
People have stopped going to the doctor and most seem fine - megacorp
https://www.nytimes.com/2020/06/22/opinion/coronavirus-reopen-hospitals.html
======
Icathian
This article seems to suggest that because no spike in short-term ailments due
to lower frequency of care has been observed in a 5-month span, there is no
damage to the quality of our society's physical health overall. That seems
incredibly myopic to me.

The real question is whether there there will be statistically detectable
increases in severity or prevalence of chronic or emergent ailments in the
long run. How many cancers are detected later, how many lower-back pain cases
are allowed to degenerate further, etc etc. And further, do those (to my mind
inevitable) subtler long-term consequences outweigh the societal gain from
less healthcare spending? They may or may not, but this article doesn't even
ask the question, let alone suggest ways to answer it. This feels like low-
effort clickbait to me.

~~~
alistairSH
In my mind, the missed cancers could be a problem.

But, there's a lot of "health care" that doesn't really need to happen. A few
of my family members have chronic health issues that require medication. These
are typically prescribed 6-months at a time, requiring in-person bi-annual
follow-ups. That's a waste of both parties time - patient and doctor - as 95%
of the time, the result is "here's another 6 months" and 5% "here's the same
drug, with an adjust dose".

Those appointments should only occur if there's an issue that requires new
dosing or a change of medication. The rest of the time, it should be either
completely automatic, or at most a simple phone call. I assume this doesn't
happen, either because it's a CYA maneuver by the physician, or because the
physician wants to bill for the appointment.

~~~
wincy
I recently started paying for Direct Primary Care. We signed up as seeing a
doctor during COVID became even more difficult than usual. It’s definitely a
luxury but I pay $100 a month and my wife and I can bug our respective doctors
(she has a woman doctor that will only accept women and children patients; my
male doctor only accepts male patients) whenever we want. Obviously we try not
to bug them all the time and be respectful, but I’m seeing weird spots at 7pm;
text my doctor he says don’t worry about it. I’m kind of a hypochondriac —
this saves me a trip to the ER. I say I’m pretty sure I have a sinus
infection, and the symptoms are similar to one I had last year. He wrote me a
prescription for antibiotics, tells me to let him know if it doesn’t clear up.

It feels how I’d expect modern medicine to feel, rather than everything being
set up to gatekeep me from interacting with the doctor in any way except for
fifteen minutes after paying $150 for the pleasure. The doctor has an
incentive to keep us healthy because we’re not paying by the visit anymore.

I love love the direct primary care approach and wish I’d started paying for
it sooner.

~~~
smnrchrds
> _she has a woman doctor that will only accept women and children patients;
> my male doctor only accepts male patients_

Is that legal?

~~~
ardy42
> Is that legal?

IIRC, gynecologists aren't even allowed to treat men, even though they're most
qualified to treat certain diseases/problems that males can have (just far
more rarely than women). I don't remember the specifics, though.

~~~
smnrchrds
Is this true? It seems like a decision that was in effect for less than three
months only in the US back in 2013 and it was quickly reversed. Has this been
reinstated since?

[https://www.cbc.ca/radio/whitecoat/why-can-t-
gynaecologists-...](https://www.cbc.ca/radio/whitecoat/why-can-t-
gynaecologists-treat-male-patients-1.2790475)

------
throwaway_USD
This is like a cruel joke...its like saying if you are not diagnosed with a
disease you don't have it.

All anyone need to look at is the incidences of people getting a chronic
condition as soon become medicare eligible. Its like magic people are healthy,
then they receive Medicare and they get chronic conditions...no they had the
chronic condition they just weren't diagnosed and treated until Medicare
eligible.

Medicare Patient Chronic Condition Statistics:

Over one half of beneficiaries less than 65 years had two or more chronic
conditions compared to: Sixty-three percent of those 65-74 years, • Seventy-
eight percent of those 75-84 years and, • Eighty-three percent of
beneficiaries 85 years and older.

If people were covered and had access to care then the incidences would
dramatically go down, instead we all but ensure by the time they hit Medicare
and the taxpayers pick up the bills they have multiple expensive chronic
conditions that have gone undiagnosed and untreated for years.

~~~
bjarneh
> .its like saying if you are not diagnosed with a disease you don't have it.

But most "seem fine" :-)

------
cephaslr
There is an (admittedly controversial) idea within the medical community of
Specialist induced demand. I have heard it quoted to me that studies have
shown that when a medical specialist moves into an area that they then
generate more demand for related procedures. Personally I am not in the
medical profession but am wondering if anyone more knowledgeable can speak to
this. Specially what percentage of procedures could be considered in this
category or is this just ridiculous?

