{"items": [{"author": "Todd", "source_link": "https://www.facebook.com/jefftk/posts/441600805867857?comment_id=441603219200949", "anchor": "fb-441603219200949", "service": "fb", "text": "I guess I should say I'm not surprised, but I would have been happy to be more wrong about this. Although clearly there's room for pushing things in the \"good value\" category- it's got to be worth spending at least a little extra money to avoid problems. I guess the question is how much?", "timestamp": "1337989244"}, {"author": "Mac", "source_link": "https://www.facebook.com/jefftk/posts/441600805867857?comment_id=441612669200004", "anchor": "fb-441612669200004", "service": "fb", "text": "Adjusted quality life year. Gotta understand it to make sense of $ in health care.", "timestamp": "1337990515"}, {"author": "Jeff Kaufman", "source_link": "https://www.facebook.com/jefftk/posts/441600805867857?comment_id=441659175862020", "anchor": "fb-441659175862020", "service": "fb", "text": "@Walker: I'm not sure what you're saying. In the post I do use QALYs.", "timestamp": "1337991909"}, {"author": "Mac", "source_link": "https://www.facebook.com/jefftk/posts/441600805867857?comment_id=441683409192930", "anchor": "fb-441683409192930", "service": "fb", "text": "Opps. Didn't carefully read the notes.", "timestamp": "1337994836"}, {"author": "Victor", "source_link": "https://www.facebook.com/jefftk/posts/441600805867857?comment_id=441689152525689", "anchor": "fb-441689152525689", "service": "fb", "text": "Several reports lately suggest that screening tests cause more expense and harm than good. These tests can lead to extensive tests and even unnecessary treatments. Certainly true with PSA screening for prostate cancer and probably for many other tests as well.", "timestamp": "1337995555"}, {"author": "BDan", "source_link": "https://www.facebook.com/jefftk/posts/441600805867857?comment_id=441722589189012", "anchor": "fb-441722589189012", "service": "fb", "text": "Note, however, that as far as I know all of those studies are about screening the general population -- the statistics change when you start talking about at-risk populations (like people with family histories). I'd likewise be interested to see the value of \"preventative\" care for people with chronic illnesses, who make up a huge percentage of the population. (More than 8% of all Americans have diabetes, for example, and the numbers are similar for asthma.)", "timestamp": "1338000237"}, {"author": "Kevin", "source_link": "https://www.facebook.com/jefftk/posts/441600805867857?comment_id=441727122521892", "anchor": "fb-441727122521892", "service": "fb", "text": "I think regular physicals present an excellent *opportunity* to reduce long-term costs, not just through preventive medicine but through education, networking, and doctor-patient relationships. I am distressed to hear your findings that no net benefit to this end is apparently realized during a typical annual physical.
I think medicine is profit-driven right now. If our medical culture tends to favor expensive unnecessary (and even counterproductive) procedures, and thus contact with doctors tends to promote these things, then our correct course of action is to avoid unnecessary contact with doctors?? I see a different solution...
I understand that contact with doctors costs money. It seems to me that the cost of a simple physical is a drop in the bucket of potential annual health costs. It seems like there is great potential for prevention in this context to outweigh the small cost of a physical. Not to claim that's what's happening.
There's also likely to be a lot of variation between different doctors, and different patient demographics... not just relating to doctor 'competence' and patient health risk, but relating to what transpires during a physical, what information is exchanged (both ways), and how decisions are reached.
