The FDA bears the brunt of all public outrage of anything even tangentially related to medicine. They are bureaucrats who want to avoid responsibility at any cost. The FDA also bears none of the costs of testing new products.
What outcome did you expect?
A different model might take the utility of public safety into account. Instead of "safety at any cost", it might be "more good than harm".
That's not true. I've read the FDA regulations, and I've read transcripts of FDA hearings, which are now online. They have to weigh the benefits of the new drugs against the dangers. They have long debates in the hearings over the benefits and the potential harm. And some of the people on the panel are sympathetic to the industry. It's a difficult balance http://www.reuters.com/article/2013/10/18/us-ariad-cancer-idUSBRE99H0BP20131018
There were lots of drugs, like erythropoetin, that the drug companies over-promoted and made lots of money on, even though they were killing people. Their excuse was, "We didn't get a statistical signal." Every time a pro-business administration takes over, the FDA loosens up its regulations, and the bodies start dropping, so they tighten up the regulations again.
The FDA is not allowed to take the financial cost of the new drugs into account. That's not in their legal mandate.
If doctors were actually using these mail-order tests to make medical decisions, that would be a concern.
I don't think it's realistic to expect that anybody would for example get a double mastectomy/ovarectomy on the basis of this test. No licensed doctor in the US would operate on a woman on that basis.
(In fact, a doctor in Australia wrote an article about that in the New England Journal of Medicine. A woman had gone to a "free screening" at a "health fair" and the "alternative medicine practitioner" told her that she had cancer, and sold her a few thousand dollars worth of "alternative medicines" to treat it. This woman went to this real doctor, an oncologist, demanding to be treated for cancer. The oncologist kept telling her, "but you don't have cancer!")
Similarly, I can't follow the FDA's argument that this test could affect a patient's use of warfarin (although I give them credit for trying to make a case).
The FDA jurisdiction over medical tests (as opposed to therapeutic drugs) is interesting.
I once researched this. The manufacturer has to give the FDA enough information that the FDA has to certify that tests used for medical purposes are accurate.
Question: Exactly what do they accurately measure?
Is it enough to measure the presence of marijuana (with 99.9% accuracy)?*
Or is the medical question whether the person being tested has marijuana abuse, which means that marijuana use is interfering with education, recreation, social functioning, or some important life function?
Suppose a parent tests his teenager for marijuana, and beats her if she fails the test. Does the FDA have to consider those broader results of testing?
The FDA had a bit of trouble with these tests, and finally decided that their responsibility ended at certifying that it accurately indicated the presence of marijuana.
In 23andme, the FDA seems to be saying that it's not enough to report the results accurately (or within the stated accuracy), but they have to consider the consequences of finding out the results.
__________ *Slashdot readers will immediately recognize that if the false positive rate is 0.1%, it will falsely accuse a 1 out of 1,000 subjects, which is a lot.
There was a study reported in the New England Journal of Medicine about 10 years ago about boys who had been born with bladder exstrophy, and converted to girls.
In that condition, the abdominal wall doesn't form properly and the internal organs, including the genitals, are exposed and malformed.
When they were born, surgeons couldn't reconstruct male genitals, so they were converted into females and raised as females, with hormone replacements. Their parents were told to never disclose to them that they had originally been male. Some of them had sisters, and they were raised like their sisters.
This was a natural experiment to see the effect of nurture on gender identity.
The NEJM study was a followup of 20 of these patients most of whom were teenagers or young adults at this time.
The attempt to convert them to females was mostly unsuccessful. The children identified as males throughout childhood, by most measures. They preferred male toys, like weapons and trucks, to female toys, like dolls. They preferred male clothing. They often stated that they felt like boys. Some of them did finally assume a male identity. Most of them eventually found out about the surgery.
Out of the 20, one adjusted to being female.
They were making clear choices of male toys as early as three months old. They could actually identify weapons toys at that age and preferred them. (It's an interesting question of how evolution would "know" what a 20th century weapon is.)
