birdog1960 Posted September 13, 2010 Share Posted September 13, 2010 Again, patients don't NEED to hear it from a doctor. It might make more of an impact coming from one, but people know what they're doing. And the percentage of patients who listen is still too small to create meaningful change, hence the need to legislate behavior. in this study , informing of lung age resulted in 13.6% abstinence rate at 1 year vs 6.3 for control...certainly worth my time in counseling and doubling the abstinence rate at 1 year seems a meaningful change to me...i'll bet the smokers you see who are ultimately successful at quitting and need the extra push would agree... number needed to "treat" (at minimal cost) = 14- bet that's better than nnt for pre anesthesia beta blockers. the point is, evidence, ie the scientific method, matters. Link to comment Share on other sites More sharing options...
Doc Posted September 13, 2010 Share Posted September 13, 2010 in this study , informing of lung age resulted in 13.6% abstinence rate at 1 year vs 6.3 for control...certainly worth my time in counseling and doubling the abstinence rate at 1 year seems a meaningful change to me...i'll bet the smokers you see who are ultimately successful at quitting and need the extra push would agree... number needed to "treat" (at minimal cost) = 14- bet that's better than nnt for pre anesthesia beta blockers. the point is, evidence, ie the scientific method, matters. Most treatments are based on evidence that they work. This isn't some revelation. And while getting 7.3% more smokers to quit in Hertfordshire is great, it doesn't necessarily have relevance for American smokers, nor does it address the 86.4% of smokers who don't want to quit. Hence the need to legislate behavior, to effect major change. Link to comment Share on other sites More sharing options...
IDBillzFan Posted September 13, 2010 Share Posted September 13, 2010 Most treatments are based on evidence that they work. This isn't some revelation. And while getting 7.3% more smokers to quit in Hertfordshire is great, it doesn't necessarily have relevance for American smokers, nor does it address the 86.4% of smokers who don't want to quit. Hence the need to legislate behavior, to effect major change. Frankly, now that we know drunks live longer than sober people, I'm waiting for the health care initiative that will promote incentives for more drinking. Now there's a health care bill I can get behind. Link to comment Share on other sites More sharing options...
Doc Posted September 14, 2010 Share Posted September 14, 2010 Frankly, now that we know drunks live longer than sober people, I'm waiting for the health care initiative that will promote incentives for more drinking. Now there's a health care bill I can get behind. Sorry, the alcohol lobby didn't bring enough money to the table. Link to comment Share on other sites More sharing options...
Chef Jim Posted September 14, 2010 Share Posted September 14, 2010 Sorry, the alcohol lobby didn't bring enough money to the table. Sorry dudes, I really can't give you anymore. Man's gotta eat too ya know. Link to comment Share on other sites More sharing options...
ExiledInIllinois Posted September 14, 2010 Share Posted September 14, 2010 Frankly, now that we know drunks live longer than sober people, I'm waiting for the health care initiative that will promote incentives for more drinking. Now there's a health care bill I can get behind. Correction... Drunks that start drinking after 55. So yes, once you retire or at least get close to retiring... Drink all you want! Sorry dudes, I really can't give you anymore. Man's gotta eat too ya know. You 55 yet? You still got time to croak before you are counted in that drinking study. Link to comment Share on other sites More sharing options...
birdog1960 Posted September 14, 2010 Share Posted September 14, 2010 (edited) Most treatments are based on evidence that they work. This isn't some revelation. of course not. it's widely accepted, which is why i asked how you could question it. nevertheless, the US is arguably the world leader in the use of non evidence based testing and intervention and guess what the motive generally is? profit. look at cardiac ct (calcium scoring)- absolutely no evidence of positive effect on mortality yet almost every hospital or cardiology group is hawking them for screening despite the ACC's insistence that they not be used for screening the general population. what is to be done with a positive result from a cardiac ct? no one really knows but most patients go for cath (and diagnostic cath hasn't been shown to reduce mortality like many other cardiac tests) thus churning more billings and collections. classic example of technology ahead of science but there's no one to apply the brakes. and we wonder why insurance rates increase. Edited September 14, 2010 by birdog1960 Link to comment Share on other sites More sharing options...
