"Scandal" should be avoided because it "degrades the trust of the public in the profession." An age-old saw trotted out to justify the cover-up of diverse kinds of negligence and malfeasance in all manner of professions the world over.
It works precisely until there is a scandal too big to cover-up.
There are always degrees of uncertainty in any physical engineering project. It doesn't help anybody to have the general public being told to second-guess the work.
All four experts in TFA independently identified the same problematic strut, "11", after a weekend of unpaid work. That doesn't sound like "uncertainty" to me.
>And yet some of them got the surgeries and some didn’t, so it’s unclear if the control was adequate.
It is what it is. The documented evidence suggests that the medical histories of the two groups diverged strongly at the moment of surgery.
It is possible that the decision to have surgery depended primarily upon an arbitrary judgment of the surgeon, in which case the randomization is adequate.
It is also possible that the pre-surgery health of the two groups diverged in a way that was not well-documented in the medical record, in which case the control is inadequate.
However, this latter possibility is still not flattering to the medical community. If the conclusion of the study is even possibly correct, it raises a serious question of why such a flimsy paper trail accompanied such a momentous cost-benefit decision in the lives of these children.
>The treatment cures (in around 97% of cases) tonsilitis.
I feel like this is a kind of doublespeak and a rather misleading way of phrasing things. It of course stands to reason that excising an organ in toto will be very effective at preventing a person from having continued inflammation of that organ, as it is no longer part of their body, in the same way that toenail fungus can almost certainly be "cured" by amputating the affected toe.
The latter rarely happens, because people understand the value of their toes and realize that having toenail fungus is typically better than having no toe at all. But for organs inside the body, whose function is less plain to the lay person, patients are largely at the mercy of doctors to give them an honest appraisal of the life-long risk of removing them, and whether it might be warranted in a particular situation.
It seems that in many of these cases, it would be far more straightforward and honest to simply say "If [organ X] is really bothering you, I can cut it out," rather than cite some pseudo-scientific percentage purporting to describe how often surgery can "cure" some abstracted set of symptoms or "chief complaint." Doctors (especially specialists!) seem reluctant to move beyond this rather myopic way of conceptualizing health care. The idea that medicine is simply a game of "complaint whack-a-mole" might be psychologically comforting to a doctor (as well as financially lucrative in fee-for-service jurisdictions), but, from the perspective of the patient, it makes little sense to fix one symptom only to acquire five more of greater severity.
The question people really want answered is: "If I cut out [organ X], is it going to cause me other problems down the road?" But this is the very thing that doctors/surgeons so often seem so curiously (willfully?) ignorant of, even for "routine" procedures. Isn't it rather bizarre that, despite tonsillectomies and adenoidectomies being performed on millions of children over many decades, often for the most trivial of justifications, the analysis described in the linked paper took until 2018 to be completed, by a trio of PhDs no less?
Is it just too psychologically burdensome for surgeons to worry about the long term health of their patients or the long-term consequences of their procedures?
I think tcj_phx certainly does have a point, that people are not so much interested in "treating symptoms" as they are in doing what will preserve their whole-body health well into old age. If doctors can't say what will best achieve that, either because they don't know or haven't bothered to look into it carefully, they need to be very upfront about their ignorance and inability to provide a well-considered recommendation.
Our system is such a disaster, even "preventative care" can be a wolf in sheep's clothing. There's basically nothing to disincentivize doctors or pharma from aggressively selling drugs and procedures that give no benefit or even cause harm.
It is an interesting way of seeing it. The way I look at it is that by not having universal healthcare, like the rest of the civilized world, is costing you a lot of money to sustain.
Take for example Lantus insulin. My gf needs about a box a month and in the US is at least $289.46. Here in Ireland without insurance you pay 40€ and we pay only 5 euro when properly insured. Actually you can apply for chronic disease card and it is free to you, those 5 euro cover all. Checking strips, insulin meter, needles, all covered. So it is not healthcare what is expensive, it is making money out of you.