So even when you convert boys to girls, and raise them as girls, they still have inherent male preferences -- which overcome strong efforts at nurture.
It seems reasonable that whatever those inherent preferences are, they could at least occasionally encourage certain STEM specialists in girls to a disproportionate degree.
I think this makes a good case that the lack of women in engineering is caused in significant part by their individual personal preferences. There are a few women engineers, but you can't expect parity.
Ha! You think Zuckerberg and Bill Gates just were lucky? Both had to fight tooth and nail against many competitors for several years and fend off many different challenges.
Your whole posts reeks of ignorance of history.
I read some of the history. Let's take Bill Gates. His father was a senior partner at the law firm of Preston, Gates & Ellis, which meant he made about $1 million a year.
So Bill Gates grew up as a multi-millionaire. If he got into horses, he could buy one. If he got into computers, he could buy one.
How many people have opportunities like that? 1%? 1/1,000?
It's true Bill Gates was smart, had to work hard and be aggressive, etc. But he also had the opportunities of being born into wealth.
You don't see a problem? Well part of the problem was this:
Dad brings home a gift for each kid, and automatically brings home the following:
Boy gets electronic toy
Girl gets nurse a doll kit
There was no asking about interests, because the societal expectations of the time. So kids with interests that weren't the norm for their gender had such interests discouraged.
Where did you see that? On 1950s television?
Boys and girls have different preferences for toys, from the earliest age. There's psychological literature on that.
>How do you as a teacher ensure that at least 40% of your students are girls? Throw out some boys that are interested in programming?
Yes. That's exactly how it works in NCLB. Identify the failing ones and pull them from the class or school before they start affecting your averages. This situation is no different.
That's how NCLB is destroying our education system.
There's lots of evidence that the main factor that affects student achievement is family income. Children from families with higher income do better on standardized tests. Children from families with lower income do worse.
When you fire teachers because their students do worse on tests, you're firing teachers who teach low-income students.
In New York City, a lot of principals are complaining that they had to fire probationary teachers who were obviously good teachers, but scored low on a composite formula that nobody (literally) understands. The ratings failed standard statistical tests.
Around the country, success stories like Michelle Rhee turned out to be due to cheating.
NCLB was invented by screwballs who hadn't taught themselves and didn't understand education (or statistics). Most of them were economists who thought you could do anything by providing economic incentives.
They didn't know enough science to realize that when you try something, and it fails repeatedly, repeatedly, your theory is wrong.
Social mobility usually refers to a relative difference, from one level of the economy to the next one up.
If you start out in a slum in Bangladesh, even if you are entrepreneurial and hard-working, you won't rise very far.
However, if you compare two developed countries --
A person starting out in the bottom 1/5 of the income distribution in France, Germany or the Scandinavian countries would be more likely to make it up to the next 1/5 than a person in the bottom 1/5 in the US.
And a person in the bottom 1/5 in those European countries would be better off in absolute terms than a person in the bottom 1/5 or 2/5 in the US. In Europe they would have free health care, housing, job training, employment services, education, day care, etc.
The Communists didn't consider free schools to be charity. They were something that the people worked to create, and they belonged to the people by right. Conversely, after they got an education, as a doctor, for example, they were expected to repay the people by working for them.
When the British started their health care system, they told people, "This is not charity. This is yours by right. Your taxes paid for it." And they referred to it as a free system.
Even the critics of Communism agree that they created a good education system. I went to a few lectures by Loren Graham, the MIT professor who was the leading expert on Soviet science in the US. I asked him whether there was anything that the Soviets did well. He said yes, their education system. I met lots of Soviet emigres who went through a lot to get out, but they always said that their children were far ahead of American students the same age.
The Soviets did put the first man in space, after all.
Which approach will give you a higher rate of literacy among poor people -- having the government establish free schools for everyone in the country, or letting parents educate their own children in the free market by paying for it?
If you look at China throughout its history, it was during the Communist period that they turned an illiterate country into a country where everyone could read.
