

If We Told You That, We Would Have to Shoot You - dpatru
http://www.whattofix.com/blog/archives/2010/06/if-we-told-you.php#more

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yummyfajitas
You live in a country where medical people of any sort (doctors, medical
suppliers, etc) can be sued _without scientific evidence_ that they harmed
anyone. They will face trial with a jury having no ability to evaluate
scientific evidence and who will make a decision based on who is more
sympathetic. The plaintiff's lawyer may _pretend to be a psychic_ and still be
awarded millions of dollars rather than being laughed out of court
([http://www.nytimes.com/2004/01/31/politics/campaign/31EDWA.h...](http://www.nytimes.com/2004/01/31/politics/campaign/31EDWA.html)).

Is it any surprise that everyone involved goes out of their way to avoid any
hint of possible legal liability?

~~~
jbooth
Medical tort costs in 2007 were 30 billion and have been increasing at about
5% a year for the last 10 years
([http://www.towersperrin.com/tp/getwebcachedoc?webc=USA/2008/...](http://www.towersperrin.com/tp/getwebcachedoc?webc=USA/2008/200811/2008_tort_costs_trends.pdf))

Meanwhile, medical costs are more on the order of 2 _trillion_ and have been
increasing by over _15_ % a year for the last 10 years.

I don't think liability is really the main cost driver here. I'd look at
profits first. $2k to do a sleep study? How much work could that possibly be?
And then they insist on _another_ one? Not to mention the whole PCP ->
specialist -> other specialist to get a frickin piece of plastic. Everyone got
a piece there.

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yummyfajitas
I don't recall claiming torts were the cause of all medical inflation. I
claimed torts were the cause of Daniel Markham being shuffled from sleep study
to sleep study and of him not being allowed to hack his own medical device.

Also, your argument is specious since it completely ignores the cost of
unnecessary medicine performed in order to ward off lawsuits. For example, a
lawsuit fearing doctor might order unnecessary tests and procedures with
little medical benefit but, but which the doctor can point to in court and say
"look, I did the best I could".

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jbooth
You claimed torts were the cause -- I'm claiming they're the excuse, and the
$2k bill is the cause. $2k in guaranteed cash is a stronger incentive than the
very remote chance of a lawsuit over sleep apnea. Even if the latter does
exist in some small number and can be blamed.

~~~
yummyfajitas
1) The pulmonary specialist who ordered the sleep study _does not get $2k_ ,
the sleep study guy does. Why would the pulmonary specialist care about
enriching the sleep study guys?

2) Humans respond disproportionately to low probability, high cost events.
Witness the reaction to "XXX causes cancer", the DC sniper, 9/11, or similar
rare events.

So yeah, I'd say fear of lawsuits is a better explanation than the desire to
make somebody else $2000 richer.

~~~
MichaelSalib
_The pulmonary specialist who ordered the sleep study does not get $2k, the
sleep study guy does. Why would the pulmonary specialist care about enriching
the sleep study guys?_

So, you're 100% certain that the pulmonary specialist is not an owner or an
investor at the sleep study facility?

In reality, it is quite common for doctors to own or invest in facilities to
which they refer their own patients.

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Zak
This is pretty problematic. The government and legal system don't seem to view
taking responsibility for your own health as a legal right. I don't care that
some people would do stupid things. A big "you shouldn't do this without a
doctor's supervision" note is really all that should be required.

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frossie
I wish people would think outside themselves for a bit. Is every person who
has self-diagnosed with Dr Google right? I am sure doctors have seen a bunch
of people that are waving some printout that says "I have X, I need Y! Stat!"
and are totally wrong. I personally don't blame them for wanting to go through
the tests.

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michaelbuckbee
It's actually an even deeper problem that people self-diagnosing through
Google, as diagnostic tools increase in sophistication and decrease in cost
you can potentially find "issues" that never existed before.

Take CT scans: if you took a random sampling of people, gave them a CT scan
and then had an ortho doc look at the result 30% of the scans would show an
"abnormality", but almost none of the patients would end up actually needing
spine surgery.

Similarly with apnea, almost everyone has some sleep apnea, but not everyone
needs a CPAP, etc.

~~~
yummyfajitas
This is simply innumeracy, in particular an inability/unwillingness to use
Bayes rule.

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shabble
My startup is working in exactly this field; building a small embedded tag
which can be linked to the data port of a variety of clinical devices,
allowing data to be offloaded into a electronic patient record or external
database.

We've had a bit of trouble getting protocols out of the manufacturers, but
generally the hospital department in change of device maintenance (here,
Medical Physics) will have access or can request it for datasheets, protocol
specifications, and almost everything you'd want.

Not sure they'd be too happy providing it to a random patient though, whereas
we have a working relationship with a few local hospitals.

I also recently underwent a sleep study for sleep apnea, and after having
waited around 4 months for the test, it will now be another 5-6 before the
specialist can review my results and make a diagnosis. Chances are any sort of
CPAP will require another test for calibration and the like as well :/

I'm highly tempted to do as described in this article, and take one of the
office test devices, a Nonin XPod <http://www.nonin.com/OEMSolutions/Xpod> and
do a bit of night-time data logging of my own. Having worked with those
devices, I quite like their very simple serial packet format, which is
standard RS232 serial, and fully documented on the public datasheet on their
website.

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Avenger42
This was posted a couple of days ago... can't find the link though.

Here it is: <http://news.ycombinator.com/item?id=1471123>

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erikstarck
Recommended reading: Andy Kessler, The End of Medicine: How Silicon Valley
(and Naked Mice) Will Reboot Your Doctor.

There are startup opportunities hidden here!

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terra_t
I dunno, these patient narratives have a way of driving me up the wall.

It seems like just about everybody who can't cope has "Obstructive Sleep
Apnea" these days... Enough that I'm starting to wonder if it's not just
fashionable, but contagious.