Cars and TVs go down in price for the same feature set as technological improvements and nor efficient business models are created. Healthcare has gotten more expensive every year for the same features(ex, a physical, or treatment for the flu). That is where healthcare is leeching money out of the economy.
They haven't provided any improvements in service or products, they've just learned how to wring more money out of everyone
First, cars haven't gone down much in price. Advanced in quality, sure. Gone down in price ? Hardly, at least in my experience. About 8-14 months net pay. TVs have gone up massively, mostly because flatscreens make ridiculous TVs possible. A CRT screen just can't be big. 50" is ridiculously large for a CRT, and anything under 40" is just unusable, so there just wasn't much difference between the cheapest and the most expensive screen in the 90s. Then, when plasma screens came, the prices for the top end went utterly ridiculous. But in the 90s you just couldn't spend a month's pay on a (single) TV. Now, 32000$ screens are in every electronics store (who do they sell these to I often wonder).
But the thing is, eliminating labor from healthcare seems to just be impossible to do in a responsible manner. So their prices go up with specialist labor prices. And yes, those have not exactly gone down. As for actual prices for basic things, I do get the impression they've gone down. Not by a lot, but 20-30% over a decade or two ? Certainly.
>TVs have gone up massively, mostly because flatscreens make ridiculous TVs possible.
Your assertions about price movements sound rather curious as they appear nearly the opposite of what is obtained by people whose job it is to measure these things. https://fee.org/media/17509/prices2-1.png
Looking at that article, they are comparing same-for-same tv sizes, and essentially saying that the 40" TVs are really cheap now.
I'm saying the biggest TVs (the ones that everybody seems to buy, like 100" and up) are far more expensive than the biggest TVs used to be 20 years back.
Also that article argues for competitive private healthcare. We've tried that. We know where that leads. Trust me, you don't want that.
It also comes with such insightful statements as this one: "Consider each product or service shown. College is heavily subsidized, regulated, and exclusionary, and the costs are soaring."
Yes this whole student loan thing we keep hearing about ... nothing to do with anything, right ?
A very limited number of features have improved (e.g. if you have HepC). At the same time there has been massive price inflation for things that are marketed as "improvements" without convincing evidence of actually being better (e.g. nexium vs prilosec, many medical devices).
>these days it seems to be mostly about generating clickbait.
Yes it's a bastardization of their profession, but everyone needs to eat.
Who knows if we'll ever get back to the quality of journalism in the Woodward/Bernstein era, when the large majority of middle-class Americans paid a monthly subscription to have professionally composed news delivered to their doorstep every morning.
Subscribe to nonprofit, or family-run, journalism that cares about the truth. ProPublica, Guardian, WaPo, now maybe LA Times, NYT (but avoid their bothsidesist politics coverage), Mother Jones, Talking Points Memo, New Yorker, etc. As long as truth seeking journalists are in control, all good - but carefully watch for ownership changes.
How is the marshmallow test (or "The Boy Who Ate the Marshmallow") different from "The Boy Who Cried Wolf"? Both teach a lesson with a nugget of wisdom, the former about the perils of self-indulgence, the latter about the foolishness of sounding a false alarm. Both lessons are supported by numerous examples--far more than 90--that each of us has observed in our own lives. But one is presented as a self-contained fictional story, while the other is told as the result of an experiment that revealed some kind of natural law.
Why is our culture so drawn to presentations of basic life lessons as if they were the results of scientific experimentation? It's as if we have some sort of self-consciousness about "believing in" fables that drives us towards the telling of "fables-as-science".
Is this field even about "science" per se? It seems more oriented towards fashioning just-so-stories that lend a scientific veneer to some piece of folk wisdom in order to generate a buzz.
My own "experimentation" suggests that the character trait that predisposes one to bandy about pop allegories such as "marshmallow test" is a portentous sign in potential managers.
Comparing growth in data storage versus energy usage per capita is interesting.
Even if you look back to the founding of the U.S., the change in energy use per person is actually only a few fold, definitely less than an order of magnitude.
Harder to compare quantity of data storage but the change would seem much larger. How much data is there, per U.S. person?
