I would assume because they live in a third world country such as the United States.
We detached this subthread from https://news.ycombinator.com/item?id=15957446 and marked it off-topic.
https://www.gofundme.com/StephenSykes
"Unfortunatey, the cost of the drug is above the NHS funding threshold. It is not therefore available on prescription and the Consultants have told us that we will need to raise the funds required to purchase the treatment that Stephen needs to give him the real prospect of becoming well again."
[0] See, e.g., https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5210230/ from January 2017: "[M]ajor issues such as timing and sequencing, treatment duration and synergistic combinatory approaches remain to be resolved. Furthermore, long-term efficacy outcomes and potential development of late toxicities in lymphoma patients are still poorly defined."
Kind of different to needing insulin, isn't it
Typically you'll be given the insulin and asked to pay later or it will be quietly written off as lost, expired, or just the cost of doing business. The pharmacists I knew we're more than willing to give a free vial if it was crucial and deal with payment later(or in many cases never). Repeat offenders are directed towards programs where they can get insulin at discount or for free. Despite the healthcare system being fucked, letting someone die without insulin is a bad PR move so the giant companies that make it will give it away if necessary (but you have to sign up and pass income checks).
Still, this is mostly just human compassion I've seen. Doctors and pharmacists I've known are generally very helpful and nurturing people. You make a lot of money but there's easier ways to make the same if human compassion isn't your thing. If this wasn't the case I assume many would die, because it doesn't seem that the government provides any protection against this.
The US medical system is corrupt and FUBAR but this is not a good example. I've worked low level jobs around retail pharmacy and emergency medicine and seen this happen firsthand many times. Healthcare providers in the US are of fairly high quality and generally will not let you die. Most of the insane costs and profiteering are focused around drug pricing, countless layers of nonsense surrounding insurance and pricing structures, and the need for hospitals to charge some people a lot to make up for the huge fraction that don't or can't pay.
In bad cases, it _does_ get that bad. Dehydration on top of losing control of my medication and a not particularly serious gastric bug ended up being a very serious thing for me.
I don’t think most diabetics are that brittle that “without insulin quickly loses their higher brain functions”.
One of the above posters explains it better than I have.
In case of hypoglycemia, it is imperative to raise blood sugar as soon as possible. You do not need prescription for that. It is achieved with regular sugar, sweets, or orange juice that everybody has in their household.
In extreme cases a shot of glycogen may be required. Glycogen is not expensive and does not require prescription. Also, most people never use that shot. I have my one, and only, shot of glycogen in my fridge for many years now. Thankfully, I never used it.
Not having insulin results in hyperglycemia or high blood sugar which causes longer term complications and severe illness but won't put you in a coma.
Complications of high blood sugar level don't develop suddenly. It's a relatively slow process that takes weeks or months. There is a medical emergency, called diabetic ketoacidosis, that results from high blood sugar level. However, that takes months of untreated high sugar levels, combined with dehydration, to develop.
A diabetic without insulin will, with time, develop a ton of serious complications. However, none of them are sudden, and certainly don't lead to a "quick loss of higher brain functions".
Acute hypoglycemia, as you mentioned, we treat with sugars, either oral glucose, or IV dextrose. Complex sugars are of course better.
I will take issue with this, however:
> Complications of high blood sugar level don't develop suddenly. It's a relatively slow process that takes weeks or months. There is a medical emergency, called diabetic ketoacidosis, that results from high blood sugar level. However, that takes months of untreated high sugar levels, combined with dehydration, to develop.
You can begin to notice symptoms of DKA in as little as 24 hours, and high acuity incidents can happen with a matter of days to a week or so.
But yes, you're right that it will not be something that has such rapid onset as described by the parent.
Interesting. Can they really develop in a single day starting from a "normal" BG level, without a longer period of elevated BG beforehand?
I guess I should have also been more precise in my comment. I was mostly referring to the severe form where actual coma can occur. Still, I'm surprised it can develop in only a couple of days.
Thanks. I definitely appreciate the correction.
Most Americans go to other countries as tourists and largely have no idea how hard everyday life there is.
https://en.wikipedia.org/wiki/Medical_tourism
Note that America is hardly unique in this respect and is both a destination and a source of such traffic.
By the way current day US citizens have may be a factor of thousands times more opportunity, freedom and economically supportive ecosystem in all of human history combined, including the current humans anywhere in the world.
I can say this as a Indian, who stayed for a few years in the US and came back to India.
Little do US citizens realize how easy they have it and how much privilege they have compared to the remainder for the world.
However, medical services in even poor European countries, so some wealthy Latin American countries like Uruguay, are far better than American alternatives.
https://www.quora.com/What-do-doctors-do-when-a-patient-cant...
>When a patient comes into the hospital and there is a limb threatening emergency, there is no consideration to the patients financial status to provide emergency surgical management, PERIOD.
https://insight.kellogg.northwestern.edu/article/who-bears-t...
>That means hospitals are effectively serving as “insurers of last resort” within the American healthcare sector by providing care to uninsured patients who cannot afford to pay their medical bills. “People are still going to the emergency room,” Garthwaite says, “and they are still receiving treatment—so the cost is still there. When governments do not provide health insurance, hospitals must effectively provide it instead.”
And before some brilliant downvoter comes along, I'd call attention to the fact I've provided sources for all of my claims. Doctors in the USA don't go through 8+ years of school and residence to simply let people die in front of them.
[edit] Per the child poster's date, I've got one more source:
>According to the Centers for Medicare & Medicaid Services, 55% of U.S. emergency care now goes uncompensated.[13]
https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_an...
That reaffirms my point. And my God, 55% is a staggering amount and it highlights many sides of the issue. That many people know and use "free" emergency care when they have to, without paying insurance. And that hospitals are the ones stuck with the burden of our medical system.
https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_an...
>It requires hospital Emergency Departments that accept payments from Medicare to provide an appropriate medical screening examination (MSE) to anyone seeking treatment for a medical condition, regardless of citizenship, legal status, or ability to pay.
Republicans profess to be against socialized medicine, yet very few of them propose repealing EMTALA. It’s suspicious.
Same end result, without the negative publicity.