The New Republic

Excellent column! The other key problem alluded to by Movin' Meat but not explicit is "...where the heck do you find pricing information?" To quote the famous TV ad, "...an educated consumer is our best customer" (or something like that). Health care pricing, save for a couple of large programs such as the Federal Employee's Benefits Program, is largely absent. At my former employer we had exactly two insurance choices and the price differential for us was negligible, about $120/year. It gets even harder when you are looking for healthcare providers and the decision to go with someone in your plan or a physician you have developed a long term relationship with who might not accept any insurance plan. Of course when a disaster strikes such as in the case Movin' Meat notes, all bets are off.

- agoldhammer@yahoo.com-old

April 22, 2011 at 9:13am

The Republicans know all this. They just don't give a damn. Nothing matters to them except increasing the wealth of corporations and the rich. That's what makes the Republican Party so evil.

- DAVIDDREIER@EARTHLINK.NET-old

April 22, 2011 at 9:15am

Private insurance works fine for an injury or temporary illness, however acute. Private insurance does not work for chronic illnesses. This was recognized in the 1960s when the federal government chose to cover most medical costs for the most prevalent chronic illness, old age. That's right, old age is a chronic illness, as the body wears out. Cancer, heart disease, renal failure (the government has chosen to cover a part (a small part) of those costs), diabetes. Anybody sufferring from these chronic illnesses will attest that the bigger battle is with their insurance.

- rayward

April 22, 2011 at 10:14am

The Republican ideal is the patent medicine market. It created a lot of wealth in the 19th Century. It didn't contribute much to public health and life expectancy though. But, why should keeping people healthy and alive be a goal of government anyway? Cops, prisons and military might -- that's the role of government.

- esmense

April 22, 2011 at 10:55am

esmense: I think the emerging Republican ideal regarding the role of government is even simpler. Administering beatings-that's the role of government. And elections are just about who's holding the stick. If someone's going to do it, it might as well be you, right? It doesn't even occur to them that government might actually be about making a better society.

- janus

April 22, 2011 at 11:14am

I agree with everything that Cohn, Krugman, and the ER MD have written ... but: What can be done to make people more responsible for taking care of themselves and thus not being a burden on the rest of us? For example: Smoking causes cancer, no doubt about it. How can we make people who choose to smoke and get cancer pay more for their health care? Type 2 diabetes can be easily controlled by diet and exercise. How can we make people who reuse to diet and exercise pay more for their health care? Heart disease can be avoided by a prudent diet and lots of exercise. Ditto question re diabetes. The chance of stroke can be substantially reduced by taking aspirin every day. Should their be a penalty for people who have stroke but didn't try to avoid it by taking aspirin? Severe melanoma can be avoided by regular skin checks and early, low cost intervention by removing doubtful moles, as well as avoiding sun burn. What can be said about people with serious melanoma who didn't take the basic preventive steps? Obesity is a major cause of a variety of diseases, and in most cases it can be controlled and even eliminated by changes in diet and behavior. What should be the financial consequences for someone who refuses to make the necessary changes? No, Rayward, you are in large part wrong: old age is not itself a chronic illness. It is merely a risk factor, to be controlled in substantial part by careful attention to controlling other risk factors by proper diet, exercise, avoiding risky behaviors, simple low cost over the counter medications (Vitamin D, aspirin, sun block, etc.) If everyone followed the simple steps I listed above, our national health care costs would go down by tens of billions.

- PeteBeck

April 22, 2011 at 11:24am

"Health care pricing ... is largely absent" It's true; not only do costs vary for the same treatment by the same doctors depending on insurance plans, but I could only rarely find anyone able to answer "how much will this cost?" when I had no health insurance at all.

- frippo

April 22, 2011 at 12:49pm

If the government wants to require that doctors must see me and give me an opinion on treatment without charging, I can see a consumer force on price. But if I have to pay for each doctor to do whatever it is that he feels is necessary to diagnose me and then expect me to shop in the same way I might do with car dealerships, it's not going to happen.

- Nusholtz

April 22, 2011 at 4:04pm

Bravo, great piece. Also needing to be addressed - I hate to say but - the profit motive - in medicine - we're essentially a captive audience and past a certain point it is indecent. I've read about shamans in Siberia and it wasn't unknown for entire villages to be bankrupted by healers. This isn't something we should emulate is it?

