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Not the same.

Orthodontic procedures generally pay off in the long run. Straight teeth and an aligned bite are typically more functional. Straight teeth are easier to clean and preserve.

In many EU countries health insurance pays for them because a long term financial argument can easily be made.

Bad teeth can cause severe health issues and get expensive later in life.

I was not arguing that orthodontics is bad. I was just using it to illustrate the expanding definition of the word "health".

Another big problem is, that we ignore the fact that we age. I do not think that care for the elderly should be an area of medicine. When your body breaks apart at 80 years old, that does not make you unhealthy, you are just old. You should not get the needed social interaction from doctors, who try to fix something that is perfectly natural to fall apart.

'Naturally' or 'natural' is a poor argument to make about not caring for the elderly.

If the elderly is not able to walk, eat, or think, then they're sick or disabled. It doesn't matter if you are 80 or 20 years old.

I think there's a pretty wide gulf between caring for people with a disability, and keeping your teeth toilet-bowl white after decades of drinking tea or coffee, or whatever.

I am not saying you should not care for your body, when you are old. I am just thinking that the amount of care you put in should have a positive ROI in quality of life and I am not so sure about that in any case of so called elderly care.

When your body breaks apart at 80 years old, that does not make you unhealthy, you are just old.

Or we could get our shit together and classify aging as a treatable disease and spend an adequate amount of research dollars on finding a cure.

Good idea. Until we have said cure lets not pretend that you can fix ageing by visiting the doctor twice every week, effectively offloading needed social interaction to them.

Edit: This view might be radical on HN, but while I do believe that we can fix ageing and that eventually someone will, I am not quite sure if we really should.

The NHS approach of putting monetary value on a year of life and comparing the drug costs to that is a good approach to reducing the spend on tired old bod's.

"Tired old bods". Will you feel the same when (touch wood) you reach such an advanced age? :)

Yes. Hopefully euthanasia will be a thing should I reach the decrepit stage. One last party (perhaps with a bit of morphine), followed by drifting to an infinite sleep... sounds fairly dignified.

Sorry, but this sounds a bit short-sighted. While nobody should be sentenced to suffer severe pain for the rest of his life, just because your body isn't as capable as it used to be doesn't necessarily mean that you want to end your life. Often there will be people that you will leave behind and you certainly don't want to explain them that it's your decision to do just that.

On top of that, this is also dangerous from a social perspective where people could get a feeling that they are supposed to go once there is nothing they can contribute to society anymore.

We should rather focus on allowing making "regular" dying more dignified rather than promoting euthanasia.

I do think it should be a personal decision. Also, euthanasia is certainly not preventable (I think of a certain gentleman that took the bottom of the river approach).

I have seen a few old people live beyond their time and wait for death though. It is quite harsh and undignified. "I am just so tired and I want to go."

There's nothing about "wired new bod's" that makes them more worthy of being alive...

I agree with you completely. While I'm not totally on board with what the NIH is described as doing, what you say is not against what the parent said. The issue is that new bods are very likely to have a lot more useful year left, which counts in the equations.

Let's say the NIH values a year of life at X. There is a 90 year old and a 10 year old who need the same treatment that costs 10X. We should be much more willing to give the treatment to the 10 year old because he has a much better chance of 'earning back the investment', whereas statistically, the 90 year old is overwhelmingly likely to die in the next 10 years.

Strictly speaking, if it costs 10x then the 10 year old will have to live to 110, whereas the 90 year old need only live to 100 to "earn back the investment".

So, your maths is incorrect, try "5x the cost". But I take your point.

It's painfully telling that we (or at least some of us) somehow consider the effort in keeping a person alive an "investment" that must be "earned back".

We a species have finite resources and can't sink all of them into every patient. Every time we treat or don't treat someone (and it's not possible to treat everyone of everything), we're making implicit statement in the form of a mathematical inequality about how we value money against human life and quality of life. The question here is whether these statements about how life balances against resources are self-consistent or not. And if they're not consistent, then that means you can re-arrange your decisions to save more lives at the same cost, or alternatively save the same number of lives at less cost. The route the NIH apparently went was to try to make their decisions consistent by explicitly giving a dollar value to a year of human life.