Speaking of looking at things selectively, that isn't really a communist achievement. That happened in basically every non-impovrished country around the globe. And most of them didn't try to follow Lysenkoism in the process.......
How about a law that says movie stars can only make 100 times what the lowest wage guy on the movie set makes? Perhaps recording artists should only make some multiple of what some guy in the studio does? Maybe authors can only make some multiple of what the editors at their publishing houses make?
Does anyone really believe laws like that that would lead to net improvements in those areas, or for society in general? Paging Harrison Bergeron. This way lies madness, folks. As P.J. O'Rourke put it:
''The free market is not a creed or an ideology that political conservatives, libertarians, and Ayn Rand acolytes want Americans to take on faith. The free market is simply a measurement. The free market tells us what people are willing to pay for a given thing at a given moment. That's all the free market does. The free market is a bathroom scale. We may not like what we see when we step on the bathroom scale, but we can't pass a law making ourselves weigh 165. Liberals and leftists think we can."
The free market assumes perfect information. We don't have perfect information. We don't even have good information, especially for the most important, expensive decisions. You're in the doctor's office, and he says you need a cortisone injection. What are you going to do during your 15-minute appointment -- pull out your iPad and start searching the Internet to double-check him?
The free market works well when for buying apples at the grocery store. It doesn't work for buying health care, housing, education or retirement security.
The free market is like one of those transuranium elements, that can be created inside a particle accelerator with the application of enormous energy, and lasts for a few microseconds before spontaneously exploding into ordinary matter.
Of all countries US is one of the last in the failing list. Venezuela, Bolivia, Cuba and most of socialist Latin America, on the other hand are in utter misery. Social Democrat countries in Latin America and Europe, as France, Spain, Portugal, Brazil and Argentina are not that bad but waaay worse than US.
Do you think France is way worse than the US? If you have an income of $100,000 or more a year, you might be better off in the US (depending on what your preferences are for luxury). If you have an income of $25,000 or less, you'd be better off in France. For one thing, you'd have pretty good health care. Doctors do house calls. For another, you'd have education. University education is still free in France, after a few demonstrations in the street to preserve it. The same university education in the U.S. would cost $100,000, and most would leave most middle class students in debt for the rest of their lives.
China is indeed doing fine (compared to what it has been during its communist phase), but it is probably one of the countries who is most practicing free market in the world currently.
If you expand the definition of "free market" to include an economy in which the members of the Communist Party political elite and the army have all the capital and and all the connections, and make all the money. The most important thing is still who your father is. It's not a country where a bright, hardworking young guy from the country can rise like Andrew Carnegie. Their health care system is a horror. Doctors give treatments that actually harm their patients (like quack "brain surgery" and IV antibiotics), because the treatments are very profitable.
They adopted the former model of the CP and army running everything, and turned it into capitalist factories where the same people who ran the CP and army still run everything.
So, you see the farther you go from Free Market the poorer the economy of a given country does. You can analyze any country throughout its history.
If you look at China throughout its history, it was during the Communist period that they turned an illiterate country into a country where everyone could read. That was the indisputable great accomplishment of the Communist party in most parts of the world -- they taught everyone to read. (When the Communists controlled Afghanistan, girls and women were going to school.) The Chinese Communists turned China into a country with a literate, educated population and an industrial base for its new capitalists to take advantage of.
You seem to be looking at social indicators selectively. There are several in which the US does badly. For example, we have among the lowest social mobility in the developed world. In the US, your father's income and social status determine your income and social status to a greater degree than almost anywhere else. We're equal to Brazil. Our health care indicators aren't that good either.
On the contrary. I pay for the test. I pay a huge premium because I wanted a policy that would cover all my medical expenses. I've paid much more to my insurance company than I took out of them.
The point is not to have more total procedures. The point is to have the care that alleviates illness and suffering.
We take far more MRI and CT scans in this country than are appropriate for medical treatment. A British radiologist wrote an essay in the New England Journal of Medicine about how, when he was in training, he told his supervisor that he wanted to do a CT scan. The supervisor asked him, What for? It's not going to make any difference in how you treat your patient. When he came to this country, doctors ordered CT scans indiscriminately, even when they had no diagnostic value. CT scans expose patients to a lot of radiation. It's hard to calculate exactly how many cancer deaths are caused by excess CTs in the US, but most calculations are in the thousands.
