Cheap and simple medical devices have to overcome deeply rooted biases

Just as true of housing, transportation, education, etc.

That sounds good, but it's not true. There's a world of minute clinics out there with PAs and LPNs. There is mail order medicine and Walmart's pharmacy. There are bronze plans/borderline broken leg plans. There's a real problem with medical care access and finances, but it's not gold-plated or nothing.

Liquid bandage is not weak "crazy glue" (cyanoacrylate). It is a completely different formulation.

https://en.wikipedia.org/wiki/Liquid_bandage

For example, the popular brand New Skin consists of:

Active ingredient: Benzethonium Chloride 0.2% (antiseptic)

Inactive Ingredients: Amyl acetate, camphor, ethyl acetate, ethyl alcohol, n-butyl acetate, nitrocellulose.

> I suspect that at least part of the difference is that veterinary medicine is mostly uncorrupted by insurance.

It’s mostly uncorrupted by million+ dollar malpractice suits.

It's also simpler because you don't need to have the stitches taken out.

Anecdote: I had a surgical incision around six inches long glued shut after an operation in the UK. No stitches. I was surprised, but from talking to the nurses it sounded like that was standard procedure. Judging from other comments, the stuff they used (DermaBond) is a variant of superglue.

Surgical staples will be stainless steel, which office staples aren't.

Regular cyanoacrylate aka “superglue” is perfectly safe for wound closure (after cleaning and disinfecting of course).

You can get spray like bandages now. Which feels like a combination of glue and some sterilization stuff added in. Stings a little bit and then dries out and sticks like glue.

It is very effective and I've used it successfully at least a dozen times. However, you virtually guarantee a scar if you use super glue. Most of us dudes don't care (as long as it's not on the face), but it's something to think about when treating others.

Nowadays they have blood clot kits you just pour into the wound. It solidifies very quickly stopping most external blood loss but has to be surgically removed by the attending physicians.

If you need to control bleeding quickly you can also use hemostatic gauze which contains a clotting agent such as kaolin clay. The gauze can be used to pack arterial wounds where a tourniquet can't be used. I keep a pack of it in my backcountry first aid kit in case someone's bleeding from an artery and I can't get a tourniquet on it, which sometimes happens when the artery retracts into the body after a cut.

https://www.amazon.com/QuikClot-Advanced-Clotting-Kaolin-Str...

Be sure you know how to use it before you need to use it though.

Except that bandages fall off when you're working, especially if you're working on something dirty. Whereas super glue holds a cut shut even if you're covered in oil. Or, if the cut is on a finger, super glue allows you to keep working as if you aren't even cut.

Superglue / cyanoacrylate wasn't discovered until the 1940s. They were trying to create clear gun sights when they discovered the fact that it sticks to everything. My understanding is that it wasn't used in the field to close wounds until the Vietnam war.

I think I've read that medical cyanoacrylate based glues don't heat up as much when they cure, so they're less likely to cause burns.

Weird, can't find anything about it at all.

https://www.washingtonpost.com/archive/lifestyle/wellness/20...

TIL that that is not what neosporin is. Since hearing about that liquid bandage thing back in the 00s, I started hearing about people in the US putting "neosporin" on minor injuries; I had just assumed it was the liquid bandage stuff. I only just googled what neosporin was now.... it's a topical antibiotic.

they used to sell alum sticks around here for small cuts.

they're still available online, albeit rarish, but they're very convenient.

Yup, or even ask if you can work the suction yourself. I've done this lots of times with my current dentist.

I hold the handpiece out of the way, and if I feel like I'm drowning, I kinda wiggle it in the direction of my mouth, they make room, and I go in and vacuum things up. If they see the need before I do, they just say "suction", just like they'd say it to any other assistant.

It's no different than holding my own jaw open. If the patient is awake, they're part of the procedure. Might as well make the most of that. And if it means less anxiety and discomfort, which means you're happier and more likely to return, that's a win for everyone.

During one visit, I noticed that the swing-arm lamp had a flat plastic cover on it that acted as a mediocre mirror, and I could see what they were doing in my mouth. As soon as I noticed that, the random shoving and scraping (which always made me nervous as hell) gained context of the work they were doing, and I calmed way down. I ask for the lamp every time now.

Bah, $10k - and yes, that was evidently the retail price for this guy :

Sorry for confusion .... Morning cough syrup hangover. Sometimes I wonder if the drug is worse than the fever! It would be nice if I could monitor my infection with this dang analyzer to see it's rise and fall :p

Heads up: it looks like they have the expiration date embedded in the first barcode and one of the pictured reagents is expired. Have you been able to set the system clock?