I think there's a lot of stuff wrong with medicine. I think that conclusions need to be drawn in that context. I think it says a lot about the state of medicine that these conclusions hold up in context.", "timestamp": "1338000746"}, {"author": "John", "source_link": "https://www.facebook.com/jefftk/posts/441600805867857?comment_id=441748505853087", "anchor": "fb-441748505853087", "service": "fb", "text": "Periodic blood pressure measurement is probably very valuable because high blood pressure is usually not self-recognizable but is usually easily controlled and failure to do that can lead to much more serious consequences and expenses. SImilarly for blood sugar because diabetes when un-controlled is usually quite disastrous and expensive. Perhaps a periodic exam by a nurse practitioner would be adequate - or at a walking pharmacy. It is also useful to have records of this data to look for trends. Regular interviews to discuss diet and exercise would be helpfull", "timestamp": "1338003419"}, {"author": "Jeremy", "source_link": "https://www.facebook.com/jefftk/posts/441600805867857?comment_id=441752559186015", "anchor": "fb-441752559186015", "service": "fb", "text": "It's not surprising that it is hard to find cost savings in preventative care given that smoking may reduce societal costs (http://www.nber.org/papers/w4891 ; the author has a pro-tobacco industry history, but the analysis is nonetheless reasonable). He concludes that under certain reasonable assumptions the net savings to society are actually $0.23 per pack. However, much of the savings comes from not having to pay retirement pensions after death, and with the trend toward individual retirement savings plans, this savings may become less significant. Additionally, the net benefit to society of the person being alive may not be properly valued by the taxes the person would pay.", "timestamp": "1338003977"}, {"author": "Jeremy", "source_link": "https://www.facebook.com/jefftk/posts/441600805867857?comment_id=441757729185498", "anchor": "fb-441757729185498", "service": "fb", "text": "More generally though, medical costs, especially indirect ones, are kind of a funny thing to analyze given that the criteria various insurance companies use for determining whether to pay for a given treatment are rather arbitrary, and the development of any new treatment for a fatal disease could completely change the results. The \"Let 'Em Die\" policy of providing no medical treatment is likely to be the most cost-effective in the vast majority of cases. The exception would be for someone whose net benefit to society during the additional time alive (which obviously is near-impossible to calculate, and could well be negative for everyone or virtually everyone anyway) is greater than the cost of the medical care. (As far as I understand, most medical costs are incurred by people who are retired or near retirement, and depending on how we approximate net benefit to society, people that are retired may not be considered to contribute much value.)", "timestamp": "1338004687"}, {"author": "David Chudzicki", "source_link": "https://www.facebook.com/jefftk/posts/441600805867857?comment_id=443581109003160", "anchor": "fb-443581109003160", "service": "fb", "text": "Along the lines of BDan's comment -- the better we can predict who needs preventative treatment, the more cost effective it will be. Hence the $1 million Heritage Health Prize, a competition to build predictive models of who will need hospitalization: http://www.heritagehealthprize.com/", "timestamp": "1338232507"}, {"author": "Jeff Kaufman", "source_link": "https://www.facebook.com/jefftk/posts/441600805867857?comment_id=443601175667820", "anchor": "fb-443601175667820", "service": "fb", "text": "@Jeremy: they're computing things based on $/QALY, not minimizing societal costs. So a \"let em die\" or \"encourage smoking\" policy look as good. For example, killing everyone would do well in terms of saving society money, but not well in terms of $/QALY.", "timestamp": "1338234560"}, {"author": "George", "source_link": "https://www.facebook.com/jefftk/posts/441600805867857?comment_id=443674855660452", "anchor": "fb-443674855660452", "service": "fb", "text": "Unfortunately, the conditions of the heritage prize, unlike the netflix prize, are intolerable for many machine learning researchers in academia and industry and so many of us are not participating.", "timestamp": "1338241768"}, {"author": "Jeremy", "source_link": "https://www.facebook.com/jefftk/posts/441600805867857?comment_id=443699555657982", "anchor": "fb-443699555657982", "service": "fb", "text": "@Jeff: I didn't read through the full article, but from a cursory glance it seems that the $/QALY metric is only used for the cost-effectiveness analysis/defining what a \"good intevention\" is, but the total medical costs irrespective of number of QALYs is used for defining cost-saving interventions. On page 9, for instance, the article does comment on the fact that cost-saving measures will often increase length of life which in turn may partially or completely negate any cost savings.", "timestamp": "1338244379"}]}