- Sophia

April 22, 2011 at 5:26pm

Pete Beck -- Although we all should do what we can to stay healthy, you have too much faith not only in our ability to control our health destinies, but also in what medical research is actually able to demonstrate with certainty. Even when science is broadly correct about risk factors, there are always a significant number of exceptions. There will always be, for instance, cases like my mother. She never smoked or drank, was physically active and a daily walker, maintained a healthy weight, was a devout religious practitioner who also, decades before it was popular (she taught herself from a book she found in a used book store), practiced daily yoga exercises, did not eat or keep sweets or processed snacks in the house (if we wanted a snack we were told to eat fruit or wait til supper), prepared a diet rich in vegetables, fruit and seafood (she was Italian), never served pastries or other baked goods except for a few traditional treats prepared on the most important holidays (Christmas and Easter), always looked at least a decade younger than her actual age, but still died at 57 from pancreatic cancer. If everybody followed your simple steps, and my mother's lifestyle, we would still have many people with expensive, devastating major illnesses and many older people suffering from the chronic illnesses that come from the natural process of break down in the human body.

- esmense

April 23, 2011 at 12:45pm

Health care is not a consumer good. It is a social responsibility. The problem is, conservatism today doesn't recognize any such thing as a "social responsibility." In their rush to reject anything with the taint of "socialism" they have rejected the very idea and purpose of human society and community; mutual aid and protection.

- esmense

April 23, 2011 at 12:54pm

esmense's comment above reflects my worst fears - that the Republican paradigm doesn't represent even the most basic ideals of a society let alone those of a civilized nation. Instead it seems to be saying, if you belong to *our* class (tribe, clan, church...) you're one of us; otherwise, not. This is fracturing America on its most basic level - the sense of community we Americans feel with and for one another.

- Sophia

April 23, 2011 at 2:03pm

Sophia and esmense hit the nail on the head. If you define down what it means to be a human being to include only your own favored "group" you can accept all sorts of degradation of your fellow man. Hobbes will never be obsolete, hopefully Humanism is equally enduring.

- Pnaut

April 23, 2011 at 5:49pm

PeteBeck, I don't want to get into another set-to with you about treating or not treating the aged, but your idea about getting people to take better care of themselves so they "won't be a burden" doesn't hold water. People's health-related behavior has little relationship to their lifetime health care cost liability, especially if you refuse to limit access to costly treatment for people of advanced age. Everybody gets sick sooner or later. A woman who never takes up smoking and therefore doesn't die of lung cancer at sixty survives to develop breast cancer at sixty five. And since breast cancer is generally more readily curable than lung cancer, she may well survive to develop Alzheimer's at eighty, all at vastly greater expense than if she had departed twenty years prior. This has actually been well studied in the UK: smoking saves the NHS money by culling the population at risk for requiring medical care. None of this, of course, means that we should stint in our efforts to get people to take good care of their health; it just means that we shouldn't imagine that we can save money by doing so.

