Just this week I was looking to get a continuous glucose monitor. I’ve heard it can really prevent diabetes and help you understand what foods spike your levels.
The fda won’t allow anyone to get these if they aren’t already diabetic.
There’s so many ways we aren’t “free” in this country to do what we want with our bodies.
I see it as nothing more than authoritarians in the health domain. They know what’s best for everyone, and clearly don’t trust that freedom empowers people.
This is at the heart of many of the issues the public has had with the US government’s response to the pandemic.
An individual getting vaccinated or not has some externalities for the rest of society. The answer from orthodox economics is to measure / estimate these externalities, and then apply taxes and/or subsidies appropriately.
The vaccines are already free for the patient, that's a generous subsidy. If that's not enough, they could give everyone who gets vaccinated fifty bucks or tax unvaccinated people some extra fee.
Another example: in Singapore the government used to cover everyone's covid hospitalization costs, recently they changed to only covering them for vaccinated people (or those with a medically valid excuse).
Mainstream economics takes the preference of some people to go unvaccinated serious. The idea would be to arrive at an accurate estimate of the externalities, and then charge that (or alternatively, subsidize the vaccinated to that amount). So that people can make accurate decisions that take their preferences _and_ the costs and benefits to wider society into account.
The idea is NOT to apply an ever increasing spiral of costs on people who make decisions we disagree with.
Over time as vaccines get better the size of the externalities might even go down. In the idealised extreme case of a vaccine that is 100% effective and can be taken by anyone who wants it, there's no externality from anti-vaxxers at all.
(In reality, there are some people who can not get vaccinated for medical reasons, and our available vaccines don't even seem to be good enough to give herd immunity at the moment.)
AFAIAA, no COVID vaccines confer "immunity" - they confer resistance. Vaccinated people can still catch and transmit COVID. The vaccines are effective at preventing you being hospitalised; this protects health services from being overwhelmed, and reduces the chance that you'll die.
I don't think that even catching live COVID confers immunity. I imagine that live COVID confers better resistance than a vaccine, especially a vaccine such as these mRNA vaccines that target a specific spike protein. But I have no reliable source for that notion (/me not a doctor or researcher, just some dude on the internet!)
If vaccines provide enough resistance (or whatever) to bring r0 below 1, that's herd immunity: any infection transmittion chain (or tree) fizzles out.
The difference is the "new normal" can be used to push mandates, censorship and other measures permanently, the same way the patriot act and TSA is still around. We're already seeing the rhetoric shifting from absolute to relative risk. For instance, the current public health narrative for vaccination (of non-risk groups and people with existing antibodies) against the new dominant omicron strain which appears much milder, is "the infection risk is reduced compared to not taking the vaccine" which is a trueism and at best misleading in terms of risk of serious disease.
That said, Omicron appears contagious enough to saturate populations even in tightly locked down regions, which would be novel even for this pandemic.
The American Public is quite possibly the most propagandized citizenry in the world. That has very high costs, and we don't talk about that anywhere near the degree we should.
What you just wrote is part of that cost.
I'm not excusing them, nor advocating their position on this, but a quick look at all this from their point of view can be illuminating.
They have been lied to, ripped off, fear mongered, and manipulated to a point where they can, do and are experiencing genuine ambiguity rooted in a basic lack of trust and inability to reason well, when said reason crosses various politicized or over exploited (manipulated) lines.
And, it's not free! We are all paying for it, and that's fine. I'm a fan of such things and feel our tax dollars could be delivering a much higher net value for all of us given a different set of priorities, but I also digress, save to point out those people will tell you it's not free, and that fact coupled with the lies and manipulation mixed in with for profit medicine issues are all more than sufficient to trigger mistrust and or reluctance to buy into what they may see as an overblown crisis.
To be clear, we are in a pandemic, yes we all need to get the shot, and we will benefit from those things in a number of ways, all of which are important.
Now, I'm stopping there with the intent of making a point: Blaming people, calling them too stupid, or crazy, or whatever basic, issue is assigned to "the problem" does not help any of us. Doing that actually makes it worse, and it makes for a more impotent conversation aimed at solutions, progress, improving on things too.
Fact is when we invest in people, we get returns. Fact also is when we spam people with BS non stop for decades, we get costs.
What makes you think so? Have you looked at other countries in detail?
There is a lot published about this. Might be worth a bit of time when you have an idle minute or few.
As a starting point, repeal of the fairness doctrine (Reagan) coupled with media deregulation (Clinton), transformed mainstream media. Today, access journalism, massive media consolidation, poor clarity programs (fact is poorly differentiated from opinion), and an AD driven culture make for quite the barrage of information, much of it contradictory when viewed as a whole.
