Random thoughts 1: Just Sayin'

[civvver]

If we could get people to lose weight, by a defined process, to make medical milestones, then heath insurance would plummet in cost. Similarly, if we could get verifiable blood testing showing compliance in taking routine medicines at a therapeutic level, then health care cost would dramatically decline.

Just as clean water was the most vital aspect of improving public heath, lack of exercise, sedentary behavior, being persistently overweight puts terrible stress on the structural integrity of the skeleton and heart. 75% of patients who are on routine medication do not take them in a manner to ensure therapeutic levels. So they have poor efficacy.

It really is very simple to fix, but very intrusive as it means being medically evaluated in a slightly different manner. If effect, you would be paid to stay healthy, versus universal coverage by detached unmotivated patients.

I believe the average number of prescriptions by retirees is five. Thus if five medicine are not taken in proper amounts, their heart medication, for example, is inadequate.

For mental illness and medications, the compliance is very poor. The same is true for medicines to treat infections.

The most expense is on the end of your life. The health costs in young adulthood are minor save pregnancy and accidents like broken bones.

We are headed that way for better or worse. Companies are already tying incentives to a lot of health monitoring practices.

For instance my company two years ago introduced and initiative that if you got a biometric screen and a physical you would get a $100 reward in your hsa if you had one, or as a taxable bonus on your paycheck if you didn't. Both of those tests are 100% covered by insurance at no patient costs since ACA went into effect and they are considered preventative care.

For 2018 they changed it even more. Instead of an all or nothing reward, now you can pick and choose which incentive activities you wish to do and you get paid for each up to $200. A physical or gynecological exam for women is worth $100, flu shot $50, biometric screening $50, health questionnaire online $50.

The rub is of course they have reduced our benefits by exactly the same amount. Where a family used to get a company contribution of $2000 into our hsa annually, last year is was $1900 and this year it's $1800. Similarly those not on hsa have seen their deductibles go up by exactly $100 and then $200.

So really we have to do all these tests just to keep the same benefit level we had before.

Supposedly this information is not shared with employers, or if it is it's in aggregate and anonymously, like hey half your employees are overweight kind of thing. However I expect privacy laws regarding this to change.

What will happen is insurance companies now have this info, they will use it against employers to raise rates. The employer will turn around and say hey gets you all need to lose weight, but since no individual benefits off their individual achievements but only from the whole, no one will do it. They'll say why am I'm dieting like crazy when Joe over there has mcdonald's every day? So companies will whine to congress and laws will get changed and they'll be able to say hey you have a bmi over 30, thus you pay a 20% premium on your health insurance premiums. They already do stuff like this in Japan and I'm sure other places too.

In the end no consumer will win. To stay at your current level you'll need to be healthy. Anyone considered unhealthy will simply pay more. No one will pay less. Insurers will reap massive profits cus that's corporate america.

Also if you think this sounds nuts, they already do this with tobacco products. If you use any tobacco products my company charges $100 a month flat fee on your insurance.

 

[hobbsyoyo]

I'm fine with companies offering health incentives. I am not fine with companies trying to force employees to behave in certain ways through punishments and effective pay cuts. I get they have financial incentive to do this but it infringes on people's rights. Which is really another reason for healthcare to be taken out of the list of things employers are expected to provide. It should be a government-funded service.

It's also funny how easily people accept having their rights infringed by corporations but if the government tries something similar people get up in arms. The stigma against tobacco is such that there wasn't a ton of backlash against the government allowing insurers to charge more for users via Obamacare. On the other hand, no one seemed to care when CVS began firing employees for using tobacco and forcing them to undergo invasive blood tests to prove they are clean. I can see that trend picking up steam in the private sector but we'll see.

 

[Cassius Critzer]

It gets worse, you know.

Do you know what genomics is? Each of us has a unique genetic code, but there are combinations which have distinctions. Those distinctions then allow scientists to study if these folks react in different ways to acquire disease states or how they will respond to pharmacological therapy.

So have the BRCA gene and then you are at risk for certain kinds of breast cancer. Or have another distinction and the chances of a certain drug treating your condition then declines, so instead she should use alternative drugs or cocktails.

It is a double-edged sword. On the positive, and if beneficent, ha(!) then if insurance companies fostered anonymous dna testing, then they could work jointly with beneficent pharmaceutical companies...ha(!)... and tailor make drugs that would have a very high success rate in treating pathological states.

On the negative side, such dna information if not private would lead to discrimination because as all insurance since the invention of managed care is built on managing risk primarily for the insurance company's profit NOT to benefit the patient as a contracted service. Formerly insurance was in pools and the risk was spread to the pool of those buying insurance...thus balanced across the pool and relatively LOW rates of cost.

