Hospital, Dignity, Reality

[sheeplady]

This is not the place to make a long and boring figure for figure exchange. I could come up with five more excerpts and then you could come up with five more and so on and so on. It accomplishes nothing. Let's just agree to disagree.

You asked for facts supporting my argument, I gave them to you. I asked for your facts, and your response is that it would be boring to do so. To me, this indicates that either you are unwilling or unable to find the facts to support your argument, you are unwilling to change your mind about the facts I presented, or that you were bluffing when you challenged me to give facts and was hoping that I would back down from the argument.

I can reassure you that this is a topic on which I am well versed and I can also reassure you that you cannot find scientific articles that argue that other developed countries follow a different standard of care for pre-term infants than approximately 24 weeks. I have looked and had motivation at the time to find articles to prove that there were differences in care standards. I have proven my point that the U.S. uses a standard practice of care for preterm babies that is used worldwide in developing countries and that there is a high rate and rising rate of preterm birth in the U.S.

If you are unwilling to engage in debate, it's your choice to do so; but please don't keep saying that we provide care to earlier pre-term infants in the United States than we do. It's very unfair to families in the U.S. who are dealing with this issue- they need to be provided with the facts and only the facts, not baseless allegations that lead to false hope. And the truth is that 24 weeks is the first time these families can expect intervention to save their child in the U.S.

 

[Baron Kurtz]

Last one from me. I REALLY want to see this data, if you could. But what I want to see is not a distillation "% greater chance of survival", what I want is a survival rate. Of the number of people who get it, how many survive? And I also need to know how the data are collected, what are the outcomes that determine "survival" (how long, is there recurrence etc etc). Obviously only the primary sources can give me this so that would be great if you could send them.

Sadly with numbers, you can make them tell you whatever you want to see when you start distilling them. Same with any kind of attempts to distil research to soundbites. A colleague of mine apparently just cured Alzheimer's … so says the press release the journal sent around the newspapers. That's news to the authors!

The raw numbers are the only ones that matter. Of cohort A with cancer X, Y survived and Z died of that cancer or a related one (post metastasis, that kind of thing), and in different countries, these are the numbers. That's all I need to know.

It means simply that if you have any kind of common cancer in US then you have a 52% greater chance of survival than the same person in Germany. Period.

 

[jamespowers]

Last one from me. I REALLY want to see this data, if you could. But what I want to see is not a distillation "% greater chance of survival", what I want is a survival rate. Of the number of people who get it, how many survive? And I also need to know how the data are collected, what are the outcomes that determine "survival" (how long, is there recurrence etc etc). Obviously only the primary sources can give me this so that would be great if you could send them.

Sadly with numbers, you can make them tell you whatever you want to see when you start distilling them. Same with any kind of attempts to distil research to soundbites. A colleague of mine apparently just cured Alzheimer's … so says the press release the journal sent around the newspapers. That's news to the authors!

The raw numbers are the only ones that matter. Of cohort A with cancer X, Y survived and Z died of that cancer or a related one (post metastasis, that kind of thing), and in different countries, these are the numbers. That's all I need to know.

I remembered one and used your menti9oned pub Med to find it. This si just one of the references:
http://web.mail.comcast.net/zimbra/mail?app=mail#64

 

[jamespowers]

You asked for facts supporting my argument, I gave them to you. I asked for your facts, and your response is that it would be boring to do so. To me, this indicates that either you are unwilling or unable to find the facts to support your argument, you are unwilling to change your mind about the facts I presented, or that you were bluffing when you challenged me to give facts and was hoping that I would back down from the argument.

I can reassure you that this is a topic on which I am well versed and I can also reassure you that you cannot find scientific articles that argue that other developed countries follow a different standard of care for pre-term infants than approximately 24 weeks. I have looked and had motivation at the time to find articles to prove that there were differences in care standards. I have proven my point that the U.S. uses a standard practice of care for preterm babies that is used worldwide in developing countries and that there is a high rate and rising rate of preterm birth in the U.S.

If you are unwilling to engage in debate, it's your choice to do so; but please don't keep saying that we provide care to earlier pre-term infants in the United States than we do. It's very unfair to families in the U.S. who are dealing with this issue- they need to be provided with the facts and only the facts, not baseless allegations that lead to false hope. And the truth is that 24 weeks is the first time these families can expect intervention to save their child in the U.S.

And this is why I don't want to go further down the line as I see this as being disruptive and beyond the point of being instructive.
The infant mortality rate is not only affected by the care we give to newborns but also the type of newborns we deal with. With the advent and increase in Invetro fertilization in the US, the birth of triplets, quadruplets and the like is soemthing that is completely different and adds to our mortality rate as well when other countries use that method far less than we do. This is just one example.
As I said though, I don't want to get into a statistic match as it will be that. You have your idea that I cannot change with whatever I bring up.

 

[sheeplady]

And this is why I don't want to go further down the line as I see this as being disruptive and beyond the point of being instructive.
The infant mortality rate is not only affected by the care we give to newborns but also the type of newborns we deal with. With the advent and increase in Invetro fertilization in the US, the birth of triplets, quadruplets and the like is soemthing that is completely different and adds to our mortality rate as well when other countries use that method far less than we do. This is just one example.
As I said though, I don't want to get into a statistic match as it will be that. You have your idea that I cannot change with whatever I bring up.

