There was even a study that found on the whole, simvastatin is equally helpful across races: http://www.ncbi.nlm.nih.gov/pubmed/16709304
The part about being asian is that asians tend not to catabolize statins as effectively, so his plasma levels are probably higher, since I found out he was taking a full "white person dose" despite advisories that simvastatin should be given at half dose for asians.
[0]I also recall hearing somewhere from a biochemist that while statins decrease cholesterol levels in asians the effect on coronary heart disease (which is what your really care about) is attenuated, and that there may be a secondary mechanism for CHD in asians... But I cannot find the source he was quoting.
http://www.ncbi.nlm.nih.gov/pubmed/21160131
as a bonus, here is the review on why asians should take less statins (hepatic enzyme clearance, probably a cyp450):
I'm not saying it doesn't suck, I just take issue with your narrative of how race is the issue at hand, and how the medical system is bigoted towards minorities.
>That's not a consequence of being non-white so much as it is a consequence of your doctor being uninformed, which impacts people of all races.
But it impacts minorities in the most general sense (i.e. not just color of skin) more than non-minorities. For fundamental reasons, studies are less statistically reliable, for starters.
I should remind you also that my father is being cared for under a universal system (the VA) I think that the unversality of it does play into the way that the doctors are informed.
that's exactly why the only solution is the null solution.
Bottom line: we need to live in a society where people actually help each other and actually show compassion, not create rediculous byzantine bureaucracies that marginally help the rich and politically well-connected that are an empty simulacrum of compassion.
The "null solution" is absurd. It simply provides that the rich get treatment and the poor do not. That would be "fair and equal" only to a barbarian.
You're projecting. If you were rich, would you help pay for the healthcare of the poor? Because I'm very much poor, and I give two hours a week towards helping feed people who are sick.
My taxes are too low. They should be increased. I regularly vote as such, as well as making campaign contributions to candidates and causes that would result in my taxes going up. I also make donations to charitable health care organizations such as Planned Parenthood and Doctors Without Borders.
Any more insulting questions?
Don't you see how what you say is a problem? Most of the ways you listed where you are "helping" are involuntary and inefficient. When I go out and help, I'm actually putting food directly in the hands of the people who are hungry. I won't say the org. I work for is perfect, but there is a far closer to 1-1 yield on the fruits of my effort. Because it's personal, it also makes me feel good. I think I'm less inclined to think, "well, gee, there's some welfare queen living off of my dole". There's accountability. If the welfare system screws up, there's a chain of unelected bureaucrats that are only held accountable to narcissistic fools who are elected based on unrelated wedge issues like abortion. If my volunteer organization screws up, then the donors stop giving and find other places for their money to help (without sounding too capitalistic about it, there are indeed competing orgs that could fill its shoes on a dime).
You're trying to vote to make the burden on other people greater, which will create a bigger bureaucracy, which will in all likelihood be more inefficient. Why not, instead of taxing people more, work harder to create a society that just does more efficient things to help? It's hard, because getting people to be BETTER people is not easy. But it's way worth it.
Yeah, there are problems in our country, like a kleptocratic upper class, but you don't think there might be better solutions that actually address that problem than the bludgeoney "tax 'em more!!1" - which, ultimately is based in the ugly emotion of envy?
Government is an instrument of society. I'm trying to use that societal instrument in a proven manner to solve societal problems that otherwise suffer a tragedy of the commons.
How, exactly are you solving the tragedy of the commons by expanding on its status as a "commons"?
And "Government is an instrument of society". That's true, but a somewhat vacuous statement. It's a very special instrument of society; and it is worth thinking about whether or not its special status makes it the "appropriate instrument". Do we really want the organization that invades brown countries and spies wantonly on everyone to be managing our medical system?
Before you dismiss that - when you vote for president (who is where the buck stops in terms of accountability) do you take into account whether or not he bombs brown people or spies? Do you want that part of the decision process contaminating the decision vis a vis his or her ability to manage the healthcare part?
Well, in 1950, women were at least six times more likely to die in childbirth.
> arguably care and outcomes were more compassionate in spite of less technology
I've never heard anyone argue that.
> Do we really want the organization that invades brown countries and spies wantonly on everyone to be managing our medical system?
Our medical system is and will forever be managed by the same people who manage the government -- the people.
You need to stop foisting ills off on "the government" as if it is something distinct. We, the voting American populace, are responsible for its actions. If we wanted real change, there would be real change.
We obviously do not. We are a selfish, violent people. Thinking we will be any different just because the word "government" isn't involved is hopelessly naïve.
