"We now have a 100% effective practical way to prevent HIV infection. "
I'm pretty sure we've had that all along, a segment of the population just didn't think it was very fun.
OK, seriously, this is a pretty big deal, and one hopes the approach is generalizable to more viruses. But it's certainly worth remembering that behavioral prevention is broad spectrum, and this is specific to one STD.
"And as always, of course, don’t forget to ask Claude."
A few weeks ago, I had pain and lots of tightness in my left calf. I had several previous issues in that area (a broken toe, multiple ankle sprains, plantar fasciitis), so I wrote out symptoms and history and asked Claude what kind of doctor I should go to for this problem. Claude correctly said I should immediately go to the ER because it might be a deep vein thrombosis, which could progress at any moment to a (potentially fatal) pulmonary embolism.
"Pregnant woman goes into labor at 22 weeks, hospital tells her she has no hope, she drives 7 miles to another hospital she finds on facebook and now she has a healthy four year old."
...this seems similar to this kind of anecdote:
"Man decides to drive home after taking 5g of dried magic mushrooms, friend tells him it's stupid and dangerous, he gets a second opinion from a more permissive friend, and now he's home safely."
Obviously it's lovely that she has a healthy four-year-old, but did she make a wise choice? Looking at the data, among survivors, 60.9% of infants born at 22 weeks’ gestation had moderate to severe impairments such as cerebral palsy, blindness/deafness etc. Almost all very premature babies have adverse neurodevelopmental outcomes. She took an unwise risk, which seems to have paid off.
Nobody is going to show off their "the doctors told us our baby didn't have a chance, we looked for a second opinion, and now we're raising a a blind, cognitively screwed child who will never be independent, has crippling anxiety, will probably never marry etc." stories, but they're more common than the "surpassing developmental milestones" stories.
I should clarify: about 70% of 22-weekers who receive some treatment die, often after prolonged suffering for both the child and the parents. About 30% survive, of whom 60.9% (18% of the total) have moderate to severe impairment - so about 12% chance of living a fairly normal life with only mild impairments, though most still face developmental/ learning challenges.
I would have said: "the potential for net-negative outcomes clearly outweighs that of net-positive", but I wouldn't begrudge them saying "no hope" to get the idea across.
Honestly I discount the 70% pretty heavily - dying after some amount of suffering and medical intervention is the default for literally everyone who exists these days.
Yep, a newborn, he was born at 35 weeks, spent 3 weeks in a neonatology ward, now he's had 3 weeks at home.
I spent a lot of time thinking how tragic it would be if his life was just those 3 weeks of suffering on a hospital ward, unable to feed himself, with no idea what was going on, sometimes in such distress that his blood oxygen dropped to dangerously low levels.
No. 'disabled' is a broad moniker. But when an individual is unable to help themselves, is old, cannot any longer look after themselves or meaningfully contribute? Maybe then they deserve an easy out.
"Letting poor people starve to death is good, actually, if they can't contribute enough to society to feed themselves. We're just giving them an easy out!"
I guess it's the level of disability. Like, if a kid is going to be autistic or wheelchair bound or something, aborting based on that would be fucked up. But what if you knew your kid was going to be born with a disease that made them suffer intense, agonizing pain 24/7 for a year and then die? I think in that case aborting the kid is probably fine
I would definitely agree with you here; from my perspective that was a stupid risk for he to take that happened to pay off. Now, I think I can see how and why someone might think that it was a worthwhile gamble, but I think Zvi should be clearer here that it obviously *was* a gamble; the outcome she got was very much not the likely one. Up to you whether it's worthwhile or not, but "seeking a second opinion" is not obviously the correct decision.
On American drug prices. What if the government opened an auction to Wegovy and Ozempic for a one time massive payment in return for a ten year contract at marginal cost? They would need to then compete with each other for the contracts, as failure to get one would mean they operate at several orders of magnitude higher price.
Net result is they get their billions early, US pays less on net for Medicare, and Americans get cheaper and better health insurance.
When you write about the cost for drugs in the USA you say:
"One obvious brainstorm is to do a price control, but as a maximum markup over the first-world average price. We will pay, say, five times the average price elsewhere. That way, the companies can negotiate harder for higher prices? Alas, I doubt a good enough multiplier would be palatable (among other issues), so I guess not."
I don't understand why this is a bad idea. I don't see why Medicare/Medicaid should pay more than the minimum price paid by others in the first world. Why wouldn't companies negotiate harder?
Could you write more about why you think this solution is unpalatable and wouldn't work?
The simplest way I feel like to explain it is I want the marginal dollar someone is looking to invest to have a very high ROI if it is put towards RX research.
I understand that the drug companies need to recoup their costs. I just don't like that the other countries are free riding on us. Suppose the market share for Wegovy is 50% US and 50% the rest of the world. Right now, Wegovy costs $1349 in the US and $92 in Britain and suppose the USA said that it wouldn't pay more than Britain or any other country in the first world. Then drug companies would make just as much money if they negotiated a global price of somewhere in the$700-800 range. (I understand that for existing drugs, the renegotiation would be difficult. However this shouldn't be a issue for any future weight loss drugs like Retatrutide or CagriSema.)