- AaronW

April 24, 2011 at 11:21pm

To AaronW: The following is simply wrong: "PeteBeck, I don't want to get into another set-to with you about treating or not treating the aged [to AW -- then why mention it, since it is not the subject here?], but your idea about getting people to take better care of themselves so they "won't be a burden" doesn't hold water. People's health-related behavior has little relationship to their lifetime health care cost liability, especially if you refuse to limit access to costly treatment for people of advanced age." I mentioned your similar statement in an earlier thread to my daughter, who is a MD/MPH and in July will begin a two year research fellowship studying one aspect of preventive care at a "top ten" medical center. She merely laughed and said you are wrong, as I did above. You seem to have the notion that the vast majority of our health care costs involve inevitable high end of life costs and that eliminating one illness just means that another will come along. Yes, a large percentage of our costs -- particularly those of Medicare, which by definition covers the elderly -- involve end of life. (Note -- fewer than 20% of all deaths in the US are in the incredibly expensive ICU's.) But viewing the population at large, the costs of health care over lifetimes would be substantially reduced if more people took good care of themselves -- simply taking a daily aspirin (to limit the chance of stroke), cutting out soft drinks (to limit the chance of obesity, diabetes, heart disease, etc.), exercising regularly (limits obesity, heart disease, diabetes, depression, maybe even cancer), getting skin check ups (catch melanoma in early stages), have a periodic colonoscopy (avoid colon cancer), a low cost generic medication can in most cases eliminate high blood pressure (which leads to heart disease), etc. Even for people who are not at "end of life", strokes, heart disease, diabetes, depression, melanoma, colon cancer ... and on and on ... represent painful and costly illnesses that in many ways can be limited and even avoided. You mentioned breast cancer: early detection limits the potentially awful consequences and, according to the Mayo Clinic web site, weight control will limit the chance of breast cancer. I'm sure that a substantial percentage of emergency room admissions are because of preventable events, including repeat admissions of patients who didn't take care of themselves as directed at the time of earlier admission. Emergency rooms are incredibly expensive: I spent five hours in one last month (an age related problem that can't be prevented) and the bill to the insurance company -- at the insurance company's negotiated rate -- was over $6,000! Professionals who have a mastery of the statistics have concluded that you are dead wrong, at least about preventive testing and exams: under Obamacare, Medicare and insurance companies must offer preventive testing and exams (including colonoscopies) at no out of pocket cost -- no copay and no charge to deductibles. And my commercial insurance company regularly sends me info on healthy lifestyles -- simply out of self interest: if I follow their advice the chance of their having to pay for my care is reduced. True -- preventive testing and exams won't avoid all illness during a lifetime (like my trip to the emergency room). But they can reduce the chances and the costs. Yes, we all have to go sometime. But we can limit a lifetime of illness and expensive care until it is time for us to go.

- PeteBeck

April 25, 2011 at 9:10am

Pete, I'd just like to point out from your first post that obesity isn't a major cause of a variety of dieases. It is, oddly enough, caused by the same things that cause a variety of diseases; that makes it a great indicator of risk for certain diseases, as has been shown repeatedly in scientific studies, but sadly not the actual cause. Unless, by "a variety of diseases" you mean a small set of musculoskeletal diseases which may be caused by it, as well as an additional set which can be complicated by it.

- GSpinks

April 25, 2011 at 5:28pm

Display Settings:AbstractSend to: N Engl J Med. 1997 Oct 9;337(15):1052-7. The health care costs of smoking. Barendregt JJ, Bonneux L, van der Maas PJ. Source Department of Public Health, Erasmus University, Rotterdam, the Netherlands. Abstract BACKGROUND: Although smoking cessation is desirable from a public health perspective, its consequences with respect to health care costs are still debated. Smokers have more disease than nonsmokers, but nonsmokers live longer and can incur more health costs at advanced ages. We analyzed health care costs for smokers and nonsmokers and estimated the economic consequences of smoking cessation. METHODS: We used three life tables to examine the effect of smoking on health care costs - one for a mixed population of smokers and nonsmokers, one for a population of smokers, and one for a population of nonsmokers. We also used a dynamic method to estimate the effects of smoking cessation on health care costs over time. RESULTS: Health care costs for smokers at a given age are as much as 40 percent higher than those for nonsmokers, but in a population in which no one smoked the costs would be 7 percent higher among men and 4 percent higher among women than the costs in the current mixed population of smokers and nonsmokers. If all smokers quit, health care costs would be lower at first, but after 15 years they would become higher than at present. In the long term, complete smoking cessation would produce a net increase in health care costs, but it could still be seen as economically favorable under reasonable assumptions of discount rate and evaluation period. CONCLUSIONS: If people stopped smoking, there would be a savings in health care costs, but only in the short term. Eventually, smoking cessation would lead to increased health care costs. Comment in N Engl J Med. 1998 Feb 12;338(7):470; author reply 472. N Engl J Med. 1998 Feb 12;338(7):471; author reply 472. N Engl J Med. 1998 Feb 12;338(7):470-1; author reply 472. N Engl J Med. 1998 Feb 12;338(7):471-2. N Engl J Med. 1998 Feb 12;338(7):471; author reply 472. PMID: 9321534 [PubMed - indexed for MEDLINE] Free Article Publication Types, MeSH Terms LinkOut - more resources