> Do you want that part of the decision process contaminating the decision vis a vis his or her ability to manage the healthcare part?
Presidents manage very little. Cabinet secretaries and heads of independent agencies who are confirmed by the Senate oversee civil servants who manage the day-to-day operation of virtually everything that happens in the United States government.
Besides, the only system under which no one has influence over something I don't want them to is a system in which I am an absolute monarch. Do you want that?
You're cherry-picking data. 1950 wasn't a utopia. The military was spreading chlamydia and radioactive materials in black neighborhoods "just to see what would happen". But I think considering the level of social consciousness AND technology that existed at the time, things were in many ways better. More to the point, especially with regards to the discussion: If you went to the hospital, your bills were reasonable - you wouldn't go into debt, the quality of service (relative to what could be provided) was high. If you were poor, you would probably be treated pro bono without hesitation.
If your claim is that the technology to save lives really is that expensive, I think you're wrong. Even the oft-repeated mantra that it's rapacious insurance companies is a flawed narrative: http://biz.yahoo.com/p/5qpmu.html (there are rapacious companies in there but it's not insurance) and I would be deeply suspicious of whoever is selling that narrative.
"the government" as if it is something distinct
It is distinct. If you wrong me, I cannot imprison you in my basement. I cannot hire lackeys to invade your home and threaten you with guns and shoot your dog. There's a categorical difference.
>We, the voting American populace, are responsible for its actions.
No, we're not. If you "voted for the other guy", in what way are you responsible? For not trying hard enough? If you're opposed to the war, are you responsible because you didn't go far enough to stop it? How far would be enough? Saying we are is kind of jingoistic. Ultimately, we're citizens of the planet, and any given person has a finite capacity to change it for the better; and expecting responsibility for more is unreasonable.
>If we wanted real change, there would be real change.
That's true, but to get it we need to understand that government is NOT the solution to everything and think real hard about what it should and should not be a solution for.
>We are a selfish, violent people.
I don't see this at all. I think that perception is really a crazy media narrative caused by desperation from the disruption we're seeing in that industry, and partly from (mostly local) government interest groups seeding that impression to justify increased expenditures for specialized crimefighting units. Crime in the US is down over the last 20 years.
>Besides, the only system under which no one has influence over something I don't want them to is a system in which I am an absolute monarch. Do you want that?
I'm not an galtian individualist - I'm not suggesting that my ideal is one where no one has influence over me. My suggestion that we should make people BETTER is, quite the opposite - crafting a better society is, I think important, but to me, what the means to those ends are, is really worth thinking about.
No, I'm just remembering one piece of data off the top of my head.
> 1950 wasn't a utopia.
Definitely. Whether you could get access to reasonable (or even any) medical care depended on whether you were white. But one doctor has made a questionable decision about your father's care (by the way, you do know you can get second, even third opinions, even within a fully socialized system, right?), so you want to go back to segregated medicine.
> If you "voted for the other guy", in what way are you responsible?
"We" is society, not the individual. Society is responsible, and society is what you want to rely on, just without the "government" label attached. It's the most ridiculous idea I've ever heard.
I think you miss the point of universal healthcare. It is not that one group has a higher utilisation of the healthcare system and therefore should pay more - the principle is that everyone is guaranteed the same provisions for healthcare, regardless of their risk factors.
Personalised medicine contributes nothing to the concept of universal healthcare; except for the noble aim of enabling better treatment of people through understanding individual responses. ' The idea that someone should be restricted in their level of healthcare utilisation under a universal system is absurd; As is the notion that someone should be forced to contribute extra (apart from the incremental addition of a high income earner through increased taxation) due to a perceived increase in risk.
>>The faulty assumption behind universal healthcare is that a one-size-fits-all prescription is good for everyone,
Again, I feel like you are trying to talk about personalised medicine inside of the concept of universal healthcare. Forget about personalised medicine. What the US needs first is access that won't bankrupt. The fact is we don't know enough about personalised medicine to give people different treatments based on genetic characteristics. And we won't for years. Sure, you can look at 1 or 2 isolated instances at the moment (ACE-inhibitors and ARBs in Black people for instance) - but none of this matters when it comes to life-saving care, for which the treatment is going to be the same for everyone anyway, unless you happen to have some rare blood disorder in which case racial profiling and blood tests at the time of intervention will dictate management.
>> so in a way, it's a subsidy for rich white people.
