JCC How to be an educated consumer of health and medical news

Cool article:

https://www.usatoday.com/story/news...g-one-leg-predicts-life-longevity/7697219001/

I interpret this as meaning that as long as I'm standing on one leg, I can't die or be killed. Is this correct?

 

Ken this is nonsense.

When did you start reading USA Today?

 

Normally I don't except when it promises immortality.

 

I was led to believe that death mutated and it's mild now.

 

If you had death coming because, say, you let yourself get old, then it doesn't really count.

 

Gonna be a long painful life for me, at least according to this. Several times when I've had leg injuries my physical therapists have "challenged" me to stand on one leg for as long as I can until I can make it to 5 minutes, but the joke was on them. Even on my "bad" leg I can already balance for 5 minutes.

 

You're like a highlander.

 

This is the most relevant thread I could find:

If the solution proposed doesn’t address the underlying causes, and is just an arbitrary way to make the situation look better, then it’s not worth implementing.

Think of it this way: if you’re able to implement an algorithm which can organise a waitlist in an unbiased fashion with all the other particulars, and you still don’t have equitable outcomes, then the systemic issues causing this to persist should be directly addressed. You don’t push certain ethnicities up the waitlist at the expense of others on that waitlist - that would only serve to obscure the other issues which need addressing. You can’t solve these issues if you’ve obscured the data with your thumb on the scale. The real problem isn’t just that it’s unfair to other people who need lifesaving care, but that it fudges the data which you need so as to address the underlying issues. Out of side out of mind, as it were. Instead of being a temporary fix, it’ll be a permanent one.

 

I don't think that applies to this situation for a number of reasons:

1. Working on one doesn't actually preclude working on others. The problem is unlikely to be "solved" by this one step, because the disparity you are trying to address is multi-level/multidimensional.
2. Unlike Vivec's bizarre claim, time to surgery is not a symbolic or performative outcome. It is a substantive one. The Maori who receive surgery earlier will likely have an improved condition-specific quality of life, which was the goal of this policy.
2b. (*It's worth noting here that it's also possible other ethnicities will not be dis-serviced. Again, imagine a scenario where, although they have the same level of current illness, the Maori individual is less able to address complications due to reduced access to care. In that case, to get the same outcome for both people, it may actually make sense to let the latter person's issue be addressed first. Not because their current level of illness is different, but because their ability to tolerate sequelae conditions is lower. This is a basic principle of triage, which is only seems unusual here insofar as it is being applied in a racial/ethnic context.).
3. You can epidemiologically account for the effects of this policy, just as you can account for baseline differences in socioeconomic status and comorbid health conditions. It does make the analysis more complex, but it's not impossible to deconstruct its influence.
4. Again, "temporary" is a very relative term in this debate. A problem this broad and long-standing is unlikely to have a quick solution. A temporary solution that lasts a relatively long time is more appropriate than one with a 18 or 24-month expiration date.

Taking a step back from all this, what is the ultimate purpose of a surgical waitlist or prioritization scheme? There's a presumption that it's inherently unfair to include race/ethnicity which is not being applied to criteria like rurality or socioeconomic status, even though individuals also don't have a great deal of influence over these parts of their lives either (and indeed, in countries like the United States, there's a lot of pushback against such considerations). In this view, healthcare is something to be earned. If instead, we consider that healthcare is freely deserved by all, and that the state's primary objective is to distribute it equitably, then the goal should be to design a system that allows the best health outcomes across the board. By that logic, anything which helps us achieve high quality, equitable healthcare is a reasonable metric to consider, including things like gender, race, or rurality.

 

How did we go from standing on one leg immortality to this drivel

 

The reason why those other criteria are appropriate is that they can materially impact whether getting the treatment earlier is necessary. Someone in a rural area, for example, may have limited access to other care to assist with their condition, which is the same for economic position. Someone at a certain age may require earlier intervention. I can’t see why ethnicity would impact upon why someone needs prioritisation, unless the condition is one which impacts an ethnic group in a particular way.

The purpose of the prioritisation scheme is to assess whether individual people require earlier treatment. It’s not about addressing systemic issues of racism. It’s about ensuring that someone who needs faster treatment is provided it. All else being equal, why would ethnicity impact why an individual needs prioritisation? If two people match in all other criteria, why should ethnicity be the deciding factor? What would the justification be?

I’m open to being convinced on this.

The example you’ve given here, for example, would be captured by their social-economic situation (or whatever the underlying reason is they have less access to care). While Māori disproportionately have less access to care, the appropriate way to assess whether someone lacks said access, isn’t with reference to their ethnicity, but rather to the practical reason why they don’t have access (i.e. they are poor, they live in a rural community, etc).

