Comment by DanBC | Hacker News Reader

Comment by DanBC | Hacker News Reader

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> When it comes to access to medical technology the world is remarkably flat: the poor struggle in this as in everything else, but the wealthy have no more ability to buy a way out of aging (or heart disease, or cancer, or any of the other conditions that attend aging) right this instant than does anyone else. What they do have is a far greater ability to create a near future in which rejuvenation biotechnologies exist and are just as widely available as any present day clinical procedure.

This is a surprising paragraph. I'm not sure how you're defining "poor".

Illnesses of old age are a "luxury" that poor people don't have, because poverty related illnesses kill them before they get chance to be old.

Access to chemotherapy or radiotherapy or surgery is much easier for wealthy people than it is for poor people. (Although variations in cancer survival rates across wealthy countries shows that it's not just cash that makes a difference).

And rich people may not fund research into illnesses that affect them, but pharma knows where the money is. Compare the amount of money spent researching erectile dysfunction versus malaria.

> Compare the amount of money spent researching erectile dysfunction versus malaria.

I don't think much money goes into researching ED. The father of one of my med school classmates discovered the principle of action behind sildenafil and the other nitric oxide pathway interventions. They were working on preserving blood flow to the heart during a heart attack.

Compared to the vast toolbox of medical devices, the reebok-pump style penile implants are pretty simple implant system, probably one the way out as the old smokers die off (Leriche syndrome is primarily a vascular problem of smokers).

If you have some data, I'd love to see it, but I suspect there's a lot more time and money spent on malaria than ED at the research level. At the consumer level, the reverse is probably true.

I've never understood why ED is always the example of trivial medicine. Maybe I'm the only one who wouldn't go on living with no sex ever again. They weren't even working on it until they found a promising treatment by accident.

I agree. It's not trivial, and although very few people die from erectile dysfunction it was a bad example to use. My last paragraph talks about cough medicine.

Here's some information about medication costs in the NHS for 2011.

(http://www.ic.nhs.uk/webfiles/publications/007_Primary_Care/...)

A search for viagra shows the page for ED meds. Sildenafil totals are 1,279,500 prescribed, at a cost of £40,872,800 (Check my decimal places!) and the total for all ED meds is £84,033,500.

That might not sound like much - the UK wants to spend something like £500m per year just on malaria.

But spending on ED targets a small number of mostly old people. The QALY cost is about $11,000. Spending on malaria targets a very large number of people, many young, but people of all ages.

If you want an actual trivial medication let's look at cough medicine; mostly sugary syrup with strong flavorings, sometimes with paracetamol and sometimes with other stuff. Most doctors say it's pointless and expensive and that people do just as well with hot lemon and honey and correctly taken paracetamol. We spend about £500m in the UK on cough mixtures. Americans spend about $2Billion. (That B isn't a typo.)

Malaria spending (http://www.guardian.co.uk/global-development/2012/apr/25/wor...)

ED QALYs (http://www.ncbi.nlm.nih.gov/pubmed/10858175)

Cough medicine spending (http://www.mintel.com/press-centre/press-releases/410/consum...)

But by the same argument, cough medicine spending is by virtually everyone for their own direct benefit: that 500m targets a vastly greater number of people in the UK than malaria spending.

> Access to chemotherapy or radiotherapy or surgery is much easier for wealthy people than it is for poor people.

Is it? When I underwent chemotherapy, I did not pay for anything (to be honest, I paid gas to get to the hospital, but did not pay for medics, hospital bed, tests, blood analysis nor lost my salary for the days I could not work). Even though the price of some of the medics that were injected in me twice a month was greater than my monthly salary. Cancer is a disease for which poors are very well treated in France (So yes, in some wealthy country, cash makes no difference).

Yes.

I have relatives who died due to a lack of health care. They felt sick for a long time, but only got treatment once the chronic problem became acute. Unfortunately, when a chronic undiagnosed cancer condition becomes acute, it means that it has metastasized and the survival rates drops precipitously. Lack of health care meant that the sick person died in pain instead of getting better early on and living for many more years. (Nota bene: this is a USA story - I am under the impression that this would not happen in basically any other western democracy)

Yes, but what if they needed to stay working just to feed themselves and were unable to work as hard because of the chemo?

Just because a procedure is "free" doesn't mean it doesn't cost anything :)

Social Security and Medicaid/Medicare step in at this point.

By poor I mean the many people paid less than $3usd per day.

I think it says something that one of the most critically acclaimed TV series in the US right now is premised on a middle-class high school teacher who turns to a life of crime when his state-provided health insurance is insufficient to cover his cancer treatment.

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