ExiledInIllinois Posted September 14, 2010 Share Posted September 14, 2010 (edited) of course not. it's widely accepted, which is why i asked how you could question it. nevertheless, the US is arguably the world leader in the use of non evidence based testing and intervention and guess what the motive generally is? profit. look at cardiac ct (calcium scoring)- absolutely no evidence of positive effect on mortality yet almost every hospital or cardiology group is hawking them for screening despite the ACC's insistence that they not be used for screening the general population. what is to be done with a positive result from a cardiac ct? no one really knows but most patients go for cath (and diagnostic cath hasn't been shown to reduce mortality like many other cardiac tests) thus churning more billings and collections. classic example of technology ahead of science but there's no one to apply the brakes. and we wonder why insurance rates increase. Good point. Some would say it is the patient's responsibility to "apply the brakes." Like yesterday, I take the kidlets to the dentist and they are saying that another YEARLY full mouth x-ray is needed (just my daughter) that isn't covered... Then they give me a dirty look when I say just do what is covered. These health dogs sure know how to tug on the heartstrings and make you feel like you are doing something wrong. I am federal employee... Between what my agency shells out along with my part... Over 600 bucks every two weeks... That is over 16k a year... We mine as well pock it into a fund... And take just catastrophic out... That is a tone of money! Edited September 14, 2010 by ExiledInIllinois Link to comment Share on other sites More sharing options...
Chef Jim Posted September 14, 2010 Share Posted September 14, 2010 Good point. Some would say it is the patient's responsibility to "apply the brakes." Like yesterday, I take the kidlets to the dentist and they are saying that another YEARLY full mouth x-ray is needed (just my daughter) that isn't covered... Then they give me a dirty look when I say just do what is covered. These health dogs sure know how to tug on the heartstrings and make you feel like you are doing something wrong. I am federal employee... Between what my agency shells out along with my part... Over 600 bucks every two weeks... That is over 16k a year... We mine as well pock it into a fund... And take just catastrophic out... That is a tone of money! I found a long time ago the preventive medicine is the best way to keep the dental bills low. I do whatever they tell me. You have a good dentist they will have you do the right thing. I had a great on in Orange county and I think I found one up here. Link to comment Share on other sites More sharing options...
ExiledInIllinois Posted September 14, 2010 Share Posted September 14, 2010 I found a long time ago the preventive medicine is the best way to keep the dental bills low. I do whatever they tell me. You have a good dentist they will have you do the right thing. I had a great on in Orange county and I think I found one up here. True... I totally agree. She just had x-rays and is 8... Now they want the full mouth every year... I can see every two years, she doesn't even have her adult teeth all of them. Again... I agree, just seems like a money grab and then added exposure. You are only as healthy as your teeth! They effect the whole body! I wore braces, my wife did, and now my son just got them... I think it is eqaully as important to have confidence in your smile too! On the medical insurance front... My son did break his elbow 5 years ago and it cost 15k... I guess they are know getting their (Humana) back... Link to comment Share on other sites More sharing options...
Doc Posted September 14, 2010 Share Posted September 14, 2010 of course not. it's widely accepted, which is why i asked how you could question it. nevertheless, the US is arguably the world leader in the use of non evidence based testing and intervention and guess what the motive generally is? profit. look at cardiac ct (calcium scoring)- absolutely no evidence of positive effect on mortality yet almost every hospital or cardiology group is hawking them for screening despite the ACC's insistence that they not be used for screening the general population. what is to be done with a positive result from a cardiac ct? no one really knows but most patients go for cath (and diagnostic cath hasn't been shown to reduce mortality like many other cardiac tests) thus churning more billings and collections. classic example of technology ahead of science but there's no one to apply the brakes. and we wonder why insurance rates increase. Good point. Some would say it is the patient's responsibility to "apply the brakes." That's just it. Patients want everything done. They want the latest and greatest and they don't want to have to pay/don't care who pays for it. And if something is missed, guess what happens? Yet where was tort reform in all of this? The evidence shows that tort reform reduces costs, and even Barry admitted it, but since it was only "$90B" or so, it wasn't worth pursuing. You know why? Profits (for Barry's brethren lawyers). What drives most EVERYTHING is profits. The evidence also shows that people who eat right, exercise, and avoid high risk activities, are healthier. Perhaps we should start there first? Link to comment Share on other sites More sharing options...
ExiledInIllinois Posted September 14, 2010 Share Posted September 14, 2010 The evidence also shows that people who eat right, exercise, and avoid high risk activities, are healthier. Perhaps we should start there first? True. Good luck. Easier said than done. It also costs more "up front" to maintain like you said. Especially if somebody is a poor slob working a lower paying manual labor job... I don't agree, but the last thing they might want to do is show discipline, spend more time and money, and put out any more sweat to do things "right." Again, I don't agree... Why would they toil even more... They may be already tired from toiling all day... Creates a vicious circle of undiscipline behavior. Now if they work a 40 hour weekday desk job with bennies and get compensated handsomely... There is NO excuse for being undisciplined! I am sure some will not agree with what constitutes "adequate burden" in one's life... They will just say "change it." Link to comment Share on other sites More sharing options...