Are you still arguing that our intervention time of 24 weeks is different than the intervention time of 24 weeks in most developed countries for preterm babies?

 

[jamespowers]

Are you still arguing that our intervention time of 24 weeks is different than the intervention time of 24 weeks in most developed countries for preterm babies?

Yes that too and that is my last word on it. Call Dr. Atlas if you have further questions at (650) 723-7426. Reference his book:In Excellent Health: Setting the Record Straight on America’s Health Care.

 

[tonyb]

Might this be illuminating at this point?

http://www.skepdic.com/confirmbias.html

 

[sheeplady]

Yes that too and that is my last word on it. Call Dr. Atlas if you have further questions at (650) 723-7426. Reference his book:In Excellent Health: Setting the Record Straight on America’s Health Care.

I'm not seeing any discussion in that book about viability dates for preterm babies. Can you give a page number?

I'm really curious because nothing I have read has indicated anything different than what I have spoken about, and I've read not only scientific reports, but guidelines produced by insurance companies, national healthcare systems, and independent healthcare organizations that provide guidelines to physicians and healthcare workers about viability dates. I've also spoken to numerous healthcare practitioners that work in NICUs and to many families with premies about their practical experiences with viability dates and successful outcomes, both inside the U.S. as well as in other parts of the world.

 

[jamespowers]

I'm not seeing any discussion in that book about viability dates for preterm babies. Can you give a page number?

I'm really curious because nothing I have read has indicated anything different than what I have spoken about, and I've read not only scientific reports, but guidelines produced by insurance companies, national healthcare systems, and independent healthcare organizations that provide guidelines to physicians and healthcare workers about viability dates. I've also spoken to numerous healthcare practitioners that work in NICUs and to many families with premies about their practical experiences with viability dates and successful outcomes, both inside the U.S. as well as in other parts of the world.

I don't have access to the book right now but I did find this interview with him that lasts about and hour. If you have that long to listen to it then give it a try. If you don't then they have a transcription and arguments after it. It is somewhat of a tedious read but it gives you an idea.

 

[AmateisGal]

Might this be illuminating at this point?

http://www.skepdic.com/confirmbias.html

Yep.

 

[sheeplady]

I don't have access to the book right now but I did find this interview with him that lasts about and hour. If you have that long to listen to it then give it a try. If you don't then they have a transcription and arguments after it. It is somewhat of a tedious read but it gives you an idea.

Ok, I will take a look at it. I need to look at it more in depth because I haven't spotted anything about preterm viability dates, but I only did a quick scan.

ETA: Ok, I found this part, but there's no information in there about viability dates being different in other countries according to my reading of it:
"And many other reasons as well, including things like: the United States has a medical culture of doing what I would call the full court press. Every baby. So, we go to great lengths to prolong and hopefully end up having a success of survival--like I said, the weakest and most vulnerable infants."
I'd really like to see his sources, because I've been told (and read and read looking for anything that would give a baby born before 24 weeks hope) that no one saves babies as a manner of practice under 24 weeks. Many countries do have weight limits (that is very much true) but many practitioners do enforce weight limits too in the states. A rather gruesome business.

As far as the infant mortality rate, he may very well be right.

 

[jamespowers]

Ok, I will take a look at it. I need to look at it more in depth because I haven't spotted anything about preterm viability dates, but I only did a quick scan.

For what you want go to section 11:42. I told you it could be tedious. lol I have a few other things specific to that as well but not here with me.

 

[sheeplady]

For what you want go to section 11:42. I told you it could be tedious. lol I have a few other things specific to that as well but not here with me.

I think I found it and put it in my edit.

 

[tonyb]

"Winning" an argument is way too often considered a worthy end in and of itself, no matter how illusory that "victory" truly is.

I have a friend (yes, he's a friend, and an obnoxious guy, but that's not the worst thing you can call a person) who is of a personality type with which most of us are sadly all too familiar. This guy comes into a room and within a minute (if even that long) he gets to pontificating on his gripe of the day, and how it's another sign that the world is going to hell because it fails to recognize the wisdom of his absolutist point of view.

Those who know him at all don't even bother challenging him, because that results in his getting louder and more forceful, prompts him into citing only that data that he convinces himself supports his position (whether it actually does or not), while dismissing if not ignoring that which refutes it (a clear display of "confirmation bias" if ever there was one), and it just delays his departure.

So everyone else's silence, which is really an indication of their annoyance and boredom, he takes as a sign he has "won." Just what he has won, I doubt even he knows. But it's usually clear that what he hasn't won is a single convert to his side.

