
Why a Health Program That Works in America Failed in Britain - nols
http://www.theatlantic.com/health/archive/2015/10/nurse-family-partnership/412000/?single_page=true
======
pjc50
Lede is buried in the middle:

 _One reason the U.K. results were so lackluster might be that the Lancet
study compared home-visiting to “usual care,” or the health care new moms
would receive anyway. But since the U.K. has universal health care and the
U.S. does not, it could be that there was less of a difference between the two
British groups than the two American ones._

~~~
sago
Also

 _most of the American studies on NFP were conducted by the program’s own
developer_

~~~
mike_hearn
_Scientifically, it’s not ideal to have the same person who came up with a
program trying to determine whether the program is any good._

Not ideal?

This is a great example of the use of understatement if there ever was one.
I'd say such a conflict of interest would put the credibility of the entire
study at risk.

------
im3w1l
>Just as many moms who were visited by nurses had a second pregnancy within
two years.

It is just hinted at in The Atlantic's article, but the original Lancet
article confirms that they wanted to reduce second pregnancies.

Why was that?

------
ommunist
It should read otherwise. Why America never attempted to copy successful
British model of healthcare. Paracetamol is the key!

------
JamesMcMinn
Fail -> Isn't Needed.

~~~
DanBC
No, it is needed.

There's a bunch of public health stuff where England needs to do better.
(Mothers smoking through pregnancy, mothers drinking too much through
pregnancy, mother taking drugs through pregnancy, mothers eating too much
through pregnancy, children not breast fed, children weaned too soon, children
weaned with wrong food, children given added-sugar drinks, children and
mothers at risk of violence, children and mothers at risk of accidental harm,
etc etc. (It's a long list! And there's plenty more)

This are partially helped by the universal access new mothers have to health
visitors, and access to things like Sure Start Centres (I'm not sure if those
centres are still available though), but there's still a lot to be done.

~~~
robk
Drinking during pregnancy seems pretty usual across Europe. I don't think I
ever saw a pregnant woman drinking even once in the USA.

~~~
hacker_9
It's known and accepted in the UK you can't drink/smoke when pregnant. It's
social taboo. I've never seen it in the UK.

~~~
DanBC
"never seen it" is not the same as "it doesn't happen".

Smoking during pregnancy has been on the decline for years, and 2014 was the
lowest it's been.

[http://www.hscic.gov.uk/article/4788/Prevalence-of-
mothers-s...](http://www.hscic.gov.uk/article/4788/Prevalence-of-mothers-
smoking-whilst-pregnant-is-lowest-on-record)

> Today's report shows the prevalence of women who classed themselves as
> smokers whilst pregnant fell to 12.0 per cent (75,910 out of 632,960
> maternities)3 from 12.7 per cent (83,490 out of 658,110 maternities) in the
> previous year4, and this continues the steady decline from 2006-07 when this
> was 15.1 per cent.5

Lowest on record, but still 12% is pretty high. I suspect the reason, as you
say, is the taboo. A pregnant woman who smokes faces a lot of judgement, so
she's probably going to smoke at home.

------
javert
What you are describing is "stupid." Why even bother to try to fix stupid?

Stupid people do stupid things and the more you try to support them, the more
they do it.

People need to learn discipline.

~~~
DanBC
What a nasty, judgemental, comment.

You support people to stop smoking / drinking because being a judgemental cunt
and yelling "JUST STOP SMOKING" at them doesn't work, and we know it doesn't
work.

Your approach literally kills babies.

~~~
javert
All right, but the smoking point is not really relevant and the rest of your
comment is just emotionalism and insults.

If you can't make an actual argument, and all you can do is whine, you are
just showing that you don't _have_ a rational argument.

~~~
rodgerd
> the rest of your comment is just emotionalism and insults.

> Stupid people do stupid things and the more you try to support them, the
> more they do it.

You're a hypocrite.

~~~
javert
I hate to see a discussion become a degraded flame war but I am the one who
was attacked and who called it out, not the one who started it.

~~~
Mz
This is the first comment I saw, as I spend a good bit of time on the new
comments page. I used to get attacked a lot on HN, so I came here intending to
be supportive.

Unfortunately, unless I missed something, you were not personally attacked.
Your _comment_ was critiqued, and accurately so. If you do not want people to
describe your comments as nasty and judgemental, it helps to make sure they
aren't.

So I will suggest that rather than defending your right to making sweeping
judgements, you try to up your game. And, for now, walk away from this one and
let it go. Sometimes, not digging your grave deeper is as good as it gets.

/wisdom from the school of hard knocks

~~~
javert
I was attacked. The following comment:

> You're a hypocrite. (-rogered)

I responded to that comment twice. First, defending myself as not having made
hypocritical comments. Then, somewhat "regretting" that, I made a second
comment pointing out that I regretted flaming but that I had been attacked and
was merely defending myself.

So at the point of making that second comment, where I said I was attacked, I
was actually referring to the immediate parent, the one I quote above, not the
original comments by DanBC.

At least, I think that's right.

Anyway, I appreciate the advice, and I did indeed walk away (actually, I did
it before your comment---I made a comment stating as much).

