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Comment by krisoft | Hacker News Reader

I know that Tanina Agosto‘s story is not the main content of the article, but it makes me incredibly angry.

The idea that someone lives in a supposedly developed country , has very worrying neurological symptomps and is not seen by a doctor for months is barbaric. The fact that she literally works in a hospital is an extra layer of insult on top of this.

How are people okay with this system?

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Surely the story has been inaccurately recounted, as picking a pinched nerve, then recommending chiropractic treatment for a patient with a lack of sensation on one side of the body seems unlikely from anyone with any medical knowledge.

I didn't read the article. But my friend here in London couldn't get past GP with half of her body losing sensation. It took a LOT of pressure from her husband to get to see somebody relevant.

It turned out to be quite serious but healable given timely help. Most people would just give up until much more problematic symptoms develop.

It is your health; I don’t know about the US but in NL UK ES PT you have to apply yourself to get attention but then you do; I get help fast whatever I have because I am not taking no for an answer; people who do, well, it is your health; it is not exactly ok to just walk out when you are in trouble. You push and don’t leave until you get help. My gp did what Seinfeld George wanted; go away it’s not cancer; it was cancer and I knew it but you have to get aggressive to get attention in many places as most people go to their doctor for a chat because they need to (which, in an ideal world, is a reason to go as well by the way). People believe their gp is a smart person and knows things; they don’t; they are the gatekeepers: don’t listen to them, just get referred asap.

Yeah...

My impression is that NHS has some sort of guidelines explaining default GP reactions to keywords.

E.g., "pain in the back" is the fastest way to end the conversation.

Why would you say that? Have you ever had to deal with either a not-well-known or not-often-believed-in disease? There are millions of people in the US who have to deal with this type of shit at every visit, and they are largely women and particularly women of color. There are journal articles describing some of it. It’s not at all uncommon. Having watched this type of thing happen to my wife, I highly doubt the story has been reported inaccurately. I now have to attend all of my wife’s doctor’s visits (even with female doctors) to ensure that doctors don’t dismiss her or her condition. And oddly enough, it happens significantly less frequently when I’m there. (Though it does still happen.)

> Why would you say that?

I’m yet to come across a medical doctor who would recommend a chiropractor, but regularly encounter them dismissing that profession. Neck manipulations in particular.

I am well aware of minorities and women lacking equal access to healthcare, and it’s grim. If anyone wants some disheartening reading, your comment brought to mind to things: this was inflicted on women here in New Zealand.

https://en.m.wikipedia.org/wiki/Cartwright_InquiryWe

And this was a recent report on Maori healthcare, finding that Maori face significant prejudice in their healthcare (see page 17 of the report for a summary). https://waitangitribunal.govt.nz/news/tribunal/

The idea that someone lives in a supposedly developed country , has very worrying neurological symptomps and is not seen by a doctor for months is barbaric.

That's not what happened? She saw a doctor within a day, and was unfortunately misdiagnosed.

The 29-year-old couldn’t control her left side, even her face. “Literally the top of my head to the bottom of my foot on the left side of my body could not feel anything.” The next day, Agosto spoke with a doctor at the New York City hospital where she works as a medical secretary. He told her that she probably had a pinched nerve and to see a chiropractor.

“Spoke with a doctor” sounds like she had a chat with a coworker on a hallway. If that is not the case and she was properly examined then misdiagnosed then the journalist choose a misleading wording.

Where isn’t this true unless you’re rich and connected?

Australia? MS clinics around the country are free under Medicare, as is treatment. My friend is receiving twice annual infusions of Ocrelizumab. It literally costs them nothing.

I mean you can argue that Australia is a rich country, but it’s available to any citizen regardless of wealth.

You first need to get someone to prescribe Ocrelizumab

That really was not a problem.

https://www.msaustralia.org.au/news/subsidy-recommendations-...

It's not available if you have early, MRI-active primary progressive MS. PBAC decided not to reimbursement ocrelizumab for that.

Many if not most countries have preferred front-line treatments, usually decided by a combination of overall costs. These costs will include things like actual monetary cost, how closely you need to be monitored by your doctors (blood tests and stuff), how severe side effects are, how much the reduce disability in the long term, the ability of patients to stick with it and things like that.

Right. And some countries choose to have first-line treatments that prioritize lower cost over efficacy of therapy. It's great as a taxpayer, not so great at a patient.

Some countries prescribe Rituximab as quasi off-label for MS. Basically same drug for all intents and purposes as Ocrevus.

I think Sweden uses Rituximab openly for MS. In the US I've heard some neuros prescribe Rituximab if insurance won't cover O.

Rituximab was shown to be inferior in a head to head comparison against ocrelizumab.

Most of europe

In most parts of Europe getting to a specialist (e.g. a neurologist in this case) may still involve a long wait.

That’s because people trust their gp; if you don’t, you get referred fast. At least where I have lived and I am on public healthcare; experience with NL ES PT UK BE; never have to wait for anything.

No, in Poland it’s because there is simply a long wait for on and not because people trust their gp (quite the opposite in many cases)

That's the case in many places of the US as well.

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