- AaronW

April 25, 2011 at 6:04pm

To GSpinks: Sorry, you are absolutely wrong. In most cases -- not all -- obesity is simply caused by ingesting more calories than are burned. Social factors are very important. For example, people who live in Manhattan tend to walk more than people in rural areas, and also tend to be less obese. People who exercise more than 1/2 hour a day, and work up a sweat while doing it, tend to be less obese. People who watch tv 3 or 4 hours a day are more obese. The types of food you eat are relevant -- too many sodas and chips, too much fatty meat, too much candy, sugar, and cake, too few vegetables, all lead to obesity. Obesity can cause high blood pressure, heart disease, cancer, stroke, osteoarthritis, and numerous other illnesses. Here is an explanation of the causes and the consequences from Mayo clinic: Causes By Mayo Clinic staff Although there are genetic and hormonal influences on body weight, the bottom line is that obesity occurs when you take in more calories than you burn through exercise and normal daily activities. Your body stores these excess calories as fat. Obesity usually results from a combination of causes and contributing factors, including: Inactivity. If you're not very active, you don't burn as many calories. Unfortunately, today most adults spend most of their day sitting, whether at home, at work or during leisure activities. With a sedentary lifestyle, you can easily take in more calories every day than you burn off through exercise or normal daily activities. Watching too much television is one of the biggest contributors to a sedentary lifestyle and weight gain. Unhealthy diet and eating habits. Having a diet that's high in calories, eating fast food, skipping breakfast, eating most of your calories at night, consuming high-calorie drinks and eating oversized portions all contribute to weight gain.Pregnancy. During pregnancy a woman's weight necessarily increases. Some women find this weight difficult to lose after the baby is born. This weight gain may contribute to the development of obesity in women. Lack of sleep. Getting less than seven hours of sleep a night can cause changes in hormones that increase your appetite. You may also crave foods high in calories and carbohydrates, which can contribute to weight gain.Certain medications. Some medications can lead to weight gain if you don't compensate through diet or activity. These medications include some antidepressants, anti-seizure medications, diabetes medications, antipsychotic medications, steroids and beta blockers. Medical problems. Obesity can sometimes be traced to a medical cause, such as Prader-Willi syndrome, Cushing's syndrome, polycystic ovary syndrome, and other diseases and conditions. Some medical problems, such as arthritis, can lead to decreased activity, which may result in weight gain. A low metabolism is unlikely to cause obesity, as is having low thyroid function. Complications By Mayo Clinic staff If you're obese, you're more likely to develop a number of potentially serious health problems, including: Blood (fat) lipid abnormalities Cancer, including cancer of the uterus, cervix, ovaries, breast, colon, rectum and prostate Depression Gallbladder disease Gynecological problems, such as infertility and irregular periods Heart disease High blood pressure Metabolic syndrome Nonalcoholic fatty liver disease Osteoarthritis Skin problems, such as intertrigo and impaired wound healing Sleep apnea Stroke Type 2 diabetes

- PeteBeck

April 25, 2011 at 7:06pm

To AaronW: Frankly, Doc, your posts are getting to be silly. The results of cessation of cigarette smoking in the 90's (the studies you cite are roughly 15 years old) are at best what are called "anecdotal" -- which is to say they apply only to a limited set of circumstances and so are not valid bases of broad generalizations about the consequences of healthy living and preventive medicine. And even your limited sample -- cessation of cigarette smoking-- does not take into account what the NEJM authors acknowledge, that is: " but it [smoking cessation] could still be seen as economically favorable under reasonable assumptions of discount rate and evaluation period." Equally important, the study does not take into account the external costs. For example, the death from smoking of a family's primary wage earner has consequences far different rom the death from other causes of a retired non-smoker. Also, progress in treating cancer has advanced in 15 years, resulting in higher costs in exchange for somewhat longer, miserable lives. But most significantly!!!!!!!!!!!! cessation of smoking is only one of the many, many preventive acts I mentioned and which you choose to ignore. It turns out, despite what you may think, that some widely held factual beliefs are actually well founded. But enough -- I'm sure you are happy in your state of chronic denial and sense of being a wiser than the rest of us contrarian. Unfortunately, since you are an MD, some people may believe you.