The reason is that radiologists get paid by the x-ray. If a radiologist can bill $2,000 for a useless CT scan, a lot of them will do it. Especially if he just bought a $3 million machine and he's making payments on it.
The cost of health care in Canada is half of ours. They were slower to adopt CTs and they do a lot fewer. Their outcomes are just as good.
If you could diagnose a patient by giving him a $1,000 x-ray, or get the same diagnosis by simply asking him a few questions, why in the world would you give him an x-ray? Which is what the British would say.
The solution, if you want one, is to evaluate treatments by evidence-based medicine, to avoid waste, as NICE does in the UK.
The real point is that she should be allowed to refer you to someone who is allowed, in this case a dermatologist. The whole GP-as-gatekeeper issue is really profit-driven disfunction. Of course, in most jurisdictions medicine is a self-regulating profession statistically dominated by GPs, so it may be a while before that changes.
If she refers me to a dermatologist, I'm out (or rather, my insurance company is out) $200. If I show it to my GP, he can immediately tell me that it's nothing to worry about, in one of my regular visits, for which my insurance company pays $50. So how did the NP save any money? Or convenience? Or anything?
If diabetics can give themselves their own insulin injections, there's no reason the average Joe shouldn't be able to give themselves a flu shot, or at least get one from somebody who doesn't cost as much to employ as a nurse.
When I got my flu shot, the nurse had an epi-pen prominently on the table. A small number of people respond to flu shots with an anaphylactic reaction. If you had an anaphylactic reaction, would you want it to be handled by a nurse or by a graduate of a 6-month medical technologist school?
We need to bring the cost of healthcare down, especially for routine procedures if we want people to be able to afford medical care in the future.
Other countries have brought their cost of health care down. Canada spends half what we do for the same outcomes. Maybe we should try some of their ideas.
How do you think tests always work? The doctor sends you out to get tested, you get the test results, and the doctor explains them to you. Getting them at Walmart instead of paying $400 at some "lab" in a strip mall changes nothing except price.
My doctor's office takes a blood and urine test and sends it to the lab himself. Then he reviews them to see whether they show any reason for further intervention, and gives me a copy. My insurance covers it. Under Obamacare, all the insurance companies will cover recommended tests with no copayments, so you won't be saving any money.
There's not just one set of blood tests, there are many different panels of tests. There's the SMA-12, SMA-20, and others. A doctor will order particular tests because he wants to check something out. If a doctor thinks I might have lupus or multiple sclerosis, he'll order tests for that. Wallmart isn't going to do that.
Medical tests aren't commodities. One of the most important things about routine tests like PSA is the trend over time. Testing equipment has to be calibrated. Two labs can get different readings for the same blood sample. That's why a doctor would want to use his own lab. If your PSA is up from last year, is that because you have prostate cancer, or because the Wallmart lab is calibrated differently than the CVS lab?
I don't think do-it-yourself medicine is the way to save costs.
The point is that even though your doctor orders tests, it's useless, often misleading, and sometimes dangerous for you to bypass your doctor and get the same (or similar) tests cheap in a pharmacy.
If you don't have the skill set to understand the tests, and your pharmacist can't legally explain them to you (because he doesn't have the skill set either) what's the point of getting them?
Slashdot Mirror
George W Bush knew that there were no WMDs in Iraq, but he had to go ahead too.
I think the wording of the law is "diagnose or treat."
Informing someone of a predisposition to a disease may not fall under that authority.
I'm glad that Sergy Brinn's ex-wife has enough money to take it to court to get a fully-argued resolution.
"don't have the right paperwork" is a big deal. That's like not having a reliable source in a Wikipedia article.
You wouldn't want to go to a doctor who didn't have the right paperwork.