I comment less and less on HN.

edit: This conversation has been disconnected by the mods from the original
thread, otherwise I wouldn't be willing to clutter up the thread with this
mess. Also, that I'm still getting downvoted on a thread that is disconnected
perhaps supports my slight suspicion that I get auto-downvoted by a bot
whenever I post.

\---

edit: here is my response to the below comment which I found, only after
writing it, I could not post, due to being rate limited.

I'm pretty surprised by your comment here.

I wasn't crabbing at you or trying to argue.

You said I hadn't been attacked, which was mistaken (an entire comment only
consistent of "You are a hypocrite,") and I poited out your mistake.

I told you I appreciated your advice.

I pointed out that this kind of meta-conversation is only acceptable to me
because it has been disconnected from the main thread, and by that I was
trying to demonstrate that I am trying to behave ethically. In other words,
I'm trying to say "I don't want to keep flaiming the issue, but I think it's
OK to have this out-of-band conversaiton."

So what is your problem?

> "I don't agree but I am not going to argue it" instead of deleting your
> comment is still arguing it.

I don't agree with this. The comment I was responding to said:

> Your "rational argument" amounted to "people are stupid, fuck 'em."

And that is a malignant distortion of what I said.

I think it's fine for me to state that, while I'm not going to offer a
rebuttal, I don't agree that it is accurate.

tl;dr your aggression here is unwarranted. You come in supposedly offering
"wisdom" and trying to help and you just become aggressive when I take you up
on that and actually try to talk to you. Giving you the benefit of the doubt,
I guess the sentiment of what I was saying to you didn't come across.

~~~
Mz
"Walking away" = "shut up and stop posting". You are failing to do that.
Editing your comment to say "I don't agree but I am not going to argue it"
instead of deleting your comment is _still arguing_ it. Coming here to crab at
me some about the whole thing is _still arguing_ it.

I have a great deal of sympathy for your frustrations, but the way you are
handling this is only going to make things worse.

I don't care to have an argument with you, so this will be my last comment.

Take care.

~~~
javert
I'm pretty surprised by your comment here.

I wasn't crabbing at you or trying to argue.

You said I hadn't been attacked, which was mistaken (an entire comment only
consistent of "You are a hypocrite,") and I poited out your mistake.

I told you I appreciated your advice.

I pointed out that this kind of meta-conversation is only acceptable to me
because it has been disconnected from the main thread, and by that I was
trying to demonstrate that I am trying to behave ethically. In other words,
I'm trying to say "I don't want to keep flaiming the issue, but I think it's
OK to have this out-of-band conversaiton."

So what is your problem?

> "I don't agree but I am not going to argue it" instead of deleting your
> comment is still arguing it.

I don't agree with this. The comment I was responding to said:

> Your "rational argument" amounted to "people are stupid, fuck 'em."

And that is a malignant distortion of what I said.

I think it's fine for me to state that, while I'm not going to offer a
rebuttal, I don't agree that it is accurate.

tl;dr your aggression here is unwarranted. You come in supposedly offering
"wisdom" and trying to help and you just become aggressive when I take you up
on that and actually try to talk to you. Giving you the benefit of the doubt,
I guess the sentiment of what I was saying to you didn't come across.

------
javert
99% of science today involves people self-reporting results, with tenure,
grant money, etc. dependent on those results.

So are you saying that the credibility of 99% of science is at risk?

Note that peer review doesn't get out of this because it really is "peer"
review, i.e., an old boys' network.

~~~
0x49
This should make anyone think twice when they see that next study on climate
change.

~~~
PhasmaFelis
Why do climate change deniers always assume that anything that even vaguely
implies a problem with even one climate-change study is a complete refutation
of the entire field of climate science?

~~~
0x49
Because its not 1 study. Its 99% of all studies..and if the system is this
way, how can you possibly trust any studies?? The system needs to be scrapped
and started over. If you cant see this or dont want this, you are part of the
problem.

Hackernews is supposed to be about free thought and open source and in
reality, anyone with an opinion against the narrative is silenced.

Im not even close to a troll and i have had many of my comments silenced over
the past week.

True science is striving for the truth, even if it makes that same person
wrong.

without truth, we will have no progress. I suppose this means that myself and
hackernews just dont have a good 'culture fit'. Im more about getting to the
truth, expressing free thought, and having intelligent discussions. Not having
to walk on egg-shells and fear the down vote and account ban for saying
something that goes against the personal beliefs of the mods.

the community rules are also heavily skewed toward one group, because like
many other inclusive groups, its an attempt to socially engineer the thoughts
and beliefs of the community. Dictatorships and evil people have been using
these techniques for centuries.

If i wanted this, i would work for a big corporation again.

Im done. Its only been a week, but im not coming back.

~~~
PhasmaFelis
> _Because its not 1 study. Its 99% of all studies..and if the system is this
> way, how can you possibly trust any studies??_

That's exactly my point. You're saying that the many, many studies that
support the idea of climate change are meaningless, because science is a lie.
But you still want me to trust _your_ studies that say climate change is a
myth. If your premise is true, then we can't trust anything, ever, not even
the stuff you like.