- PeteBeck

April 25, 2011 at 7:24pm

Well, Pete, if a peer-reviewed study in a high impact-factor journal like NEJM that speaks directly to the question at hand is in your book "silly" or "anecdotal" then I'm afraid you and I have no further basis for discussion. The study's age is irrelevant; in the past 15 years there has been no change in either the health effects of smoking or health care economics to render its findings invalid. The studies linking smoking to lung cancer are over 40 years old; you could question their validity on that basis too, but you'd be wrong. Finally, regarding external costs, I don't disagree. But you will recall that in my original post I argued that getting people to quit smoking was an excellent idea. I merely suggested that we shouldn't look to prevention as a way to save on HEALTH CARE costs.

- AaronW

April 25, 2011 at 9:13pm

why are liberals so stupid about how markets work? Cohn's_disease especially 1. Life-style choices are the primary determinant of health care costs. Individual choice 2. Not following treatments for diseases (letting them become worse) next largest cost. Also individual choice. 3. The 0.1% of the time where only one treatment works, causing perfectly inelastic demand, is not the situation you design health care around. This is the exception.

- mr_rationale

April 25, 2011 at 9:48pm

"1. Life-style choices are the primary determinant of health care costs. Individual choice" As I have just been explaining to Pete Beck, this is completely untrue. Life-style choices affect the age at which a person gets sick, not whether they get sick. The lifetime burden of disease is largely insensitive to lifestyle choices. Besides, most disease is only partially a function or not in any way a function of patients' choices. Here's a partial list of all then common, expensive diseases NOT related to personal behavior: Breast cancer Prostate cancer Colon cancer Lymphoma Leukemia Brain tumors Staph aureus bloodstream infections (other than those associated with injection drug use) Community acquired pneumonia Hospital acquired pneumonia Motor vehicle trauma (other than when injured person was driving drunk) Domestic violence-related trauma Schizophrenia Cerebral palsy Multiple sclerosis Coronary heart disease in non-smokers (the majority) Bipolar disorder Type I diabetes Septic shock Cystic fibrosis Sickle-cell anaemia The flu Strep throat Rocky mountain spotted fever

- AaronW

April 25, 2011 at 11:39pm

"3. The 0.1% of the time where only one treatment works, causing perfectly inelastic demand, is not the situation you design health care around. This is the exception." This statement is equally stupid. Medical science functions to identify the single best treatment for every disease that it can. For most conditions--far more than your fanciful 0.1%--if there is any choice at all between treatments it's a choice between basically identical drugs from different manufacturers that are usually priced within pennies of one another or else it's a choice between wildly different treatments where a whole bunch of considerations such as patient's tolerance for uncertainty and physical suffering come into play long before price. Besides, most of the time what patients are buying is a professional service. The only way a patient can choose a different treatment plan is either to refuse treatment entirely--not a great option most of the time--or else fire his doctor and get a new one when most of the time the new doc will recommend exactly the same treatment as the first one.

- AaronW

April 25, 2011 at 11:56pm

OK, Doc, I'll break my vow of silence to lay it on the line. You are a sloppy thinker and reader. Here is a quote from you: "Well, Pete, if a peer-reviewed study in a high impact-factor journal like NEJM that speaks directly to the question at hand is in your book "silly" or "anecdotal" then I'm afraid you and I have no further basis for discussion." The POINT I was making AND WHICH YOU HAVE CHOSEN TO IGNORE is that to assert that the study of cost benefits of smoking cessation proves your far ranging point about the cost benefits of all preventive medicine and lifestyle changes is anecdotal and silly -- which it is. Smoking is only one part of the health care problem. Or, to put it simply and frankly, your response to me misrepresents what I have said. I think that's dishonest. "The study's age is irrelevant; in the past 15 years there has been no change in either the health effects of smoking or health care economics to render its findings invalid. The studies linking smoking to lung cancer are over 40 years old; you could question their validity on that basis too, but you'd be wrong." Doc, you are waiving red herrings. I don't question that smoking causes cancer. But in the last 15 years health care economics have certainly changed, which is to say health care is increasingly expensive because MD's, like you, have a far greater array of expensive life extending tools at their disposal. Why won't you acknowledge that simple fact? "Finally, regarding external costs, I don't disagree. But you will recall that in my original post I argued that getting people to quit smoking was an excellent idea. I merely suggested that we shouldn't look to prevention as a way to save on HEALTH CARE costs." OK, we agree on something. But for some reason you ignore the conclusion even stated in the NEJM report that a $ spent on health care today is far more expensive in real terms than a $ spent 30 years from now because of the present value of money. That's simple economics, which I think even you could understand if you were to back away from your hard core contrarian stance.