birdog1960 Posted September 14, 2010 Share Posted September 14, 2010 (edited) That's just it. Patients want everything done. They want the latest and greatest and they don't want to have to pay/don't care who pays for it. And if something is missed, guess what happens? Yet where was tort reform in all of this? The evidence shows that tort reform reduces costs, and even Barry admitted it, but since it was only "$90B" or so, it wasn't worth pursuing. You know why? Profits (for Barry's brethren lawyers). What drives most EVERYTHING is profits. The evidence also shows that people who eat right, exercise, and avoid high risk activities, are healthier. Perhaps we should start there first? the govt is the only entity capable of setting evidence based practice guidelines (as done in the UK, and which you correctly construe to be rationing) which would mitigate the grocery list requests of patients and allow docs to just say no when appropriate. there would of course need to be a safe harbor within those guidelines immunizing against malpractice if they are followed. i believe this will be the course followed if reform is allowed to play out. there would likely have to be financial incentives for docs to follow the guidelines and keep costs in line. i'm all for malpractice reform in general. no argument from me that special interests block it and i find it reprehensible. i'm in total agreement on lifestyle issues. that constitutes much of my argument: less can be more. we are not getting the results we want or value for the massive expense putting catheters, needles, radiation, scalpels, scopes and monitors in and around every orifice of every patient that complains of flatulence, belly aches and restless legs. Edited September 14, 2010 by birdog1960 Link to comment Share on other sites More sharing options...
Doc Posted September 15, 2010 Share Posted September 15, 2010 If the government is going to determine what care you get, so as to contain costs, then it might as well dictate how you live, which will do far more in that respect. Any discussion on true health reform needs to start and end with people taking better care of themselves, since focusing on how to change/improve treating disease is just spinning wheels when the root causes of the problems are left unfettered. But we know that will never happen, so the problem of rising costs will continue to get worse as we insure more and more people who still don't care enough to take better care of themselves, regardless of whether we use evidence-based practice or not. Link to comment Share on other sites More sharing options...
Pine Barrens Mafia Posted September 15, 2010 Share Posted September 15, 2010 Cripple doctor fight! I keed! I keed! Link to comment Share on other sites More sharing options...
birdog1960 Posted September 15, 2010 Share Posted September 15, 2010 Cripple doctor fight! I keed! I keed! a duel. squash rackets at dawn? Link to comment Share on other sites More sharing options...
Doc Posted September 15, 2010 Share Posted September 15, 2010 Cripple doctor fight! I keed! I keed! "Cripple?" a duel. squash rackets at dawn? More like low score at noon. Link to comment Share on other sites More sharing options...
BB27 Posted September 20, 2010 Share Posted September 20, 2010 (edited) If the government is going to determine what care you get, so as to contain costs, then it might as well dictate how you live, which will do far more in that respect. Any discussion on true health reform needs to start and end with people taking better care of themselves, since focusing on how to change/improve treating disease is just spinning wheels when the root causes of the problems are left unfettered. But we know that will never happen, so the problem of rising costs will continue to get worse as we insure more and more people who still don't care enough to take better care of themselves, regardless of whether we use evidence-based practice or not. Maybe the govt should have camps where they send people who "don't take better care of themselves," ............. Oh yeah, did I mention that we are a free country? Who sets the standard? Skinny guy? Fat guy? How about athletes? Maybe if you can't run a mile in under 9 minutes? Can you see where this is going? Edited September 20, 2010 by BB27 Link to comment Share on other sites More sharing options...
Doc Posted September 20, 2010 Share Posted September 20, 2010 (edited) Maybe the govt should have camps where they send people who "don't take better care of themselves," ............. Oh yeah, did I mention that we are a free country? Who sets the standard? Skinny guy? Fat guy? How about athletes? Maybe if you can't run a mile in under 9 minutes? Can you see where this is going? Where what, or more precisely, who is going? I have no problem with letting people live their lives. But if you don't take care of yourself, don't expect a handout, and don't expect to even pay as much as someone else who is healthy, just like you wouldn't expect a bad driver to pay the same (or nothing) for car insurance. The government ultimately would like to dictate behavior, so as to curb costs, and this is just the first step. Edited September 20, 2010 by Doc Link to comment Share on other sites More sharing options...
BB27 Posted September 20, 2010 Share Posted September 20, 2010 Where what, or more precisely, who is going? I have no problem with letting people live their lives. But if you don't take care of yourself, don't expect a handout, and don't expect to even pay as much as someone else who is healthy, just like you wouldn't expect a bad driver to pay the same (or nothing) for car insurance. The government ultimately would like to dictate behavior, so as to curb costs, and this is just the first step. Your example about car insurance (you've never lived in Massachusetts ! ! ! ! ) Link to comment Share on other sites More sharing options...
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