As a personal example, I received a nose surgery once that opened my nasal
area so I could breathe better but it only lasted a few months and after that
it seems to have reverted so it appears to be an unnecessary procedure at the
end of the day. I have just decided to live with the difficulty as the
recovery was awful.

Potentially relevant link:
[http://www.mit.edu/~erinmj/files/PID.pdf](http://www.mit.edu/~erinmj/files/PID.pdf)

------
burkaman
> In a recent survey, only one in 10 respondents said their or a family
> member’s health had worsened as a result of delayed care during the
> pandemic.

That's 30 million people. And in a fantasy world where going to the doctor in
America was cheap and easy, I imagine most people would be happy to go
regularly if they knew there was a 10% chance it would make them healthier.

Also, how are people answering this survey? One of the main points of going to
a doctor is to detect problems or risky behavior that you don't know about.
You cannot replace going to the doctor with answering the single question
self-assessment "Has my health worsened?"

~~~
votepaunchy
If the average family size is three, then to account for the "or a family
member's health" would mean something on the order of 10 million Americans
adversely affected.

~~~
burkaman
That's true. But again, how could people know? My parents are not going to
mention some minor health problem on the phone with me, especially if they
can't go to the doctor to confirm there's something wrong.

------
eyerony
If I could get antibiotics for strep or sinus infections without going to
them, I'd pretty much never go. Those visits are really dumb because I already
know what's wrong, and just need them to say "yep, it's the thing you already
knew it was, here's a prescription and a bill for doing nothing useful"

... actually on reflection already knowing what's wrong and just needing a
doctor to say it so treatment can proceed is the norm for interaction with
doctors _generally_ among friends and family. Including having to gently walk
the doctor to the correct diagnosis so they don't waste a bunch of time and
get you in for more visits and tests than you need.

~~~
Wowfunhappy
The fact that you used antibiotics as the example makes me very uneasy on
this.

Antibiotics are almost certainly over-prescribed, and humanity is ultimately
going to lose them as a result. It's good to make absolutely sure that you
need them.

~~~
eyerony
By the time I get them for those things I'm usually sitting at about 4 hours
of sleep over the last 48-72(!) hours and unable to eat or (sometimes) even
keep water down, so yeah, I need 'em. I wait that long so my body has a change
to fight it off without resorting to antibiotics, which sometimes does work.
Though also to avoid spending two and a half hours being sick and miserable in
the car, at the doctor's office, in the car again, at the pharmacy, then in
the car again, rather than at home resting, until I just _cannot_ avoid it.

------
fullshark
> Most

Isn't the primary point of going to the doctor "anomaly detection" i.e. this
thing is bothering me, will it go away on its own or do I need to do more?
Most being fine is expected, doesn't mean losing doctors visits was not a big
deal. I've heard lot of speculation that we've lost months of early cancer
detections due to the lockdown for example. Future date statistical analysis
will confirm the long term cost of sacrificing thousands of doctor visits.

------
silveroriole
“Only” 1 in 10 respondents said their health had worsened due to delayed
treatment? That seems really high to me! There’s a very obvious ulterior
motive we could ascribe to papers publishing anti-healthcare pieces.

e: and note this is only people whose health WORSENED. People like me who have
a condition which has stayed the same, but have not been able to receive
further tests and treatment, are not accounted for in that figure.

~~~
votepaunchy
The quote is "only one in 10 respondents said their health or a family
member’s health had worsened as a result of delayed care". You may still think
this is high, but it's not "1 in 10" when accounting for family size.

------
JoeAltmaier
The postponed dentist visits will have their fallout (!) eventually. Delayed
annual visits to check for skin cancer, colon cancer etc will statistically
hurt us. Mammograms put off, should have a definite downside in terms of early
detection.

Heck, even delaying car maintenance will cost folks hard cash later. The bill
will definitely come due, for the slowdown.

~~~
Sevrene
Sometimes being too cautious can cause harm too. It's not so clear cut as you
might think. For instance, pushing mammograms earlier in life causes over
diagnosis (around 20% in one study), leading to invasive surgeries that were
not actually required, and they're not without risk. It can be pretty intense
having a cancer scare, too.

So if we spend more money on these and we do them more often yet they don't
actually improve mortality, is it worth it? There's a trade up there which
your doctor should be making.

~~~
JoeAltmaier
Hm. 'Getting scared' vs 'missing a cancer and dying'. There's a disparity in
the cost of those two false results. I know which side I'm on.

~~~
Sevrene
22% unnecessary surgeries following mammograms[1] is not just 'getting scared'
these are invasive surgeries with real risks. Are you strawmanning my point or
just being hyperbolic? Again, I ask, hoping for a less flippant answer; if we
spend money, time, effort on increasing mammograms that doesn't actually
improve overall mortality and has it's own risks, should we still do it?