- PeteBeck

April 26, 2011 at 3:11am

The following medical advice from AaronW is substantially FALSE: "1. Life-style choices are the primary determinant of health care costs. Individual choice" As I have just been explaining to Pete Beck, this is completely untrue. Life-style choices affect the age at which a person gets sick, not whether they get sick. The lifetime burden of disease is largely insensitive to lifestyle choices. Besides, most disease is only partially a function or not in any way a function of patients' choices. Here's a partial list of all then common, expensive diseases NOT related to personal behavior: Breast cancer Prostate cancer Colon cancer Lymphoma Leukemia Brain tumors Staph aureus bloodstream infections (other than those associated with injection drug use) Community acquired pneumonia Hospital acquired pneumonia Motor vehicle trauma (other than when injured person was driving drunk) Domestic violence-related trauma Schizophrenia Cerebral palsy Multiple sclerosis Coronary heart disease in non-smokers (the majority) Bipolar disorder Type I diabetes Septic shock Cystic fibrosis Sickle-cell anaemia The flu Strep throat Rocky mountain spotted fever" IN RESPONSE: In fact, many if not most serious cancers -- including breast cancer --are frequently the result of life style choices (which include preventive medicine). To take a simple example, colonoscopies can substantially reduce the chance of serious colon cancer by removing polyps. Motor vehicle trauma is caused by many, many more things than drunk driving. Try speeding, bad brakes, lack of attention to driving conditions, and ignoring traffic lights, for starters. All of those are the result of bad behaviors Domestic violence trauma can be reduced by proper mental health intervention and even simple medication. The flu can be prevented by flu shots -- duhhh as they say. If you don't know that Doc, you don't know much. Coronary heart disease can be caused by high blood pressure and high cholosterol, which in most cases can easily be brought under control by generic medicines and proper diet and exercise. Yes, you have been "explaining" stuff to me, Pete Beck, but your explaining is factually false. Doc, your medical "advice" stinks.

- PeteBeck

April 26, 2011 at 3:32am

The following medical advice from AaronW is substantially FALSE: "1. Life-style choices are the primary determinant of health care costs. Individual choice" As I have just been explaining to Pete Beck, this is completely untrue. Life-style choices affect the age at which a person gets sick, not whether they get sick. The lifetime burden of disease is largely insensitive to lifestyle choices. Besides, most disease is only partially a function or not in any way a function of patients' choices. Here's a partial list of all then common, expensive diseases NOT related to personal behavior: Breast cancer Prostate cancer Colon cancer Lymphoma Leukemia Brain tumors Staph aureus bloodstream infections (other than those associated with injection drug use) Community acquired pneumonia Hospital acquired pneumonia Motor vehicle trauma (other than when injured person was driving drunk) Domestic violence-related trauma Schizophrenia Cerebral palsy Multiple sclerosis Coronary heart disease in non-smokers (the majority) Bipolar disorder Type I diabetes Septic shock Cystic fibrosis Sickle-cell anaemia The flu Strep throat Rocky mountain spotted fever" IN RESPONSE: In fact, many if not most serious cancers -- including breast cancer --are frequently the result of life style choices (which include preventive medicine). To take a simple example, colonoscopies can substantially reduce the chance of serious colon cancer by removing polyps. Motor vehicle trauma is caused by many, many more things than drunk driving. Try speeding, bad brakes, lack of attention to driving conditions, and ignoring traffic lights, for starters. All of those are the result of bad behaviors Domestic violence trauma can be reduced by proper mental health intervention and even simple medication. The flu can be prevented by flu shots -- duhhh as they say. If you don't know that Doc, you don't know much. Coronary heart disease can be caused by high blood pressure and high cholosterol, which in most cases can easily be brought under control by generic medicines and proper diet and exercise. Yes, you have been "explaining" stuff to me, Pete Beck, but your explaining is factually false. Doc, your medical "advice" stinks.