The FDA bears the brunt of all public outrage of anything even tangentially related to medicine. They are bureaucrats who want to avoid responsibility at any cost. The FDA also bears none of the costs of testing new products.
What outcome did you expect?
A different model might take the utility of public safety into account. Instead of "safety at any cost", it might be "more good than harm".
That's not true. I've read the FDA regulations, and I've read transcripts of FDA hearings, which are now online. They have to weigh the benefits of the new drugs against the dangers. They have long debates in the hearings over the benefits and the potential harm. And some of the people on the panel are sympathetic to the industry. It's a difficult balance http://www.reuters.com/article/2013/10/18/us-ariad-cancer-idUSBRE99H0BP20131018
There were lots of drugs, like erythropoetin, that the drug companies over-promoted and made lots of money on, even though they were killing people. Their excuse was, "We didn't get a statistical signal." Every time a pro-business administration takes over, the FDA loosens up its regulations, and the bodies start dropping, so they tighten up the regulations again.
The FDA is not allowed to take the financial cost of the new drugs into account. That's not in their legal mandate.
If doctors were actually using these mail-order tests to make medical decisions, that would be a concern.
I don't think it's realistic to expect that anybody would for example get a double mastectomy/ovarectomy on the basis of this test. No licensed doctor in the US would operate on a woman on that basis.
(In fact, a doctor in Australia wrote an article about that in the New England Journal of Medicine. A woman had gone to a "free screening" at a "health fair" and the "alternative medicine practitioner" told her that she had cancer, and sold her a few thousand dollars worth of "alternative medicines" to treat it. This woman went to this real doctor, an oncologist, demanding to be treated for cancer. The oncologist kept telling her, "but you don't have cancer!")
Similarly, I can't follow the FDA's argument that this test could affect a patient's use of warfarin (although I give them credit for trying to make a case).
The FDA seems to give a free hand to companies selling some dubious tests http://www.hairanalysiskit.com/glink/1a.htm?gclid=COTshpbjgLsCFQbNOgodGUMAbQ so there are some legitimate questions.
Regulators protecting us from dangerous health fraud? Or jack-booted thugs restricting our freedom? You decide.
The FDA jurisdiction over medical tests (as opposed to therapeutic drugs) is interesting.
I once researched this. The manufacturer has to give the FDA enough information that the FDA has to certify that tests used for medical purposes are accurate.
Question: Exactly what do they accurately measure?
Take this test, for example: http://www.walgreens.com/store/c/at-home-drug-test,-marijuana/ID=prod375983-product
Is it enough to measure the presence of marijuana (with 99.9% accuracy)?*
Or is the medical question whether the person being tested has marijuana abuse, which means that marijuana use is interfering with education, recreation, social functioning, or some important life function?
Suppose a parent tests his teenager for marijuana, and beats her if she fails the test. Does the FDA have to consider those broader results of testing?
The FDA had a bit of trouble with these tests, and finally decided that their responsibility ended at certifying that it accurately indicated the presence of marijuana.
In 23andme, the FDA seems to be saying that it's not enough to report the results accurately (or within the stated accuracy), but they have to consider the consequences of finding out the results.
__________
*Slashdot readers will immediately recognize that if the false positive rate is 0.1%, it will falsely accuse a 1 out of 1,000 subjects, which is a lot.
There was a study reported in the New England Journal of Medicine about 10 years ago about boys who had been born with bladder exstrophy, and converted to girls.
In that condition, the abdominal wall doesn't form properly and the internal organs, including the genitals, are exposed and malformed.
When they were born, surgeons couldn't reconstruct male genitals, so they were converted into females and raised as females, with hormone replacements. Their parents were told to never disclose to them that they had originally been male. Some of them had sisters, and they were raised like their sisters.
This was a natural experiment to see the effect of nurture on gender identity.
The NEJM study was a followup of 20 of these patients most of whom were teenagers or young adults at this time.
The attempt to convert them to females was mostly unsuccessful. The children identified as males throughout childhood, by most measures. They preferred male toys, like weapons and trucks, to female toys, like dolls. They preferred male clothing. They often stated that they felt like boys. Some of them did finally assume a male identity. Most of them eventually found out about the surgery.
