
The Heroism of Incremental Care - mhb
http://www.newyorker.com/magazine/2017/01/23/the-heroism-of-incremental-care/#aaa
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adpirz
There's a great book by Paul Dutton of Northern Arizona University called
"Differential Diagnoses" comparing US and French healthcare in depth that
talks about the ratio of GP's to specialists and its direct correlation with
positive health outcomes, among other things. If you're interested in the
field, worth a read, here's a good introductory portion:

[http://digitalcommons.ilr.cornell.edu/cgi/viewcontent.cgi?ar...](http://digitalcommons.ilr.cornell.edu/cgi/viewcontent.cgi?article=1033&context=books)

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vmarsy
That looks like a very interesting read, skimming through it, it says that
France spends around 10% of GDP on healthcare while the US spends 15%, but yet
France gets a better health coverage, and a better life expectancy.

One of the first tables compares number and there's the most striking one :
Obesity in France 9.4%, in the US it's 30.6%.

Could it be one reason that, with less obesity, French people are more healthy
to start with, so they require less care? Does the book address this?

In other words, what if:

    
    
                 Life expectancy with 0 healthcare , Life expectancy with healthcare
        France                 50 (made up)        ,     79.4
        USA                    35 (made up)        ,     77.5

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cm2012
That's weird data. By every measure I've seen France and the USA have almost
identical obesity. [https://www.google.com/search?ie=UTF-8&client=ms-android-
spr...](https://www.google.com/search?ie=UTF-8&client=ms-android-sprint-
us&source=android-browser&q=france+obesity+rate)

~~~
vmarsy
The 9.4% was data from 2002.

The french wikipedia page says a 2012 study shows that while 32,3 % are (25 ≤
BMI < 30 kg/m2), only 15 % are(BMI≥ 30 kg/m2).

If from 2012 to 2014 it jumped from 15 to 23.9 there would be a problem. I'm
unable to track down where that 23.9% came from on the English wikpedia, but
it looks like those WHO report anything above 25 BMI, whereas the other data
is above 30 BMI

EDIT: Wikipedia is simply wrong, if you look at

[http://apps.who.int/bmi/index.jsp](http://apps.who.int/bmi/index.jsp) and
search for _BMI adults % obese ( >=30.0)_, then France most recent data is
16.9%, (USA is 33.9)

the Wikipedia article claims : _Based on World Health Organisation (WHO) data
published in 2014, 23.9% of French adults (age 18+) were clinically obese with
a body mass index (BMI) of 30 or greater_

EDIT2: Found an interactive map
[http://gamapserver.who.int/gho/interactive_charts/ncd/risk_f...](http://gamapserver.who.int/gho/interactive_charts/ncd/risk_factors/obesity/atlas.html)

where it claims 22.0 for 2014 (still not 23.9), but it also claims 18.2% for
2005, but it says 12.4% for 2006 on the table, there's a different in
reporting between the two. The interactive maps does an "age standardize
estimate" whatever this means :)

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bbctol
In general, I think the linking of _good_ with _heroism_ is a net negative for
society. Articles like these are a reminder of how much space there is to
redefine heroism, or abandon it altogether, and how important it is to
remember the good that is done that is not dramatic, individual, and quick.

~~~
maxxxxx
This is a bigger issue in the whole society. People who do a good, steady,
useful job without much fuzz don't get appreciated. It's like the focus on
"job creators" but they also need people who buy their stuff and work for
them. A society where everybody needs to be a "hero" will go under quickly.

~~~
putsteadywere
In Australia, the ratio of officers to sailors on ships has changed from:

1960s - DDG ‐ a ratio of 1 officer to 15.65 crew

1980s - FFG ‐ a ratio of 1 officer to 7.5 crew

modern - Armidale - a ratio of 1 officer to 2.5 crew

I've heard that other nation's services are seeing commensurate changes.

[0]:
[http://www.defence.gov.au/Whitepaper/docs/036-O'Keefe.pdf](http://www.defence.gov.au/Whitepaper/docs/036-O'Keefe.pdf)

~~~
evgen
Others have mentioned the automation factor, but let me add another one. Those
of us outside the military probably equate "officer" to "management", but a
more apt comparison might be to "college graduate." Now, how many different
ways can we think of that a state-of-the-art surface vessel might need a
higher proportion of educated crew vs. maintenance staff who are mostly high-
school grads who have received maybe a year or two of ship-specific vocational
training?

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nradov
In most navies the majority of complex maintenance work is performed by senior
NCOs (chiefs) and warrant officers, not by commissioned officers. Those chiefs
have a lot more than 2 years of vocational training.

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paulplug
I suffer from severe migraines. My mom does too. I get them at least 3 times a
week, and it really knocks me down. This really struck a chord with me. After
a couple of paragraphs I couldn't stop reading. Very encouraging.

I'm originally from Italy. Growing up my mom and I tried all sorts of
medications available in Italy, but none of them made a real difference. I
moved to the US a few years back and I tried a few off the counter headache
medications (Acetaminophen + Caffeine + Aspirine) and much to my surprised it
really helped. I'm not sure why, but these are not available in europe. I
started bringing them back home to my mom. It helps with the really tough
migraines, instead of being in my room, lights off, puking, I can walk around
and even do some work.

~~~
jadyoyster
Paracetamol, aspirine and caffeine are definitely available over the counter
in Europe!

~~~
maxerickson
Are they marketed as a single pill?

(eg [https://www.excedrin.com/products/extra-
strength/](https://www.excedrin.com/products/extra-strength/) )

~~~
stdbrouw
Paracetamol and caffeine is a common combination in Europe too. I wouldn't be
inclined to move countries or even to bring home medication from abroad just
so I could take my medication as a single pill instead of two.

~~~
maxerickson
Of course moving for such generic drugs would be a strange thing, but lack of
the combo pills in Europe might explain why moving to the US prompted the
other poster to try the combination.

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jessriedel
So the guy is told that migraines generally improve as you age. He goes to
this specialist, and there's minimal progress for _three years_ , and then
later things get better. How do we know any of this is causative?

More generally, do journalists without scientific training need to consult
with anyone before declaring who we should be praising for health
improvements?

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sbierwagen

      More generally, do journalists without scientific 
      training need to consult with anyone before declaring 
      who we should be praising for health improvements?
    

>Atul Gawande (born November 5, 1965) is an American surgeon, writer, and
public health researcher. He practices general and endocrine surgery at
Brigham and Women's Hospital in Boston, Massachusetts. He is a professor in
the Department of Health Policy and Management at the Harvard T.H. Chan School
of Public Health and the Samuel O. Thier Professor of Surgery at Harvard
Medical School. In public health, he is executive director of Ariadne Labs, a
joint center for health systems innovation, and chairman of Lifebox, a
nonprofit that works on reducing deaths in surgery globally.[2]

>He has written extensively on medicine and public health for The New Yorker
and Slate, and is the author of the books Complications, Better, The Checklist
Manifesto, and Being Mortal.

[https://en.wikipedia.org/wiki/Atul_Gawande](https://en.wikipedia.org/wiki/Atul_Gawande)

~~~
jessriedel
Thanks. Certainly good to know, but I am happy to stand by my criticism, both
specific and general.

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wyldfire
What a great article. Thanks for sharing!

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shanacarp
For this very reason, it bothers me that there is no adult equivalent to Apgar
scores

