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Comment by volgo | Hacker News Reader

This is actually fine for something like healthcare.

We get into this sacred idea that you _must_ have the best healthcare and treatment. Once you declare something as a _must have_, it becomes extremely expensive. Think education, healthcare, automobiles.

In reality, you don't need the best treatment, just very low cost "pretty good" treatment. Taking an IV shouldn't cost $900 using some advanced equipment. It should cost $50 with a cheap plastic bag hanging from a wall hanger.

We also need to scale medical malpractice lawsuits wayyyyy down. IMO doctors aren't out to get or harm you. Most of them want to help. It's impossible not to make mistakes as human beings. You should be able to take that risk, give that you're ok with driving on the road which is one of the riskiest things you have accepted

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Yeah, the 'best' care is needed mostly for critical life threatening situations and for emergency situations such as accidents/fire etc. If one were to see the relief camps or first aid offered during war, it becomes pretty evident that a well sterilized plastic bag should suffice for IV. Probably not even costing 50$.

Getting to "good enough" touches right at the center of the healthcare problem.

But, aren't those things determined by medical boards and not insurance companies?

Yes, but someone has to translate a medical board's opinion into decisions about what is covered and what isn't. That's what insurance companies do.

I'm not sure you've personally used "'pretty good'" treatment. There's a reason why generics and off-branded items are so cheap, and it's not because they don't do marketing. If you don't know: they're shit and the FDA will not prosecute large equivalency discrepancies.

I'm also not sure you've visited small town/rural doctors. While perhaps in the city (and under private coverage), doctors have natural competition with other professionals to provide the best service. Whereas doctors under relatively "public" coverage and in small areas without competition/alternatives, they really don't need to offer good, or even ethical service. It may not even be hugely unethical, like pulling wisdom teeth, when they're not causing issue or doing unneeded surgeries for "preventative" measure, or liberally prescribing medication under the guise of "quality of life improvement."

This post gives off a very strong sense of disassociation from the reality of things for the not-so well-off, i.e more than 90% of the population.

> There's a reason why generics and off-branded items are so cheap, and it's not because they don't do marketing. If you don't know: they're shit and the FDA will not prosecute large equivalency discrepancies.

You need to back this up with some citations.

I think the OP is overstating by calling generic drug "shit". However, generic drugs do not have to be identical to the branded versions. As measured by pharmacokinetics, they need to fall within 80% to 125% of the branded version. So there is some variation. This webpage does a nice job explaining.[1]

The generic drugs also do not have to have the same excipients (inactive materials used to make the final drug product like a pill or capsule). Normally this doesn't matter, but if you have an allergy to an excipient, the branded might be the only one you can take.

Finally, there have been issues with some generic drugs, namely generic Wellbutrin. The FDA asked for bioequivalence data on some dosage forms, but not the 300 mg pill. That pill released drug much faster than the branded and patients had some nasty side effects as a result. I've also heard the same with some generic anti-epileptics. Epilepsy is a disease where drug levels need to be very tightly controlled.

[1]http://www.pharmacytimes.com/contributor/timothy-o-shea/2016...

Sure, do you want evidence that generic manufacturers don't follow strict quality control and equivalency testing? I can dig those up from the FDA's database.

Do you want evidence that generics manufacturers fake their equivalency tests? This is going to be harder, because the FDA doesn't publish the private sector data. I can try to see what I have on hand.

Do you want evidence that the FDA doesn't prosecute these huge problems? I can only point to the routine handing out of the equivalent of "yellow cards," i.e warnings of misconduct, but still allowing repeat-offenders to sell in the U.S.

Considering the large degree to which your claims contradict the conventional wisdom of "generics are just as good as name brand drugs," it would be good if you actually gathered and presented some of this evidence (and demonstrated that these issues are prevalent/damaging enough to matter) instead of just threatening to do so.

That’s nice, but we all want you go dig that up.

Please feel free to provide some citations. I think if you make claims that you say are easy to dig up evidence for, it would be good if you did so.

Why is pulling wisdom teeth unethical?

It's not.

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