Out of the 20, one adjusted to being female.
They were making clear choices of male toys as early as three months old. They could actually identify weapons toys at that age and preferred them. (It's an interesting question of how evolution would "know" what a 20th century weapon is.)
So even when you convert boys to girls, and raise them as girls, they still have inherent male preferences -- which overcome strong efforts at nurture.
It seems reasonable that whatever those inherent preferences are, they could at least occasionally encourage certain STEM specialists in girls to a disproportionate degree.
I think this makes a good case that the lack of women in engineering is caused in significant part by their individual personal preferences. There are a few women engineers, but you can't expect parity.
Ha! You think Zuckerberg and Bill Gates just were lucky? Both had to fight tooth and nail against many competitors for several years and fend off many different challenges.
Your whole posts reeks of ignorance of history.
I read some of the history. Let's take Bill Gates. His father was a senior partner at the law firm of Preston, Gates & Ellis, which meant he made about $1 million a year.
So Bill Gates grew up as a multi-millionaire. If he got into horses, he could buy one. If he got into computers, he could buy one.
How many people have opportunities like that? 1%? 1/1,000?
It's true Bill Gates was smart, had to work hard and be aggressive, etc. But he also had the opportunities of being born into wealth.
You don't see a problem? Well part of the problem was this:
Dad brings home a gift for each kid, and automatically brings home the following:
Boy gets electronic toy
Girl gets nurse a doll kit
There was no asking about interests, because the societal expectations of the time. So kids with interests that weren't the norm for their gender had such interests discouraged.
Where did you see that? On 1950s television?
Boys and girls have different preferences for toys, from the earliest age. There's psychological literature on that.
>How do you as a teacher ensure that at least 40% of your students are girls? Throw out some boys that are interested in programming?
Yes. That's exactly how it works in NCLB. Identify the failing ones and pull them from the class or school before they start affecting your averages. This situation is no different.
That's how NCLB is destroying our education system.
There's lots of evidence that the main factor that affects student achievement is family income. Children from families with higher income do better on standardized tests. Children from families with lower income do worse.
When you fire teachers because their students do worse on tests, you're firing teachers who teach low-income students.
In New York City, a lot of principals are complaining that they had to fire probationary teachers who were obviously good teachers, but scored low on a composite formula that nobody (literally) understands. The ratings failed standard statistical tests.
Around the country, success stories like Michelle Rhee turned out to be due to cheating.
NCLB was invented by screwballs who hadn't taught themselves and didn't understand education (or statistics). Most of them were economists who thought you could do anything by providing economic incentives.
They didn't know enough science to realize that when you try something, and it fails repeatedly, repeatedly, your theory is wrong.
Yes.
Social mobility usually refers to a relative difference, from one level of the economy to the next one up.
If you start out in a slum in Bangladesh, even if you are entrepreneurial and hard-working, you won't rise very far.
However, if you compare two developed countries --
A person starting out in the bottom 1/5 of the income distribution in France, Germany or the Scandinavian countries would be more likely to make it up to the next 1/5 than a person in the bottom 1/5 in the US.
And a person in the bottom 1/5 in those European countries would be better off in absolute terms than a person in the bottom 1/5 or 2/5 in the US. In Europe they would have free health care, housing, job training, employment services, education, day care, etc.
The Communists didn't consider free schools to be charity. They were something that the people worked to create, and they belonged to the people by right. Conversely, after they got an education, as a doctor, for example, they were expected to repay the people by working for them.
When the British started their health care system, they told people, "This is not charity. This is yours by right. Your taxes paid for it." And they referred to it as a free system.
Even the critics of Communism agree that they created a good education system. I went to a few lectures by Loren Graham, the MIT professor who was the leading expert on Soviet science in the US. I asked him whether there was anything that the Soviets did well. He said yes, their education system. I met lots of Soviet emigres who went through a lot to get out, but they always said that their children were far ahead of American students the same age.