I'm not saying this because I think we should never investigate or search for
cancer, I'm just stating that it's not as clear as 'mammogram always good'. We
must weigh the risks with the benefits and we cannot just ignore the harm
because we're scared of the possibility of death.

[1]
[https://www.bmj.com/content/348/bmj.g366](https://www.bmj.com/content/348/bmj.g366)

~~~
JoeAltmaier
That seems exaggerated - the 'unnecessary surgeries' are biopsies, right?
Hardly a life-threatening procedure. That sounds hyperbolic too?

This 20-year-old study shows that mammograms are matched by excellent
screening programs in Canada. Is that the choice being made today? The
screening programs in Canada were discontinued. Is the real choice now between
mammograms and nothing? I didn't understand that development at all.

In the last 10 years, there's been a decrease in mortality by 25% or better.
That's the good news today. And its all attributed to early detection. Clearly
the most important factor in survival.

I think 20-year-old data is not the greatest basis for an informed choice on
this subject. E.g. MRIs became common after that study was over. The world has
changed, a lot, since then.

~~~
Sevrene
It was published in Feburary 2014.

I'm not intentionally trying to sound hyperbolic. Are you? They are literally
classified as invasive procedures. It is by definition unnecessary. There are
going to be false-positives in these screenings and these false-positives can
be harmful. Early detection + cancer = good. Early detection + no cancer =
bad. So we must balance these two. I agree detecting cancer early is a good
thing, but that's not what I was saying.

What's the deal, do you think there's no false positives, do you think over
detection has no harms?

If you want something more recent, here's one published February 2020:

"...A further contributor is overdiagnosis, or the diagnosis of cancer in
people who would never have experienced symptoms or harm had the cancer
remained undetected and untreated. Overdiagnosis of certain screen‐detected
cancers is common including 20–50% of prostate cancer and 11–19% of breast
cancer diagnoses.

Cancer can also be overdiagnosed outside screening programs. Overdiagnosis of
thyroid cancer is attributable to incidental detection during investigations
of unrelated problems; overdiagnosis of renal cancer and melanoma is less well
investigated.

Overdiagnosis is important because of the associated iatrogenic harms and
costs. Harms include the psychosocial impact of unnecessary cancer diagnoses,
such as the increased suicide risk for men after being diagnosed with prostate
cancer. Cancer treatments such as surgery, radiotherapy, endocrine therapy,
and chemotherapy can cause physical harm, but the risks are considered
acceptable if diagnosis is appropriate. When someone is unnecessarily
diagnosed with cancer, however, they can only be harmed by treatment, not
helped."

...

"Overdiagnosis of breast cancers is largely attributable to the national
screening program, that of prostate cancers and melanoma to opportunistic but
extensive screening in Australia. Renal cancer overdiagnosis appears to be
largely linked with cancers detected as incidental findings during abdominal
imaging for an unrelated reason (incidentalomas). Overdiagnosis of thyroid
cancer is related to both incidentalomas and to excessive investigation of
thyroid function test abnormalities"

[https://www.mja.com.au/system/files/issues/212_04/mja250455....](https://www.mja.com.au/system/files/issues/212_04/mja250455.pdf)

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ianleeclark
The more I think about the healthcare problem in the United States, the more
it appears to be a Gordian knot.

The author doesn't explicitly call for any policy proposal, rather he wishes
some medically informed patient into existence. This effectively turns the
doctor-patient relationship on its head, but, unfortunately, it seems
reasonable to do so, given the opioid epidemic. I don't want to have to know
as much as my doctor, I just want them to tell me how to fix it, and I am
willing to bet most people largely feel the same.

On the other hand, I can hardly imagine that decreased consumption of
healthcare isn't going to cause corporations to recoup lost profits elsewhere,
so I'm not sure if the long-run is particularly different from the author's
suggestion.

In short: indecision.

------
Kednicma
I can't speak for others, but I'm between jobs due to the pandemic and can't
afford health care without employer-provided insurance. Most people are fine
most of the time, which is why it doesn't seem like a problem. But I bet that
it will eventually be a problem; chronic issues need to be taken care of, and
everybody can benefit from a visit to the dentist now and then.

------
op03
Not leaving home much probably minimizes exposure to all the usual threats.

Reminds me of my grandaunt who rarely left the house after the death of her
husband. But she was very active, and had family members around to help out.
She was quite healthy till the end and outlived her siblings/peer group by a
big margin.

------
h2odragon
Last time I went to a doctor, I was concerned about intestinal blockage; they
gave me a prescription for a drug that slows intestinal motility. And told me
I couldn't afford any tests to confirm my notions of what my actual health
issues might be.