Treating the cost of saving a life as a cost is a completely different question than treating it as an investment. Human lives have value, in and of themselves, irrespective of whether or not sinking some number of dollars into extending them can — let alone should — be "earned back".

Whatever you call it, the value that patient N derives from cost C needs to be compared to the value that patient N+1 would derive from that same cost C.

When the NIH (or equivalent) turn that into a C/expected number of years, they're doing a scarce resource allocation problem. Unless you have infinite resources to give every patient every available treatment, you have to do allocation somehow.

Giving a 10-year old a treatment that you'd deny a 90-year old seems perfectly sane and rational to me.

I can't tell if you're agreeing with the concept and just disagreeing with the terminology, or if you believe there's a fundamentally better way?

>We a species have finite resources and can't sink all of them into every patient. Every time we treat or don't treat someone (and it's not possible to treat everyone of everything), we're making implicit statement in the form of a mathematical inequality about how we value money against human life and quality of life.

We spend more on dog food than we do on millions of patients.

So, no, it's not a question of "finite resources".

Or, rather, it would be, if we were anywhere near exhausting our resources.

I don't have the slightest idea what you're saying.

What bizzaro math are these?

First of all, 10X is not a factor of age! "X" was meant as an arbitrary monetary unit, and the cost is the same 10X for both the kid and the 90 year old.

Second, "returning the investment" doesn't mean "reaching 100 years old". It just means "getting more years of life for the same cost".

Even if the boy lived only to 30 or 40, he still lived 20 or 30 years, whereas for the 90 year old living up to 100 or 110 would be extremely rare.

If an additional year of life is valued at "X" and the cost of the treatment is "10X", the 10 year old has to live to 20 and the 90 year old to 100 to "break even" (assuming a discount rate of 0).

I literally cannot figure out where your math went off the rails.

It is beyond offensive to imply that 60 year old individual is worth less to society than a 30 year old individual, and that there are life-saving measures appropriate for the latter that are too costly for the former.

I don't know why this comment is being downvoted. If medicine still advances at the rate it is now, by the time we will be 60, the average old age will be in the 100s.

Due to "rectangularisation of the survival curve", probably not (there appears to be a max age of around 110). Current rates are 3 months more life expectancy per calendar year. However, in the US and various other places the improvement is seriously wobbling due to wobbly bellies.

Let's say the treatment guarantees until life expectancy of 88, ignoring a few details. Do we say that 28 years of life is worth the same as 58 years of life, keeping in mind budget is fixed?

I mostly disagree although I understand and appreciate the sentiment of your post.

You have to consider first of all that we're working with scarce resources. When we're not, it's not even an issue to compare two lives if you can save them both. But in the case that there are limited resources and you happen to have to choose between focusing on two different groups of people and make that tradeoff, you inevitably have to base your decision on something.

Now if you have a 15 year old kid and an 80 year old person, and both are dying from some preventable disease at a rate of 1% per year, and you have a scarce budget to focus on researching one particular disease, which one do you choose to focus on?

Well flipping a coin is probably shit. But making a ranking based on qualify adjusted life years[0] probably makes more sense. Of course it's not perfect, but it's not beyond offensive if you ask me to go about reasoning like this to partially inform policy decisions.

[0]https://en.wikipedia.org/wiki/Quality-adjusted_life_year

I suspect the idea sounds 'wrong' when talking about adults, but most people feel it is intuitive when talking about young children. Which person should you rescue first, the 4 year old or the 64 year old?

These issues I suspect are very rife for post-hoc rationalisation around gut-feelings of morality: https://www.youtube.com/watch?v=5YL3LT1ZvOM

What scarce resources are you referring to in the developed world?

Bill Gates turns 60 this year. It's pretty safe to assume he'll accomplish more in the next 20 years than you will in your lifetime.

> What scarce resources are you referring to in the developed world?