So with managed care they switched to a higher profit model where low risk young patients got cheap rates because by actuarial studies the chance of actually using the insurance was small. But the more you used it, the higher the rate.

So with DNA testing, insurance companies could KNOW that your private DNA reveals a preponderance of risk to acquire various pathological states at a much higher rate than another person. Thus they could raise your rates outrageously because they have a predictor of future disease.

And coupled with lifestyle like smoking, obesity, drinking, recreational drugs, alternative sexuality, ethnicity, blah blah blah then these vastly increase how DNA and lifestyle can predict future potential disease.

No one...I mean no one should do a voluntary DNA test for ancestry...because if that information is sold or given to the government, then this is a record of your risk of future illness.

And if hospitals and medical centers are allowed to retain your samples to do research on your dna,then there is no guarantee of privacy and it not being sold to insurance companies.

It is the new discrimination and based upon profit.

Without serious visionary healthcare and politics and philosophy(specifically called bioethics)and patients' responsibility then we could see a time where an insurance company by virtue of dna studies charge outrageous fees because your dna says you might get sick.

Even if ancestry companies who compile dna testing do in fact destroy your dna, as they promise to do, they already have the dna signature that is unique to you. Then they likely sell the information and collate all the information they have of millions of people and this is a very dangerous Wild West frontier with few checks and balances on privacy.

In a dark future, a person's dna could reveal a chance of acquiring a specific cancer that is very expensive to treat and then elect not to hire them or to eliminate their position and never say why.

 

[Borachio]

Nope. I don't know what genomics is.

Never heard of the word before.

But thanks for asking.

 

[Arakhor]

It's from the Greek for "birth/creation" and "management".

 

[Cassius Critzer]

Here is more about genomics and it probably is going to affect every patient and family. When you sign up for a procedure, there may be a vague rider which involves genomics without specifying and regards storing your dna to do studies and using it for research and and and.

https://www.genome.gov/27527652/genomic-medicine-and-health-care/

.
"Genomic medicine is an emerging medical discipline that involves using genomic information about an individual as part of their clinical care (e.g. for diagnostic or therapeutic decision-making) and the health outcomes and policy implications of that clinical use."

The opportunity to use genomic information to improve health - genomic medicine - is a direct result of the Human Genome Project. NHGRI does this by supporting scientific research that helps us understand illness at the molecular level and by increasing our ability to apply that knowledge to keep people healthy and do more to help those who are ill. This is the essence of genomic medicine.

Using knowledge of a person's health risks and diagnosis to guide their healthcare is not new. But the use of genetic information for health care has been relatively uncommon. This is changing. A tidal wave of information and genomic testing opportunities are both expanding our options, affecting many more medical conditions, and raising new questions.

 

[The_J]

And if hospitals and medical centers are allowed to retain your samples to do research on your dna,then there is no guarantee of privacy and it not being sold to insurance companies.

lol no.
The privacy regulations are strict. PII are never shared. Results from these data will be shared, but always anonymized. If not, then this is purely by error. Nobody wants to ruin their reputation and to risk that they will not be getting more funding.
Here you even need to get a certificate of good conduct (not that this is hard...) before you are allowed to handle sensitive data.
For one of our publications I might need to get to..err... I wouldn't even know whom exactly, the hospital lawyer? The data management department? To figure out if the patient identifiers from the internal databases are considered PII and are allowed or not allowed to be shared.
And I'm not even talking about human genetic material here, but only "sample X was derived from patient ID Y". I fear though we'll have to synomize (if that's a word) these IDs, so that only the few people in our department who have access to this one specific table can look up which sample belongs to which patient.
And everyone who's working with that kind of data is very aware that you need to be conscious about what and what can not be shared.
Nothing is getting sold there to anyone.

 

[Cassius Critzer]

How do you know what corporate is doing? At the tech level or even at the lower administrative level, you are out of the loop what corporate does to make a buck.

I mean maybe the folks in the Netherlands are 100% moral and ethical and would never dream of selling data. That sure is not the case in the USA.

It isn't the physical sample which is medical waste but the data that is my concern which is forever.

You should know for example that there are old tissue samples dating back 100 years in America and have been studied in areas like virology so they are not automatically destroyed.

This is a very standard bioethics concern
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564466/
This is a fairly typical bioethics article.

HIPAA was enacted to ensure patient privacy but frequently this is violated as anyone can see into records and even though this was written as a provision there is still concern as there is a checkered history of medical abuse of patients without going.into sordid details.

 

[The_J]

How do you know what corporate is doing? At the tech level or even at the lower administrative level, you are out of the loop what corporate does to make a buck.