I wish people didn't phrase things this way. There's no single "meaning" to all of this. It's a bunch of different people with different priorities making different cost-benefit tradeoffs.

I mean, what would you do if a loved one died at least in part because someone was trying to save $1,000 on their treatment? How would you feel? What if you were permanently disabled or put in months of agonizing pain, and there were more expensive options that would have had a lower chance of doing that? Or just might have had a lower chance of doing that?

From the 10 miles up view, it's easy to say, "Holy shit, the US has such a high health care cost, we could get 97% of the same care at 50% of the cost," and that seems like a great idea. When you're personally looking at tragedy to save an amount of money that is not that significant for your specific medical case (the waste comes when it's applied to 50 more people who don't really benefit from it), the calculus looks very different.

It may still be the right decision. But can we be compassionate about the victims of that decision?

Then layer in that it is not in fact uncontroversially the case that this is what drives the costs of the US healthcare system. And layer in that there is unavoidable uncertainty about when a higher-cost procedure or device or medicine is really higher quality and when it's not, because we have well-founded limitations on how many experiments we can do on people.

I don't think it serves anyone to take such a moralizing tone. Liability exists for a reason. These cost-benefit decisions are tough ones. Information is not perfect.

Most of the time those are the same things.

The FDA's drug approval criteria are extremely strict. Ask anyone who works in pharma and they can probably name at least a couple of drugs which showed great promise but got axed by the FDA on dubious grounds.

A classic example is Aspirin. We know from over a hundred years of experience that Aspirin is a widely useful and relatively safe drug, but if it were discovered today the FDA would never allow it to market, let alone approve it for OTC sales. Aspirin's mechanism of action is far too broad and the gastrointestinal side effects alone would be considered grounds for rejection.

So, the food regulation side of the FDA's activities have certainly saved millions of lives and probably swamp what the FDA does in terms of drug regulations. But generally new drugs tend to be rolled out gradually, doctors hear about disasters, and I'd be surprised if the FDA saved more than a thousand lives a year at most. On the other hand a bad call in disallowing new medicines can have very bad consequences. The FDA only allowed the use of beta blockers in the US about a decade after they came into use in Europe which probably cost something on the order of 100,000 excess deaths. Those early beta blockers did have serious problems and the FDA's decision also probably saved 1,000 people from liver failure after taking those drugs but I don't think that justified withholding the category until a liver-safe version was made. These days the FDA is less strict than it was in the 1960s and has certainly improved. But we can still do better to move more in the direction of European style regulation where they have a dozen competing EpiPen equivalents.

What are your thoughts on this article? (which also cites a bunch of other articles on the first line)

https://slatestarcodex.com/2016/08/29/reverse-voxsplaining-d...

Oh, they do.

https://www.npr.org/sections/health-shots/2018/05/25/6136857...

Um, please, finish the quote:

> "In many countries, Burke says, doctors resort to using a makeshift solution: a Coke bottle filled with water and attached to some tubing. The D.I.Y. approach can save an infant’s life but risks causing blindness."

That NOT a better solution, thanks.

The entire article is rife with this.

Ketamine isn't a better anesthetic--it's acceptable if you don't have enough anesthesiologists.

The condom with a catherer isn't better, but it is acceptable if you don't have a real UBT.

It's disappointing to see the fact that the ethics really aren't clear until the whole way at the end rather than acknowledging it in a much more important manner earlier in the article.

> "Kass, the bioethicist, is trying to puzzle out the ethics of what might be seen as lower-quality solutions."

Doctors are also more likely to use these solutions with lower-socioeconomic groups--that is the whole point of them being cheaper, after all. And that opens an even bigger issue in places like the US.

This is why we pay the most of any other country... we try for best outcomes.

If something cheap is used in the UK with a 97% good outcomes, we will spend 3 million to ensure we get closer to 98% outcome.

It seems like the real problem here is suing culture. I'm pretty sure the hospital would win that case here in the UK. As they should, because money saved in one person's treatment, means money that can be spent on someone else's (and the more cost-efficient the treatments, the better the overall level of care).

I've long argued that we need a separate court system for medical & healthcare cases.

Our current civil courts aren't set up (conceptually) to consider best available science and standards of care at the time of treatment.

So we get pathological outcomes like overuse of cesarean delivery because one jury one time bought the argument that vaginal births caused cerebral palsy. And there's really no formal way to undo these bad legal precedents.