How so? Because they live longer anyway? Because they are less likely to indulge in the risk factors that result in early mortality? Again, Universal healthcare doesnt discriminate. But since rich black/brown/yellow/white/green people pay a higher proportion of taxes anyway, shouldn't your argument here be that Universal healthcare is a tax on rich people?
Additionally, just because you are on a high dose of a Statin, in a high risk population, doesn't mean you are developing myopathy. CK levels should usually be checked after a month or 2 of Statin therapy in line with followup for new lipid levels, and in the absence of symptoms it can be fairly safely ruled that you aren't experiencing a complication of a statin drug. But you probably already know this.
You're missing my point. If those provisions are the same, that's exactly the problem. It's only worse if they aren't the same (because who chooses?)
CK levels warnings are only triggered when you are having a serious complication from the statin. When you have a lesser complication, like, "going to the gym sucks instead of making you feel good", and you aren't aware of what's happening, and it's making you fatter, and your quality of life is going down, then what?
The principle is not about ensuring that someone with a specific amino acid substitution receives a specific drug, because this is an example of the specific medical management of a specific patient. If you are going to continue to insist that your dad was treated inappropriately, and I have no reason to be able to assume one way or the other from my current position on the other side of the planet without a through examination of your father and his medical results, then what you are complaining about is not universal healthcare per se but in fact poor care by the treating physician. Which could happen under any system, anywhere.
>universal healthcare ... poor care by the treating physician
These issues are entangled. I should let you know, that despite being in the US, my father is effectively being treated by a "universal healthcare" system - the VA.
The issues are no more entangled than that 'healthcare providers' are a subset of 'healthcare' and within healthcare providers are going to be doctors administrating care that is not up to the best evidence. Universal healthcare is no defence against that, but either is any other form of healthcare. If you select your own doctor you have every chance of choosing one that may give you treatment against the best evidence.
It seems you are saying that universal healthcare means that you will get poor healthcare. I vehemently disagree with this proposition, not just based on your single anecdote but because I live in a country with a universal healthcare system and I have worked within it and in a few months I will be dispensing care from within it as a doctor. Every system has failures but this criticism isn't an indictment of the entire system
If you think that there will be an effective firewall between the two systems, I've got a bridge I want to sell you.
>Access to life saving treatment when required, as required, access to free hospital and cheap/free out of hospital medication
What happens when that medication is fundamentally uncheap, like herceptin, in New Zealand? Sure, herceptin is contrived, because that's a patenting issue. what if it's discodermolide, which doesn't exist in more than ~10 g quantity in the universe and is rediculously expensive to manufacture? Who gets/who doesnt?
Ultimately, no treatment is life-saving. We all die. Which ones are worth it? Who makes a valuation on life? How long until we find a hyperexpensive drug that prolongs the life of a politically-connected child with an orphan disease, and people begin to question, "why is this person's life subsidized", but not mine?
Well, there you go, you've said it yourself. What you are talking about is not universal healthcare. Debate over, closed; we aren't even talking about the same thing. You are in no way, shape or form talking about universal healthcare, don't even delude yourself that you are - in trying to define it you are explicitly defining against it.
> What happens when that medication is fundamentally uncheap, like herceptin, in New Zealand? Sure, herceptin is contrived, because that's a patenting issue. what if it's discodermolide, which doesn't exist in more than ~10 g quantity in the universe and is rediculously expensive to manufacture? Who gets/who doesnt?
Well, let's first look at the other side of the coin. What happens in the US if you want access to this Drug? What happens in Africa? These new monoclonal antibodies are presenting big challenges to health economics everywhere. As far as I can ascertain NZ currently will pay for 52 weeks of Herceptin, as best evidence suggests is most effective, in line with most other countries with universal healthcare. So in these countries, regardless of who you are, how much money you have, how old you are - if you have a HER2+ breast cancer you will receive a year's worth of Herceptin, along with all your other medical treatment. So that's Initial screening mammography , Ultrasound, FNAB, Surgcial resection +- sentinel node biopsy, radiotherapy (if local excision performed) and THEN chemotherapy.
Your cost? In australia, that would be 4.20 per filled prescription of you are a health-care card holder (low income) or $23 if you don't. All that for around $40,000 worth of surgery/Investigations and another $50,000 of chemotherapy.
In the US? I guess it would depend on your insurance but if you don't, I guess you go without.
>>Who gets/who doesnt?