On the 5% of people have X% of medical claims, I don't think the commentors on it fully understand Medical claims. And emergency appendectomy + associated inpatient stay:
Will get you into the top 5%
Might get you into the top 3%
Definitely will not get you into the top 1%.
And there will be a lot of repeat players in the top since Medical claims are not randomly distributed each year! In a world where all we had to worry about were easily insurable expenses like appendectomies we would not be spending the GDP on health we do.
The real problem in healthcare spending is, yes, cancer, but also people with long-term chronic conditions that are expensive year over year.
We deal with some of that population by putting them in Medicare (the elderly and people with ESRD), where provider reimbursement rates are cheaper. I think there could be some benefits to doing so with more conditions so that the remaining population is closer to an actual insurance market rather than whatever it is right now.
On number one, I went to the emergency room a few months ago wearing my pajamas. They were nice pajamas. I needed pain medication, and the pharmacist who came to administer the drugs was a bit of a throwback to the 60s. He looks at me and says, "Those are nice pajamas. We don't get pajamas like those in here often. Those are Thurston Howell the Third pajamas!" So that made me laugh, and the drugs worked really well.
Be careful the use of ozempic and wegovy could very well be a slippery slope towards caloric restrictive diets and that seems to shorten lifespan in big things.
Isn’t part of the dynamic here that there is a cap on the number of medical school spots (which hasn’t been raised in 50 years even as the population has grown larger and older), and that this is justified because of limited residencies? While nobody wants to add more residences because after all there are limited med school grads. I assume this mutually reinforcing structure is intentional.
If it was really just about money, presumably we could let residents pay for the privilege and let the market find the right price (positive or negative)?
Thank you.
Given my handle I've ended up with a few people yelling at me on Twitter about the goings on at the WHO, simultaneously hilarious and frustrating.
Podcast episode for this post:
https://open.substack.com/pub/dwatvpodcast/p/medical-roundup-4?r=67y1h&utm_campaign=post&utm_medium=web&showWelcomeOnShare=true
"We now have a 100% effective practical way to prevent HIV infection. "
I'm pretty sure we've had that all along, a segment of the population just didn't think it was very fun.
OK, seriously, this is a pretty big deal, and one hopes the approach is generalizable to more viruses. But it's certainly worth remembering that behavioral prevention is broad spectrum, and this is specific to one STD.
DoxyPEP as well now
"And as always, of course, don’t forget to ask Claude."
A few weeks ago, I had pain and lots of tightness in my left calf. I had several previous issues in that area (a broken toe, multiple ankle sprains, plantar fasciitis), so I wrote out symptoms and history and asked Claude what kind of doctor I should go to for this problem. Claude correctly said I should immediately go to the ER because it might be a deep vein thrombosis, which could progress at any moment to a (potentially fatal) pulmonary embolism.
was it?
Yes.
> Meanwhile, we reduce uncertainty, and Novo Nordisk gets the payout right away
Subsidizing a European drug maker probably won't go over well.
"Pregnant woman goes into labor at 22 weeks, hospital tells her she has no hope, she drives 7 miles to another hospital she finds on facebook and now she has a healthy four year old."
...this seems similar to this kind of anecdote:
"Man decides to drive home after taking 5g of dried magic mushrooms, friend tells him it's stupid and dangerous, he gets a second opinion from a more permissive friend, and now he's home safely."
Obviously it's lovely that she has a healthy four-year-old, but did she make a wise choice? Looking at the data, among survivors, 60.9% of infants born at 22 weeks’ gestation had moderate to severe impairments such as cerebral palsy, blindness/deafness etc. Almost all very premature babies have adverse neurodevelopmental outcomes. She took an unwise risk, which seems to have paid off.
Nobody is going to show off their "the doctors told us our baby didn't have a chance, we looked for a second opinion, and now we're raising a a blind, cognitively screwed child who will never be independent, has crippling anxiety, will probably never marry etc." stories, but they're more common than the "surpassing developmental milestones" stories.
39.1% chance of living a full life without impairment isn't "no hope."
I should clarify: about 70% of 22-weekers who receive some treatment die, often after prolonged suffering for both the child and the parents. About 30% survive, of whom 60.9% (18% of the total) have moderate to severe impairment - so about 12% chance of living a fairly normal life with only mild impairments, though most still face developmental/ learning challenges.
I would have said: "the potential for net-negative outcomes clearly outweighs that of net-positive", but I wouldn't begrudge them saying "no hope" to get the idea across.
If I got in a car accident and had a 12% chance of living a normal life I sure hope the doctors would try!
It depends very much what the other 88% looks like.
Honestly I discount the 70% pretty heavily - dying after some amount of suffering and medical intervention is the default for literally everyone who exists these days.
Do you have kids?