I've never been one of those who delegates the responsibility for my health to
a doctor; but at least they used to be valuable consultants. Today I cannot
imagine a circumstance that would make me _want_ to be a customer of a health
care provider. I can only hope to find a alternate source for any treatments
they keep exclusive to themselves if i ever need one.

------
thecloudball
I have realized doctors don't do much good, except for very extreme treatments
for life-threatening conditions (surgery, powerful medications etc). I'm not
saying they never help, just that 99% they do either useless or actively
damaging treatments that don't take side-effects into account. They are biased
towards unecesserary action. Overuse of antibiotics is just one way this
manifests itself, but it is true for most treatments.

------
OldHand2018
I'd love to go to the doctor, but I don't have a pressing emergency; no-one is
willing to schedule an appointment.

I'd love to do to the dentist; the very few I've found willing to do routine
teeth cleaning have a reservation system that requires winning the scheduling
lottery.

I guess that superficially, I'm fine. For now, at least. At least I have an
HSA; most of my health insurance money is sitting in an account instead of
being lost forever.

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braymundo
Iatrogenesis. Nassim Taleb explains a great deal about it in Antifragile:
[https://en.wikipedia.org/wiki/Iatrogenesis](https://en.wikipedia.org/wiki/Iatrogenesis)

------
7177Y
Most people were also stuck at home, living a much lower impact lifestyle.

~~~
JoeAltmaier
I wondered about that - the cost to the environment (is that what you mean by
'impact'?).

I guess this is off topic. But not travelling - check. Ordering all the stuff
online from different vendors, consuming more (because, more idle leisure),
doing more home projects cost something.

Heck, construction is booming. That's an impact too. I wonder what it'll all
add up to.

------
gridlockd
Necessary or not is subjective. For example, at the collective level, lung
cancer screening costs outweigh the benefit. At the individual level, early
detection gives the best chance for survival.

------
dcolkitt
This isn't that surprising. Healthcare economists have known for a very long
time that medical spending, on the margin, has precious little impact on
actual health outcomes.[1]

Basically there's a "core" set of medicine that constitutes basic care and is
essential to health. But even during deep budget cuts or quarantine, very few
people are avoiding vaccines, not setting broken legs, and letting appendices
explode.

In contrast an enormous amount of healthcare is very expensive and of dubious
effectiveness at best. For example it's not uncommon for courses of certain
chemotherapy to cost $400,000 and have no statistical effectiveness.[2]
Overall nearly half of medical procedures are unsupported by evidence[3]. Even
procedures we take for granted, like routine mammograms[4], have no actual
impact at reducing mortality at the population level.

This is what economists call "on the margin". These are the treatments that
get cut first during rationing.

[1] [https://www.cato-unbound.org/2007/09/10/robin-hanson/cut-
med...](https://www.cato-unbound.org/2007/09/10/robin-hanson/cut-medicine-
half) [2] [https://freakonomics.com/2013/10/22/the-unsustainable-
econom...](https://freakonomics.com/2013/10/22/the-unsustainable-economics-of-
cancer-drugs/) [3] [https://www.vox.com/the-big-
idea/2017/12/28/16823266/medical...](https://www.vox.com/the-big-
idea/2017/12/28/16823266/medical-treatments-evidence-based-expensive-cost-
stents) [4] [https://theconversation.com/routine-mammograms-do-not-
save-l...](https://theconversation.com/routine-mammograms-do-not-save-lives-
the-research-is-clear-84110)

------
C1sc0cat
"seem fine" covers a lot of situation for example your having an ultra sound
and they say "oh that looks a bit small" you go from fine to not fine very
quickly

------
hackeraccount
My impression is that at a Public Health level most forms of medicine don't
make much of an impression.

Antibiotics would probably be an exception. Vaccinations if you choose to call
them medicine.

At the population level though most of the things that affect health and life
expectancy are life style choices of one type or the other that Doctors have
not show an ability to control.

My Dr. might be able to tell me that my smoking is bad. That I need to lose 10
lbs. That getting black out drunk every weekend isn't doing me any good. All
of that and more. But Dr's aren't any good about doing anything about those
things.

You could add clean water and clean air in that pile.

Compared to that cancer detection and extending the lives of people with
cancer is a drop in the bucket. Of course if you fall into that category then
it's a huge difference but overall I don't think it makes a huge difference.

------
mymythisisthis
A good time to advocate for telehealth, remote visits.

------
xnx
NYT also has the counterpoint: "Vaccine Rates Drop Dangerously as Parents
Avoid Doctor’s Visits" [https://www.nytimes.com/2020/04/23/health/coronavirus-
measle...](https://www.nytimes.com/2020/04/23/health/coronavirus-measles-
vaccines.html)