 

[Flicka]

I know for a fact that we save children as early as possible here, and have managed children as early as week 22, though before week 24 the odds are pretty poor. Over week 28, the survival rate is almost the same as for full-term babies here. I'm not sure if we have a week or weight limit (I will have to ask my sister who just finished her obstetrics/pediatrician classes to be sure -- I'm sure she can provide some numbers), but I think we try to save very premature children (def 24-25 weeks). And we don't have private hospitals here; all hospitals are publically owned and give the same treatment to all patients. Mother care is free of charge for everyone -- the government pays, whether you go to a private or public clinic so everyone has the exact same opportunity for care.

I'm not a major statistics nerd and am not interested in crunching numbers when I have no idea how they were collected or treated, but at least according the UN:s statistics for 2000-2005 and their predictions for the period leading up to 2050, they calculate both a lower death rate per 1,000 births for Sweden (and no, we don't do any of those peculiar acrobatics for births that James suggested, and I would expect that the UN tried to get comparable numbers and did some sort of washing of the statistics before publishing the report in order to make sure that they were at least somewhat comparable) and a longer life expectancy than the US. As far as infant mortality goes, only Iceland and Singapore have a lower infant mortality than we do - according to the UN, of course. You can trust them or disregard these figures if you like, but here you are: (www.un.org/esa/population/publications/wpp2006/WPP2006_Highlights_rev.pdf)

My experiences of Swedish medical care have always been excellent so I'm a little shocked at some of the stories I've seen here. I've never heard of similar things from other Swedes, so pardon me for making the conclusion that we're better off. We might complain over certain specifics about our public healthcare but if anyone much as suggested removing it, we would probably riot in the streets, high and low incomes side by side. We consider that providing free healthcare and free education is part of the government's core business and the idea of an income variable in getting access to healthcare will be absolutely morally outrageous to most Swedes. And that's not being "political", it's just part of our tradition. [huh]

 

[Flicka]

Sadly with numbers, you can make them tell you whatever you want to see when you start distilling them. Same with any kind of attempts to distil research to soundbites. A colleague of mine apparently just cured Alzheimer's … so says the press release the journal sent around the newspapers. That's news to the authors!

Ha, reminds me of one of my uncle's studies (he's a a prof of epidemiology) many years ago which the newspapers claimed showed that getting breast implants increased the risk of suicide (because there was a statistical correlation) and he just shook his head because there was some interesting stuff in that study as well!

 

[sheeplady]

I know for a fact that we save children as early as possible here, and have managed children as early as week 22, though before week 24 the odds are pretty poor. Over week 28, the survival rate is almost the same as for full-term babies here. I'm not sure if we have a week or weight limit (I will have to ask my sister who just finished her obstetrics/pediatrician classes to be sure -- I'm sure she can provide some numbers), but I think we try to save very premature children (def 24-25 weeks). And we don't have private hospitals here; all hospitals are publically owned and give the same treatment to all patients. Mother care is free of charge for everyone -- the government pays, whether you go to a private or public clinic so everyone has the exact same opportunity for care. [huh]

In the U.S. we boast a 90% survival rate for infants born at 28 weeks, which is pretty darn good if you think how small a baby is then-often under 3 pounds- and most of that 10% comes from mothers on which they aren't able to delay labor and administer steroid shots for the lungs. (You need 24 hours to administer steroid shots for them to be absorbed). At 32 weeks, the odds of survival are practically as good as a baby born at term. Of course, any baby born premature is far more likely to have a disability (cognitive and/or physical), but even those odds have improved over the past 10 years. I would imagine they are identical in Sweden.

 

[Flicka]

In the U.S. we boast a 90% survival rate for infants born at 28 weeks, which is pretty darn good if you think how small a baby is then-often under 3 pounds- and most of that 10% comes from mothers on which they aren't able to delay labor and administer steroid shots for the lungs. (You need 24 hours to administer steroid shots for them to be absorbed). At 32 weeks, the odds of survival are practically as good as a baby born at term. Of course, any baby born premature is far more likely to have a disability (cognitive and/or physical), but even those odds have improved over the past 10 years. I would imagine they are identical in Sweden.

Yup, I quoted sloppily. 28 weeks has a good chance of survival, but it isn't until 32 weeks that the chances are more or less equal with a fully grown baby.

 

[Red Diabla]

I have also come to the conclusion that the best way to avoid immersion in the medical system is to try to keep myself as healthy as possible. Certainly easier said than done.

Yes and no, it varies from person to person to some degree.

My husband had a minor medical procedure done this week, and the staff was SHOCKED at his drug intake. Not because he takes a lot of drugs, but because he takes so few! Apparently in our part of the world it's unusual for a man in his early to mid fifties to NOT be taking a ton o' drugs. Which made me realize (again) that a lot of current health care isn't about being healthy, it's about making a lot of money for big pharmaceuticals.

Also, as long as one has money, they can get good health care in the US. But it does take money. I'm lucky to have health insurance right now. Very lucky.

I'm trying to see how long I can get by on eating somewhat smart, exercising regularly, and taking vitamins before my body rebels against me!

RD

 

[scottyrocks]

I've been in and out of hospitals, as well as out-patient places, a few times in the last few years, and have had mainly pleasant (or as pleasant as being ill can be) experiences with staff, facilities, and food. I have health insurance and it covers a large portion of the charges incurred for the procedures my family and I need done.