Whatever way you try to spin this, more people have access in countries with universal healthcare. In the US you can either afford to pay or you can't. In other countries with universal healthcare, it is either provided free to all (thereby increasing uptake and availability of care); or, in the case of newer biologic treatments in the tens of thousands of dollars, it may not be approved, and you will then go without or for the top order who can afford to pay for it themselves, get access. So if you want to be really anal you can point and stare at that glaring inequity which occurs in very expensive drugs that have not yet been approved, or you can say that 'the system works! people are getting access to lifesaving medicines!' - which is what is actually happening
>>"why is this person's life subsidized", but not mine?
Again, the scenario you are making doesn't happen in the brutalistic 'death panel' terms you are attempting to cast it in. Yes, some medicines aren't available on government subsidy as mentioned before. But a hyperexpensive drug that prolongs the life is an example of Herceptin; it increases the survival of patients with HER2+ cancers, previously a poor prognisticator, to that of the hormone-receptor positive tumours. The actual decrease of recurrance was approx 13% over 5 years. So here we have a perfect example of a hyperexpensive drug, that improves survival, in a small subset of the population, that was relatively rapidly approved by the government for treatment. "why is this person's life subsidized", but not mine? - This doesn't happen. No-one is making those types of decisions. Anywhere. I don't know why everyone in the US who wants to argue so strongly against universal healthcare believes this is going to be the case. It simply doesn't happen and if your proposed system is looking like these things WILL happen then you should be trying to make your systems more like ours.
Bottom line: Universal Healthcare works. It delivers good outcomes to everyone without imposing a financial burden that will cripple for the remainder of life. It does this without 'death panels' that decide who gets care and who doesn't. If you want to argue differently, then you are not understanding how Universal healthcare actually works in the countries that have had it implemented for over 70 years. Is it perfect? No; but it does seem inherently more just.
Well, then any case I give you you will define away as no true scotsman, so yes, our debate is over. I think you have an idealistic and privileged view of what universal healthcare is that is completely closed-minded to the reality of it and the inherent flaws of it, and for that reason you will never understand my argument.
> but it does seem inherently more just.
Yeah of course, the US system is terrible, but if you're comparing the universal healthcare to the US system, I'm going to let you know, the bar is pretty damn low.
Making the decision objective does not make it just. Let's say I invented a drug that would keep people with blue eyes alive. Forever, no matter what. Doesn't work on brown eyed folk. Should such a drug be covered by universal healthcare?
Additionally, your thought experiment is utterly useless at illuminating any debate over the merits (or otherwise) of universal healthcare. Beyond the obvious absurdity of a drug of such potency being known about and deemed effective on such a small group of people lies the fact that were such a drug possible then the correlate for the rest of the population would doubtless follow. But I'll play. If it was possible, then the question of whether to make it available to everyone would be a matter for the government of the day. But having been tangentially involved with healthcare consulting the debate would go as such -'we have a drug that costs $x, but will make a person with blue eyes live forever (and, presumably, never need medical treatment again and be a productive tax-paying member of society). If we give everyone with condition a this, our healthcare costs to down by y, despite the one off cost'
So I'm not sure the point you're trying to make. Is it that the government shouldn't be involved in healthcare? Is it that people should be forced to suffer unless they can pay? Is it that you just want to strongly argue on the internet with a perfect stranger with lots of time to waste? You keep on shifting the goalposts on where you want this argument to head, it is clear to me that you have no concept of how a universal healthcare system works because the points you are raising seem really absurd to me; conversely I have no idea what sort of system you are trying to advocate for/against because most of your arguments seem directed against a fox-news image of universal healthcare that Has no basis in reality and that just don't understand.
I only found out because I got 23andMe, and I actually know biology. It was dismaying to find out that very few of the tests on 23andMe are useful for Asians like me (fewer still if you're hispanic and if you're pure African, the affymetrix chip they use is basically useless). As we move into an era of personalized medicine, we'll be subsidizing better healthcare and better outcomes for some ethnic groups over others.
The faulty assumption behind universal healthcare is that a one-size-fits-all prescription is good for everyone, but there are some really ugly disparities that no one talks about; and these disparities serve to reinforce preexisting social inequality. While I'm lucky to be in a minority group that's likely to live a long time - if we have it, a lot of universal healthcare coverage will wind up being plowed into gerontological care costs, which tend to be super-expensive; so in a way, it's a subsidy for rich white people.
Now, I do think the american healthcare system is awful. In particular being able to be put into permanent lifelong debt from healthcare costs is only one small step above barbarism. But I don't think that universal healthcare is the solution we're looking for. Obamacare is even worse, it combines the worst parts of universal healthcare with the worst parts of the crony capitalist system we have, and I won't be surprised when it turns out to be an even bigger albatross on the shoulders of this country.