What kind of question is this? You think we have infinite medical researchers with infinite resources and infinite budgets? All countries, including the richest ones, have budgets.

> Bill Gates turns 60 this year. It's pretty safe to assume he'll accomplish more in the next 20 years than you will in your lifetime.

Oh god you can't really think that's a good argument, can you? Citing Gates as your anecdotal evidence to make a point about policy that affects millions of people is outright silly. It's like saying government policy should prevent people from going to university, and dropping out once they get in, because hey Bill Gates did it and look how that turned out. Why refer to one of the most extreme outliers in modern history as a justification for medical policy for completely different, average people?

I don't even get what your point is. I made the point that it probably makes more sense to save 1% of 15 year olds (or 25 year olds for that matter, considering the other post on how children distort our perspective of morality), than 1% of 80 year olds, or 60 year olds for that matter, given a common situation of scarce resources and the need to make a trade off. (again in cases where resource scarcity doesn't matter, the discussion is irrelevant).

If you want to counter that with the point that 'but some 60 year olds are still productive, look at bill gates, his impact will be tremendous the next decades' then you fail to see how statistically that 60 year old may have already been dead 35 years earlier, and that statistically for every bill gates you'd save at 60, in this hypothetical situation, you'd give up a younger bill gates who now dies at 25, and it may be said that despite his tremendous impact late in life, it doesn't rival his impact earlier in life, and that this (having more impact before 60 than after 60) probably holds true on average, generally speaking. No amount of anecdotal evidence changes that fact.

You don't need infinite resources for a finite amount of people. You are exaggerating the choice.

The point is that you don't need to give up a younger Bill Gates for an older one.

As for the impact of his accomplishments, I think we'll need to wait until the end to evaluate it. You could argue that saving millions of lives and offering tens of millions better, healthier lives is more impactful.

The scarce resources implied here is the money that the government spends on medical treatment for the elderly, poor and disabled. Bill Gates obviously could always buy his own medical treatment.

Yes, if you have to treat everyone with Alzheimer's or cancer, that could be expensive. On their the hand, once you develop inexpensive cures, it's not such a burden.

Sure, but the money Bill Gates spends on medical treatment takes resources away from other things. Even if supply is elastic enough to adjust, it's unlikely to adjust immediately, and the adjustment will still reduce resources that would have been consumed elsewhere.

Money is a claim on future productivity. Spending it causes people in the world to adjust what they're doing to satisfy what you're asking for. Most of our claims aren't very large though, so this isn't particularly noticeable except in aggregate.

Really? The Foundation has been founded. Does it need Bill?

I ask this in seriousness -- why do we judge the possibility of the future as more valuable than the certainty of the past?

That is, why do people tend to be more sad when a kid has cancer than an old person? A child hasn't had decades to interact with and influence other people's lives. In terms of the sadness inflicted if someone were to die, an older person will have affected hundreds of lives, built things, had families, etc.

A child hasn't really impacted anyone except their parents.

I feel there's an underlying attitude that older people have had their time, and it's only right that a young person gets their chance.

But I'm not at all sure if that's true, and I wonder how much of this conversation is based on an assumption that we haven't explored verywell.

Tou need to luck at marginal cost: An old person is going to die, 100% chance, and that will cause sadness, etc. The question is what is the marginal value in each extra year of life, not is the death itself undesirable.

Your question also touches on abortion, and the argument that a fetus deserves less protection from society because of its lack of social connection. http://www.equip.org/article/steven-pinkers-evolutionary-exp...

But you touch on a deeper question also: "saving lives" is a very modern idea. Traditionally, death was quote common all all corners of society, and the solution was to make more new people.

We are used to parents and grandparents dying. We are not used to kids dying.

I think back in the times when child deaths were common, it was less hard to handle.

We're not talking about research funding. The comment I replied to referenced NHS placing a monetary value on a single year of life, which directly means that young people are "worth more" than older people.

Resources are scarce; their use must be prioritized. The answer to the difficult question of how to apportion health spending is not to take offense at being asked. You don't get to take that way out; it's not an option.