The Soviets did put the first man in space, after all.
Which approach will give you a higher rate of literacy among poor people -- having the government establish free schools for everyone in the country, or letting parents educate their own children in the free market by paying for it?
What about your negroes in the South?
If you look at China throughout its history, it was during the Communist period that they turned an illiterate country into a country where everyone could read.
Speaking of looking at things selectively, that isn't really a communist achievement. That happened in basically every non-impovrished country around the globe. And most of them didn't try to follow Lysenkoism in the process.......
China has a higher literacy rate than India.
How about a law that says movie stars can only make 100 times what the lowest wage guy on the movie set makes? Perhaps recording artists should only make some multiple of what some guy in the studio does? Maybe authors can only make some multiple of what the editors at their publishing houses make?
Does anyone really believe laws like that that would lead to net improvements in those areas, or for society in general? Paging Harrison Bergeron. This way lies madness, folks. As P.J. O'Rourke put it:
The free market assumes perfect information. We don't have perfect information. We don't even have good information, especially for the most important, expensive decisions. You're in the doctor's office, and he says you need a cortisone injection. What are you going to do during your 15-minute appointment -- pull out your iPad and start searching the Internet to double-check him?
The free market works well when for buying apples at the grocery store. It doesn't work for buying health care, housing, education or retirement security.
The free market is like one of those transuranium elements, that can be created inside a particle accelerator with the application of enormous energy, and lasts for a few microseconds before spontaneously exploding into ordinary matter.
Of all countries US is one of the last in the failing list. Venezuela, Bolivia, Cuba and most of socialist Latin America, on the other hand are in utter misery. Social Democrat countries in Latin America and Europe, as France, Spain, Portugal, Brazil and Argentina are not that bad but waaay worse than US.
Do you think France is way worse than the US? If you have an income of $100,000 or more a year, you might be better off in the US (depending on what your preferences are for luxury). If you have an income of $25,000 or less, you'd be better off in France. For one thing, you'd have pretty good health care. Doctors do house calls. For another, you'd have education. University education is still free in France, after a few demonstrations in the street to preserve it. The same university education in the U.S. would cost $100,000, and most would leave most middle class students in debt for the rest of their lives.
China is indeed doing fine (compared to what it has been during its communist phase), but it is probably one of the countries who is most practicing free market in the world currently.
If you expand the definition of "free market" to include an economy in which the members of the Communist Party political elite and the army have all the capital and and all the connections, and make all the money. The most important thing is still who your father is. It's not a country where a bright, hardworking young guy from the country can rise like Andrew Carnegie. Their health care system is a horror. Doctors give treatments that actually harm their patients (like quack "brain surgery" and IV antibiotics), because the treatments are very profitable.
They adopted the former model of the CP and army running everything, and turned it into capitalist factories where the same people who ran the CP and army still run everything.
So, you see the farther you go from Free Market the poorer the economy of a given country does. You can analyze any country throughout its history.
If you look at China throughout its history, it was during the Communist period that they turned an illiterate country into a country where everyone could read. That was the indisputable great accomplishment of the Communist party in most parts of the world -- they taught everyone to read. (When the Communists controlled Afghanistan, girls and women were going to school.) The Chinese Communists turned China into a country with a literate, educated population and an industrial base for its new capitalists to take advantage of.
You seem to be looking at social indicators selectively. There are several in which the US does badly. For example, we have among the lowest social mobility in the developed world. In the US, your father's income and social status determine your income and social status to a greater degree than almost anywhere else. We're equal to Brazil. Our health care indicators aren't that good either.
Case in point:
In patients with sciatica, MRI at 1 year did not differentiate between a favorable or unfavorable outcome.
By: Mushlin, Alvin I. ACP Journal Club. 8/20/2013, Vol. 159 Issue 4, p1-1. 1p. 1 Chart.
On the contrary. I pay for the test. I pay a huge premium because I wanted a policy that would cover all my medical expenses. I've paid much more to my insurance company than I took out of them.