We may not be at the top, and sorting that kind of thing out is very highly debatable anyway, but we are up there. It's not hard to understand how very large numbers of us struggle to make sense of the information available today.
Sidebar: There is struggling to make sense and say coming to a wrong, or very poorly supported conclusion. That's one potential. The other one is far more subtle, and that is being confused, being aware of it, feeling one isn't capable, or lacking in time, perhaps education, and seeking authorities to trust. That is more the kind of thing in play regarding vaccination struggles we see today.
People quite literally do not trust public institutions because of the political games they have seen played, poor performance of government, and generally unclear mainstream media. It's been going on for a while now, and it's starting to really add up. (in my view, of course)
End sidebar
Intrigued? I was.
Best way to start is to tune out for a while, say a few months. During this time, seek original documents, if you have a need to be informed, and you might not. It's nice to just tune out for a while, get grounded, sort of reset.
When you do seek something, get original documents, say a report, paper, whatever it is. Then compare and contrast to media on the same topic. When I did this some time back, I was frankly shocked at basic things, such as elevating speculation to fact, or cherry picking from documents to emphasize something the authors did not intend.
I don't have good answers other than to encourage people to use more diverse media sources and seek original documents where they are available and make sense to read.
> We may not be at the top, and sorting that kind of thing out is very highly debatable anyway, but we are up there.
OK, so it was just hyperbole.
I would have had hoped for a comparison to eg Soviet Russia or PR China; or perhaps Berlusconi's Italy?
See also eg https://astralcodexten.substack.com/p/dictator-book-club-orb... or https://astralcodexten.substack.com/p/book-review-the-new-su...
On the face of it, those countries seem quite a bit more 'propagandized' than the US with its relatively free access to information and competitive news landscape. American public institutions are still well working compared to eg many poor countries. (And we have to make that comparison here, since you made a universal claim.)
Wikipedia suggests that the abolish of the so called fairness doctrine might have been a good idea _against_ propaganda: https://en.wikipedia.org/wiki/FCC_fairness_doctrine#Use_as_a...
Competitive News Landscape
The US media is owned by a few large entities. It does not do reporting from a labor point of view, as one example. Indie media is under active suppression, as is any meaningful dissent on a number of fronts. What many see as "competition" is actually theatre, and is also not inclusive coverage, again labor being a super easy example to see, missing important points of view.
As for the fairness doctrine, I agree with it's impact being debatable, but doing that along with media deregulation was a one - two punch, leading directly to the death of investigative journalism and the rise of newstaiment and access journalism. This is now News Corp got started, birth of FOX, et al. State mouthpieces basically. We are currently prosecuting a journalist to death for exposure of war crimes and corruption, just to add on to what is not a ringing endorsement here.
My point in this is the current state of the US in this sense is not good, and that has a clear impact on the people. You are attempting to make a not bad point, and implying a low impact on the people.
Notably, neither of us is making a definitive good assessment.
That aligns more favorably with my point above than your counterpoint here, and the context is people refusing vaccines and other behaviors one would associate with an unclear, propaganda laden body politic. There is a lot of BS being fired at people non stop and it starts right at the top from the consolidated media, by the way currently marked as authoritative by many entities online despite it having clear conflict of interest and a poor record on a number of fronts associated with those conflicts. (war machine, economic policy, media oversight (lol), health care policy)
I've got reasonable support for that and the body of my comment.
Finally, the overall assumption being challenged here is whether to blame the people, and I do continue to reject that idea for it being unproductive and toxic to all of us.
Oh, people come up with unhealthy fads all the time by themselves. It's consistent with propaganda, but not really any evidence for it.
> Finally, the overall assumption being challenged here is whether to blame the people, and I do continue to reject that idea for it being unproductive and toxic to all of us.
Not sure about blame. The media gives people what they want, and people want drivel.
The whole point of stuff like 'fairness doctrines' etc is paternalism: given people who 'know better' the power to give people media that's supposedly better for them than what they would have chosen by themselves.
See https://slatestarcodex.com/2014/12/17/the-toxoplasma-of-rage... for an exploration of that dynamic. https://slatestarcodex.com/2015/09/11/book-review-manufactur... might also be interesting.
I don’t think you’re taking this on as your own but I’ve lost all empathy for that position. We have other mechanisms to remedy fraudulent or substantively anti-social behavior.
I was actually in the same boat as the previous commenter but my daughter has Type 1 diabetes so hardware scarcity wasn’t the limiting factor. Actually nothing was. I was able to monitor my blood glucose level continuously for a month and it answered my questions. I’ll likely do it again in a few months.