I mean maybe the folks in the Netherlands are 100% moral and ethical and would never dream of selling data. That sure is not the case in the USA.

Well, good luck with that.
They might have the ability to make these contracts, but they have absolutely no idea where this data is.
Genetic information (genome sequencing, and similar things) are not stored in the central hospital management/lab management systems, way too big for that.
Some tiny parts of the final results maybe, but definitely not all the data.
Such data resides normally on the dedicated Linux servers/HPC clusters, on which normally only the technical people mess around. Non-technical staff doesn't have access to it. Even if they got, they'd need to have the proper permissions to access the data (heck, I cannot access the data of our diagnostic laboratory, because I'm part of the research laboratory; in the same department), and would need to know how to deal with Linux itself.
This is highly unlikely.
And if someone attempted something like that... getting through all the hurdles of doing that...at some point in between you might realize that there might be some problems with that.

Things which are of more concern that the type of anonymization/de-aggregation (if that's a word) in public databases is not strong enough. E.g. it was recently shown that different datasets from the same person can be aggregated together over different databases, yielding a more specific profile (cannot remember more specific anymore, was regarding some SNP databases). With the data we are generating at the moment (microbome sequencing), we are also slowly getting to the concerns that this data might be PII, although that hasn't been proven (yet).

 

[Cassius Critzer]

And what about hacking? Hackers could probably make boatloads of money by snatching the data and selling it to pharmaceutical companies. 'Probably impossible as pharmaceutical companies are bastions of ethics and morality.

 

[Takhisis]

Hackers could probably make boatloads of money by snatching the data and selling it to pharmaceutical companies.

We'd better not have banks in that case.

 

[Lemon Merchant]

The_J is correct. Hospital and university research is aggregated and anonymized to the point where individual information cannot be seen by most of the people processing the data. By the time the data hits the servers, there is no trace of any identifying information. Hackers could get it, but they would get nothing other than the data that say, I would use to write a paper about, or abstract data that is given to a pharmaceutical company (as they often commission studies). Any information that uniquely identifies individuals is long shredded or destroyed in some fashion before it ever gets to the point where the data is handled. This difference is in individual patient files. All hell breaks loose if those get to the wild.

 

[The_J]

We also were for some time concerned regarding the use of cloud services (we still are).
One of my colleagues then said: I cannot make any sense out of this data (most of the time). And I have all the experience and accompanying metadata. If google can make sense out of this, without any experience or metadata... be my guest.
-> as also Lemon points out: Just getting the data itself is rather useless. You'd need to have some info about it, else you cannot use it.

We also recently send some data to our collaboration partners for sequencing. We're not the slightest concerned for this data, because it's for epidemiological research. You cannot make any sense out of that data without knowing from which location the samples come from.
If they find anything else by chance...good for them.
There might be samples where we could be concerned though (small, targeted selections), but for some it's just not the case.


What could be an issue: If hackers get into the actual hospital database system, and get their hands on the final analysis (e.g. diagnosis for HIV, BRCA1, etc). Or if that would be sold.

But that's independent of the initial concern of retaining samples for research, and is far more likely and dangerous.

 

[Ryika]

PewDiePie is for Polygon what Taylor Swift is for for Jezebel.

 

[shadowplay]

We really could have come up with a better name for our planet than "Earth."

 

[Snerk]

Yeah, like "Water", for instance. I mean, it does have a significantly better claim than the soil.

 

[Lohrenswald]

We really could have come up with a better name for our planet than "Earth."

the civ board

 

[Ryika]

For a bit more than 2 years now, I've been putting keeping 3-4 drawings per week into a filing folder (I hope that's the right name for the thing I mean) - I started the third of those filing folders towards the end of last year. Earlier today when I didn't really have any ideas on what to draw, and was too lazy to just do some quickposes or some other training exercises, I decided to look through a few of my older drawings and just redraw one of them with the skill level that I'm on today, and see the difference. So I looked through my old drawings, and realized that they're all very... boring. Just people in generic poses, with very generic clothes (or sometimes without). This actually holds true even until recent months, although there is some more variation the further I go towards today.

I'm not sure whether that means that I'm a very uncreative person, or whether I just have developed habits that prevent me from doing more varied stuff, but in any case, I think I need to pay attention to that and go out of my comfort zone a bit. So I've decided mostly because it was the first thing that came to my mind that I'm going to draw a frog now.

 

[Catharsis]

After a ten minute internal battle I have successfully managed to talk myself out of posting an extremely tasteless joke in an OT thread.

 

[GoodSarmatian]

After a ten minute internal battle I have successfully managed to talk myself out of posting an extremely tasteless joke in an OT thread.

And you're going to regret that for the rest of your life !