 

Take another step in your logic. Why would being in a rural area reduce access to care? Why would economic position? These are not laws of the universe or physical properties of the world. They are the result of the specific way in which we have structured our society. Although alternate social structures could yield different results, the one we actually have imparts medical disadvantage to people who are poor, live in rural areas, or both.

In the same way, is it an inherent property of race/ethnicity that they will have medical disadvantage? No, of course not. Could we imagine an alternate society that is racially equitable and this wasn't a problem? Of course. Many have existed in history. But in the current social structure that we actually have, there is racism. People who are Maori (like those who are Black in the US, or Native American/Indigenous in Canada or the US, etc) do face distinct social and medical disadvantage. As with the classes of social stratification you mention above, this can constitute a meaningful reason that earlier treatment might be necesary. Recognizing that present-day circumstances do show these disadvantages even after accounting for things like medical condition, comorbidity, socioeconomics, and location, we should also be open to addressing them.

Why? Absolutely not as a measure of restorative social justice. I agree with you that would be highly inappropriate. In the same way, considering socioeconomic status should not be a backdoor tool for either communism or Social Darwinism. Instead, in the case of both race and socioeconomic status, it is about recognizing disadvantages that negatively impact health outcomes, and addressing those because the job of the health system is to limit negative health outcomes. If we were only talking about discrimination or inequity that had no impact on health, there would be no role for discussing it in healthcare at all, let alone building policies around it.

 

You’re not explaining the practical and immediate benefit.

1. I have two people who are identical in all other terms, but one is urban and the other is rural. The rural person is prioritised because they have less access to health facilities and are less able to be aided should their condition deteriorate rapidly.

2. I have two people who are identical in all other terms, but one is older than the other. The older person is prioritised because their condition could deteriorate more quickly if left for a longer period.

3. I have two people who are otherwise identical in all other terms, but of different ethnicities. Why is one ethnicity being prioritised?

 

Wait. Do the studies show that your chances of death still decrease if you stand on one leg on the edge of a cliff?

 

We need to ask Ian Anderson.

 

I don’t understand why you are so incredulous.

1. Perhaps the evaluating physician takes Māori complaints less seriously, so the problem is never properly investigated and identified.
2. Perhaps the doctor is willing but harried and overworked. The patient speaks English poorly or not at all, and in a rush the physician uses a patient’s relative rather than a certified medical translator. Key information is misunderstood and the problem is missed.
3. Perhaps the doctor is well-meaning, has time, and speaks the same language, but the patient picks up on multiple signs of hostility in his non-verbal communication so the two never open up to each other and have the full, free-flowing exchange of information necessary to find the developing complication.
4. Maybe none of these are the problem, but because medical devices like pulse odometers and temperature probes were designed and tested only on whites, they give falsely reassuring data on the Māori patient (for instance, missing a fever).
5. Maybe the Māori patient is justifiably concerned about police harassment or arrest if they try to rush to the hospital for evaluation late at night, so they delay coming in until morning, giving a critical 8-12 hours for an infection to brew untreated.
6. Perhaps in spite of equal education and identical job posting, the Māori patient is paid less or residential segregation has forced him into a worse neighborhood where he is more likely to be exposed to something that could cause complications.

We could keep doing this all day (Each mechanism I highlighted has evidence from studies of race in mechanism, though not all have been studied in depth in Māori populations). In a given patient at a particular time, one, some, or all these issues may be in play. But what they have in common is that they reliably impart worse health outcomes to someone because of their race. It is impractical as a short term solution to re-engineer neighborhoods to reverse residential segregation, completely root out all prejudice from the entire police force, design and put into operation new medical devices that work for all populations, expand the availability of medical translators, and retrain the entire workforce of doctors and nurses. If you can compensate for all these varied effects by letting the Māori patient get surgery a few weeks earlier (thus reducing their baseline risk of complications) then that’s imminently sensible.

 

1. This problem is definitley a reality (which I have already raised) however it occurs before a patient is even put on a waitlist, and is therefore not aliviated by his policy, which is about priorising people already on the waitlist. If the their condition has been delayed because of prejudice then surely this can be covered be an accurate assessment of their condtion and then prioritising based upon that.

2. Same as above.

3. Same as above.

4. This is what I was after Wocky and is something I hadn’t considered. Whilst I’m not sure if the example you gave is accurate, if there are either technological or social issues around an accurate assessment of a condition even once identified, causing the seriousness of the issue to be misidentified and then not accurately captured by other criteria, based upon ethnicity, then this would be a relevant reason for the policy. Thank you.

5. This again seems to be addressing something which could occur prior to being on the waitlist, so 1 is applicable here as well.

6. I think this is probably something which is more appropriately assessed by reference to the postcode and the actual income of the individual.