From: geb@dsl.pitt.edu (gordon e. banks)
Newsgroups: sci.med
Subject: Re: FDA still at large
Date: 30 Jul 92 18:30:24 GMT
Organization: Decision Systems Laboratory, Univ. of Pittsburgh, PA.

In article <69nmr9j.sss@netcom.com> sss@netcom.com (Small Systems Solutions) writes:
>In article <15889@pitt.UUCP> geb@dsl.pitt.edu (gordon e. banks) writes:
>>In article <h2mm4m_.sss@netcom.com> 
>>	sss@netcom.com (Small Systems Solutions) writes:
>
>>>>... Too late for them to try the low fat diet.
>>>>Just let them croak?
>>>
>>>Maybe...compare the cost of the bypass, and all comcomitant therapies, with
>>>granting basic health care to 100 people....
>>
>>"OK, Mr. Jones, we've decided that instead of giving you your bypass,
>>we'll just confiscate your $20,000 and use it to provide basic health care
>>to 100 homeless people.  You won't be needing the money anyway
>>where you're going."  Do you see the problem with this?
>
>*His* $20,000 ?  Bzzzzt!  It's a benefit paid for him out of my pocket
>and yours.  A benefit I would choose not to pay for, if you made me
>king, unless there were compelling circumstances.
>
"Well, doc, my insurance people are being assholes and they won't pay,
but I'd rather go on living, so I got together with some relatives,
and we came up with the $20,000 for my operation.  Will you do it
now?

(Probably at least half of the patients who get this procedure would
be able to do this if they had to.)

>What percentage of total U.S. Health Care Dollars are spent on the last
>six months of life?  50%, or near that?
>
Yes, that is true.  Only very sick people die, and it takes a lot
of money to try to save very sick people.  If we just had some
way of *knowing* when someone was going to die we could just cut
them off from all treatment and send them to a hospice.  The problem
is, with most of these patients, there is some chance that we can
save them and they seem to think that they want us to try.  A lot
of research is being done now on better methods of predicting, but
it still can't be done perfectly.

>If you eliminated the percentage of coronary bypasses due to lifestyle alone,
>and further eliminated those in patients whose profile shows them to
>be poor candidates for another 5 years of breathing, what percentage
>do you estimate to be left?
>
I don't think the ones that are thought to be so ill that they won't
live another 5 years will usually get bypassed, or at least they
shouldn't (e.g. someone with terminal lung cancer or AIDS).  But
almost all of the coronary occlusions are due to lifestyle.  Are
you saying that we should not make any effort to help these people?

>Prevention, prevention, prevention. The problem with this is that there
>is nothing the physician can do to make a patient take his/her advice --
>but every respected cardiologist, and even DeBakey agrees, says that
>prevention is the *only* approach for the future of controlling heart
>disease.
>
Does he?  How silly.  It is the best approach, but it isn't the only
approach, because you can't prevent all heart disease no matter what
you do.  I agree that prevention (on the part of the patient) could
stop most of the bypasses and that bypasses are too expensive to be
a good solution, but I also think you can't forbid people to use
their money to have them done if they will clearly benefit from
the procedure.  By what right could you do that?


-- 
----------------------------------------------------------------------------
Gordon Banks  N3JXP      | "Skepticism is the chastity of the intellect, and
geb@cadre.dsl.pitt.edu   |  it is shameful to surrender it too soon." 
----------------------------------------------------------------------------