- PeteBeck

April 26, 2011 at 3:33am

The following medical advice from AaronW is substantially FALSE: "1. Life-style choices are the primary determinant of health care costs. Individual choice" As I have just been explaining to Pete Beck, this is completely untrue. Life-style choices affect the age at which a person gets sick, not whether they get sick. The lifetime burden of disease is largely insensitive to lifestyle choices. Besides, most disease is only partially a function or not in any way a function of patients' choices. Here's a partial list of all then common, expensive diseases NOT related to personal behavior: Breast cancer Prostate cancer Colon cancer Lymphoma Leukemia Brain tumors Staph aureus bloodstream infections (other than those associated with injection drug use) Community acquired pneumonia Hospital acquired pneumonia Motor vehicle trauma (other than when injured person was driving drunk) Domestic violence-related trauma Schizophrenia Cerebral palsy Multiple sclerosis Coronary heart disease in non-smokers (the majority) Bipolar disorder Type I diabetes Septic shock Cystic fibrosis Sickle-cell anaemia The flu Strep throat Rocky mountain spotted fever" IN RESPONSE: In fact, many if not most serious cancers -- including breast cancer --are frequently the result of life style choices (which include preventive medicine). To take a simple example, colonoscopies can substantially reduce the chance of serious colon cancer by removing polyps. Motor vehicle trauma is caused by many, many more things than drunk driving. Try speeding, bad brakes, lack of attention to driving conditions, and ignoring traffic lights, for starters. All of those are the result of bad behaviors Domestic violence trauma can be reduced by proper mental health intervention and even simple medication. The flu can be prevented by flu shots -- duhhh as they say. If you don't know that Doc, you don't know much. Coronary heart disease can be caused by high blood pressure and high cholosterol, which in most cases can easily be brought under control by generic medicines and proper diet and exercise. Yes, you have been "explaining" stuff to me, Pete Beck, but your explaining is factually false. Doc, your medical "advice" stinks.

- PeteBeck

April 26, 2011 at 3:33am

One last thought: Unlike most things we discuss in these TNR threads, we as individuals have little or no control over what actually happens -- we are only a few tiny voices among tens of millions. However, when it comes to health care, we can all take care of ourselves and our families. Which is why the factually incorrect postings of AaronW, who says he is an MD, are so pernicious. As an MD he has told those few readers of this thread remaining that there is nothing that you as an individual can do to prevent suffering from the flu, coronary heart disease, or colon cancer -- among others. In each case, he is absolutely wrong, and those who rely on his so-called advice are hurting themselves. AaronW has violated the basic rule -- do no harm.

- PeteBeck

April 26, 2011 at 3:49am

Pete, My name is Aaron L Walton, MD Duke 1999. If you click this link you can even see a picture of my ugly mug. http://fellowships.medicine.duke.edu/modules/fellows_infect/index.php?id=9 As for my supposedly factually incorrect post, I suggest that you drink a glass of water, reread it and take some time to reflect that my point was not that our behavior has no effect on our health but that much disease is not, as mr rationale suggested, the result of people's "lifestyle choices." Yes, the flu is partially preventable: you can get vaccinated--tho the vaccine is not 100% effective--and you can wash your hands--tho no one can wash his hands on every occasion when it might be advisable. Colon cancer too is very partially preventable, through screening with colonoscopy or annual fecal occult blood testing plus flexible sigmoidoscopy. On the other hand, there are all sorts of reasons having nothing to do with the personal choice that rationale practically makes into a religion why people don't or can't avail themselves of such prevention opportunities, among them lack of education and lack of access to primary medical care. Moreover many of the illnesses on my list are not preventable at all and bear no known relationship to any choice that anyone makes. What's pernicious in this thread is mr rationale's explicit suggestion and your implicit agreement with him that when people get sick it's their own damn fault and if they haven't been lucky enough to get insurance, to hell with them.

- AaronW

April 26, 2011 at 5:15am