative is you can let it go to collections then negotiate the total amount down to a fraction with the collections company because all they want to do is close accounts and get slightly more than they paid for the debt. I saved thousands on some medical bills doing that. It might ding your credit though.

**6souls** · 2020-09-12 14:48

**6souls** · 2020-09-24 11:01

https://twitter.com/MPRnews/status/1309154122088632320

**arus2001** · 2020-09-26 15:36

Brain eating amoebas found in Texas tap water in areas near Houston.
https://twitter.com/TCEQ/status/1309702896196431878
Makes ya wonder how long it's been there. >.>

**NynJa** · 2020-09-26 16:07

Isnt Dim from Texas? That explains a lot.

**Athas** · 2020-09-26 23:19

I didn't think you could contract Naegleria just from drinking contaminated water.

**Byrthnoth** · 2020-09-27 03:12

I'm not sure that you can, but you can probably get it from showering in the water and breathing in the shower if the concentration is high enough.

**Roranora** · 2020-09-27 09:51

one might take a drink and laugh at the wrong time and snort some water through her nose and then die

**Dimmauk** · 2020-09-27 11:28

Originally Posted by NynJa

Isnt Dim from Texas? That explains a lot.

I grew up in south central Houston because my Jewish stepdad was a drug dealer. I haven't lived there since 88.

I live in San Antonio, we have pretty good water.

**Heavencloud** · 2020-10-10 20:15

https://khn.org/news/stigma-against-...the-spotlight/

Stigma Against D.O.s Had Been Dissipating Until Trump’s Doctor Took the Spotlight

https://twitter.com/lawrence/status/...327559680?s=21

**Lucavi** · 2020-10-10 21:32

Originally Posted by 6souls

I want a bonus panel where all 3 of them (and the reporter) just deck the guy at once.

**6souls** · 2021-03-09 15:15

https://twitter.com/AP/status/1369393294074056707

**Cail** · 2021-04-07 05:42

https://www.washingtonpost.com/dc-md...governor-veto/

Arkansas’ governor on Monday vetoed a ban on gender-affirming medical care for transgender youths, calling the legislation a “vast government overreach” and a “product of the cultural war in America.” 

Gov. Asa Hutchinson (R) said that if signed into law, the bill would interfere with physicians and parents “as they deal with some of the most complex and sensitive matters involving young people.”

 The bill, which is part of a wave of similar legislation across the country, would have banned doctors from providing transgender minors with gender-affirming treatments such as puberty blockers, hormone therapies and transition-related surgeries, and from referring them for such treatments. Republican lawmakers in at least 17 other states have introduced similar bans on medical treatments for transgender minors, despite opposition from major pediatric and psychiatric organizations.