Well maybe for a lemon car, but literally the FDA was started because people would take medications and medical advice from scammers and die. Like I said, they can be overzealous and I’m not arguing that certain things should be allowed (like glucose monitors, probably), but you also have to realize that for every one of you who understand what the monitor does, there’s probably 50 people who would drink bleach solution to cure cancer and 50 more who would sell those 50 the bleach solution.
Type 1: FDA approves something that ends up killing people. Many die. Type 2: FDA doesn't approve something that would cure disease. Many die.
The FDA, and public discourse is only about Type 1, and it is the one FDA is very focused on minimizing. As a result, many Americans - probably millions over the decades - die from Type 2 errors.
> you also have to realize that for every one of you who understand what the monitor does, there’s probably 50 people who would drink bleach solution to cure cancer
If you honestly think 98% of Americans would drink bleach for their health, I understand why you favor a strict approach.
The numbers weren't quite that high, though
[0] https://www.dallasobserver.com/news/dallas-qanon-cult-member...
It’s possible to get ~50,000 lives lost over the last 80 years assuming your overly pessimistic when running the numbers, but that generally assumes people can speed things up without any negative consequences from less stringent procedures. In practice the FDA is likely moving to fast rather than to slow and would save significantly more lives long term by requiring more data.
Basically if someone gets a terminal illness and doesn’t seek medical attention, then the disease is blamed for their death.
If that same person does seek medical attention and dies anyway, it’s still the disease that killed them as long as the doc followed the FDAs runbook.
BUT if the doc tried anything new and the patient dies, well then obviously the doc killed them and they should lose their license and die bankrupt.
Clearly just letting docs go cowboy isn’t likely to have great outcomes either, but something in the middle may.
The rules are very loose for studies on terminal people, but allowing random treatments without being part of a study has minimal utility. Something might prolong someone’s life but you have no way to verify and cancer treatment very often kills people before the cancer.
Of course, that's the point I'm trying to make. Doctors have very limited opportunity to replace the runbook with a specific treatment plan because, at least based on my limited observation, they are not allowed to create specific treatment plans without the runbook.
>The rules are very loose for studies on terminal people,
The patient I was working with was terminal and the only rule that was loose seemed to be the ability to abandon a treatment plan early when it stopped showing promise.
>but allowing random treatments without being part of a study has minimal utility. Something might prolong someone’s life but you have no way to verify and cancer treatment very often kills people before the cancer.
Minimal utility to medicine maybe, but not to the individual. If a person invests hundreds or thousands of hours investigating adjuvant therapies, reviewing trial outcomes and talking to PI, researchers, clinicians and trial coordinators, I'm of the opinion their primary oncologist should at least entertain a suggestion, not just dismiss the conversation with 'that's not standard of care'.
Anyway, I'm not going to change anything here on HN. Thanks for your time.
That killed 10,000 Americans a year, 170,000 total.
That's just one drug, that finally got approved.
Atenolol is actually vastly less effective than other beta blockers and it’s continued use has cost many lives. The FDA not approving it would have been a net benefit.
1. Exist as a significant force?
2. Are being stopped by these restrictions?
3. Would do more harm than the FDA promoting ignorance of blood glucose levels?
Because from a comfortable position in an armchair, that perspective seems to be extremely pessimistic about people's ability to make basic life choices. Pessimistic to the point where I don't see how society could function if it is in line with reality.
https://en.wikipedia.org/wiki/Food_and_Drug_Administration#H...
I took you up on it regardless, and it doesn't have much to do with snake oil salesmen according to the Wikipedia article.
Either way, nobody is arguing for the abolition of the FDA. The paternalistic attitude and restrictions are what the parent commenters have an issue with.
> By the 1930s, muckraking journalists, consumer protection organizations, and federal regulators began mounting a campaign for stronger regulatory authority by publicizing a list of injurious products that had been ruled permissible under the 1906 law, including radioactive beverages, the mascara Lash lure which caused blindness, and worthless "cures" for diabetes and tuberculosis. The resulting proposed law was unable to get through the Congress of the United States for five years, but was rapidly enacted into law following the public outcry over the 1937 Elixir Sulfanilamide tragedy, in which over 100 people died after using a drug formulated with a toxic, untested solvent.
> President Franklin Delano Roosevelt signed the Federal Food, Drug, and Cosmetic Act into law on June 24, 1938.
But again, the issue is not deciding what's safe and what's effective. It's finding that something is effective and then telling citizens they can't use effective treatments (or even tests) arbitrarily.