Yep, a newborn, he was born at 35 weeks, spent 3 weeks in a neonatology ward, now he's had 3 weeks at home.
I spent a lot of time thinking how tragic it would be if his life was just those 3 weeks of suffering on a hospital ward, unable to feed himself, with no idea what was going on, sometimes in such distress that his blood oxygen dropped to dangerously low levels.
I, for one, do not think we should allow all disabled people to die for the convenience of the abled.
No. 'disabled' is a broad moniker. But when an individual is unable to help themselves, is old, cannot any longer look after themselves or meaningfully contribute? Maybe then they deserve an easy out.
"Letting poor people starve to death is good, actually, if they can't contribute enough to society to feed themselves. We're just giving them an easy out!"
I guess it's the level of disability. Like, if a kid is going to be autistic or wheelchair bound or something, aborting based on that would be fucked up. But what if you knew your kid was going to be born with a disease that made them suffer intense, agonizing pain 24/7 for a year and then die? I think in that case aborting the kid is probably fine
I would definitely agree with you here; from my perspective that was a stupid risk for he to take that happened to pay off. Now, I think I can see how and why someone might think that it was a worthwhile gamble, but I think Zvi should be clearer here that it obviously *was* a gamble; the outcome she got was very much not the likely one. Up to you whether it's worthwhile or not, but "seeking a second opinion" is not obviously the correct decision.
grok3 analysis wen
Yup! I want to see a grok3 analysis too. Has the HFE score been announced?
On American drug prices. What if the government opened an auction to Wegovy and Ozempic for a one time massive payment in return for a ten year contract at marginal cost? They would need to then compete with each other for the contracts, as failure to get one would mean they operate at several orders of magnitude higher price.
Net result is they get their billions early, US pays less on net for Medicare, and Americans get cheaper and better health insurance.
When you write about the cost for drugs in the USA you say:
"One obvious brainstorm is to do a price control, but as a maximum markup over the first-world average price. We will pay, say, five times the average price elsewhere. That way, the companies can negotiate harder for higher prices? Alas, I doubt a good enough multiplier would be palatable (among other issues), so I guess not."
I don't understand why this is a bad idea. I don't see why Medicare/Medicaid should pay more than the minimum price paid by others in the first world. Why wouldn't companies negotiate harder?
Could you write more about why you think this solution is unpalatable and wouldn't work?
The simplest way I feel like to explain it is I want the marginal dollar someone is looking to invest to have a very high ROI if it is put towards RX research.
I understand that the drug companies need to recoup their costs. I just don't like that the other countries are free riding on us. Suppose the market share for Wegovy is 50% US and 50% the rest of the world. Right now, Wegovy costs $1349 in the US and $92 in Britain and suppose the USA said that it wouldn't pay more than Britain or any other country in the first world. Then drug companies would make just as much money if they negotiated a global price of somewhere in the$700-800 range. (I understand that for existing drugs, the renegotiation would be difficult. However this shouldn't be a issue for any future weight loss drugs like Retatrutide or CagriSema.)
Ah got it - yes, I agree this is very bad and would love some of trade war stuff to be focused on fixing this. I just see:
everyone pays fair share > US subsidizes > no one pays fair share
On the 5% of people have X% of medical claims, I don't think the commentors on it fully understand Medical claims. And emergency appendectomy + associated inpatient stay:
Will get you into the top 5%
Might get you into the top 3%
Definitely will not get you into the top 1%.
And there will be a lot of repeat players in the top since Medical claims are not randomly distributed each year! In a world where all we had to worry about were easily insurable expenses like appendectomies we would not be spending the GDP on health we do.
The real problem in healthcare spending is, yes, cancer, but also people with long-term chronic conditions that are expensive year over year.
We deal with some of that population by putting them in Medicare (the elderly and people with ESRD), where provider reimbursement rates are cheaper. I think there could be some benefits to doing so with more conditions so that the remaining population is closer to an actual insurance market rather than whatever it is right now.
I think the very last link "not via health insurance" is linking to the wrong tweet?
The life extension tweet you link to has been deleted.
On number one, I went to the emergency room a few months ago wearing my pajamas. They were nice pajamas. I needed pain medication, and the pharmacist who came to administer the drugs was a bit of a throwback to the 60s. He looks at me and says, "Those are nice pajamas. We don't get pajamas like those in here often. Those are Thurston Howell the Third pajamas!" So that made me laugh, and the drugs worked really well.
The sarah constantin tweet about mouse life extension is down.
Be careful the use of ozempic and wegovy could very well be a slippery slope towards caloric restrictive diets and that seems to shorten lifespan in big things.
> you’d see expanded residency slots
Isn’t part of the dynamic here that there is a cap on the number of medical school spots (which hasn’t been raised in 50 years even as the population has grown larger and older), and that this is justified because of limited residencies? While nobody wants to add more residences because after all there are limited med school grads. I assume this mutually reinforcing structure is intentional.
If it was really just about money, presumably we could let residents pay for the privilege and let the market find the right price (positive or negative)?