The point is not to have more total procedures. The point is to have the care that alleviates illness and suffering.
We take far more MRI and CT scans in this country than are appropriate for medical treatment. A British radiologist wrote an essay in the New England Journal of Medicine about how, when he was in training, he told his supervisor that he wanted to do a CT scan. The supervisor asked him, What for? It's not going to make any difference in how you treat your patient. When he came to this country, doctors ordered CT scans indiscriminately, even when they had no diagnostic value. CT scans expose patients to a lot of radiation. It's hard to calculate exactly how many cancer deaths are caused by excess CTs in the US, but most calculations are in the thousands.
The reason is that radiologists get paid by the x-ray. If a radiologist can bill $2,000 for a useless CT scan, a lot of them will do it. Especially if he just bought a $3 million machine and he's making payments on it.
The cost of health care in Canada is half of ours. They were slower to adopt CTs and they do a lot fewer. Their outcomes are just as good.
If you could diagnose a patient by giving him a $1,000 x-ray, or get the same diagnosis by simply asking him a few questions, why in the world would you give him an x-ray? Which is what the British would say.
The solution, if you want one, is to evaluate treatments by evidence-based medicine, to avoid waste, as NICE does in the UK.
She said, "I'm not allowed to diagnose."
The real point is that she should be allowed to refer you to someone who is allowed, in this case a dermatologist. The whole GP-as-gatekeeper issue is really profit-driven disfunction. Of course, in most jurisdictions medicine is a self-regulating profession statistically dominated by GPs, so it may be a while before that changes.
If she refers me to a dermatologist, I'm out (or rather, my insurance company is out) $200. If I show it to my GP, he can immediately tell me that it's nothing to worry about, in one of my regular visits, for which my insurance company pays $50. So how did the NP save any money? Or convenience? Or anything?
If diabetics can give themselves their own insulin injections, there's no reason the average Joe shouldn't be able to give themselves a flu shot, or at least get one from somebody who doesn't cost as much to employ as a nurse.
When I got my flu shot, the nurse had an epi-pen prominently on the table. A small number of people respond to flu shots with an anaphylactic reaction. If you had an anaphylactic reaction, would you want it to be handled by a nurse or by a graduate of a 6-month medical technologist school?
We need to bring the cost of healthcare down, especially for routine procedures if we want people to be able to afford medical care in the future.
Other countries have brought their cost of health care down. Canada spends half what we do for the same outcomes. Maybe we should try some of their ideas.
How do you think tests always work? The doctor sends you out to get tested, you get the test results, and the doctor explains them to you. Getting them at Walmart instead of paying $400 at some "lab" in a strip mall changes nothing except price.
My doctor's office takes a blood and urine test and sends it to the lab himself. Then he reviews them to see whether they show any reason for further intervention, and gives me a copy. My insurance covers it. Under Obamacare, all the insurance companies will cover recommended tests with no copayments, so you won't be saving any money.
There's not just one set of blood tests, there are many different panels of tests. There's the SMA-12, SMA-20, and others. A doctor will order particular tests because he wants to check something out. If a doctor thinks I might have lupus or multiple sclerosis, he'll order tests for that. Wallmart isn't going to do that.
Medical tests aren't commodities. One of the most important things about routine tests like PSA is the trend over time. Testing equipment has to be calibrated. Two labs can get different readings for the same blood sample. That's why a doctor would want to use his own lab. If your PSA is up from last year, is that because you have prostate cancer, or because the Wallmart lab is calibrated differently than the CVS lab?
I don't think do-it-yourself medicine is the way to save costs.
The point is that even though your doctor orders tests, it's useless, often misleading, and sometimes dangerous for you to bypass your doctor and get the same (or similar) tests cheap in a pharmacy.
If you don't have the skill set to understand the tests, and your pharmacist can't legally explain them to you (because he doesn't have the skill set either) what's the point of getting them?
Oops, sorry. I was thinking of CT scans.
MRIs have their own problems. They often use gadolinium dye, which can cause permanent kidney failure.