I'm glad the FDA is testing the safety and effectiveness of tests and cures. That doesn't mean the grandparent commenter who wants to monitor their blood glucose levels should be dismissed.
I'm sure that someone could injure themselves really badly with a glucose monitor, but the risk profile probably isn't that different from the wide range of garden implements we let people run around with (like ladders or hedge clippers).
2. Not stopped from selling stuff which efficacy is not proven. Still stopped from selling stuff which is known dangerous.
3. FDA is just enforcing a CYA policy here. It shifts all decisions to doctors who can decide to prescribe a device or a drug, and are personally accountable for malpractice. No administration wants to lose political points and votes because it allowed something obscure, that something led to an accident, and the accident was turned into a national-level scandal by rage-hungry media.
Pregnancy/HIV/diabetes tests however should be rather easy to define baseline requirements/tolerances for.
And drugs are somewhere in between.
Audiophiles salesmen want to believe just as much as the customers.
Disclaimer: Built speakers and amplifiers in a previous life and never understood how people would fret so much about cables.
Consequences of any output from audiophile gear are normally not that serious. For a pregnancy test, it could be literally life and death: say, a murder from jealosy, or a suicide from guilt. This makes a strong case for regulation of what can have words "pregnancy test" and synonyms.
I'm fine with people being able to buy stuff that can kill them, be it a gun, a rope, or a substance. But I stand for clear and enforced labeling of such things, regulated proper packaging that prevents accidents, and other such measures that make sure the consumer has plenty of warning, and acts by deliberate choice.
With substances, it's much harder to assess if the thing in hand can kill you, than with a shotgun or a scythe.
Dietary supplements, homeopathic "medicine", chiropractic, essential oils, Goop and similar new age stuff ... Snake oil business is thriving and expanding if anything.
2. Something I've seen other T1s talk about - the scarcity of hardware, specifically given the current silicon shortage. While I'm not sure how much this directly affects, I do know that the Freestyle Libre sensor got significantly more expensive between 2019 till 2021 (from about $25ish to $60). But take this with caution as I moved countries and haven't continuously being using it.
https://www.fda.gov/drugs/postmarket-drug-safety-information...
2) You can treat high blood sugar with diet. You have to know you have high blood sugar though.
3) More demand generally means lower prices in the long run unless some specific component is constrained, which I doubt is the case for these sensors.
Insulin, sure. But why do you think Metformin is dangerous?
Why not oversee/regulate the market and allow good products while disallowing snake oil?
What are you even saying? We should restrict selling fish to only those who actually need omega-3 and vitamin-D? Or that we've been fishing too much for the past 50 years that the seas are dry? Or that we should restrict selling fish to those who really need it (how do you define that and who is you)?
Apologies for the fish analogy but you managed to sidetrack me from the beginning.
If there's short supply of home tests the US, the government as far as I'm aware is able to authorize production solely for a specific cause. No FDA intervention needed. But if there's no urgent need then a company can manufacture a product, and FDA can within reasonable (this is what is being argued) parameters decide who gets to sell what and to whom.
The issue outlined in the OP is that the FDA seems to be hellbent on having a monopoly on testing, whatever the testing is about. Are you able to refute that? Is there a shortage of testing going on right now?
Peter Attia's on the edge of medical care--guaranteed that some to many of his interventions aren't going to stand the test of time, but he's what you get if a highly educated doctor gets a money hose to point at "live better, longer". It goes without saying that he's a huge fan of Dexcom, and has patients in his practice wear them intermittently.
https://peterattiamd.com/are-continuous-glucose-monitors-a-w...
This has been done elsewhere, such as in Europe. For example, Supersapiens offers a similar service [1]. However, as you may note when you visit their page in the U.S., it's not offered in the U.S. This appears to be due to the fact that the sensor used, the Abbot Libre Sense [2], is not available in the U.S.
* [0] https://www.theverge.com/22794594/levels-health-glucose-fitn...
1. You need to get a doctor to write you a prescription for it. Any doctor will do, even your Primary Care Physician (PCP).
2. Medicare will only pay for it if you are diabetic (HbA1c > 7.5%).
3. You can reduce your out-of-pocket payment for it by using Pharmacy Discount Coupons from GoodRx and the type.
You are "free", you just need to get the facts right.
I suspect such devices are far from inexpensive.
So, the next best thing is to get one, hack it, whatever. Beyond that, making one.
https://www.abbott.com/corpnewsroom/strategy-and-strength/ab...
So this has nothing to do with the FDA.
edit:
just as I thought, even abbott's site wants you to get a prescription: