When Is It Ethical to Withhold Prevention?

Congress has used cost-effectiveness analyses in deciding that Medicare should cover selected secondary prevention services, such as screening for breast cancer and colon cancer. But the measure of cost per QALY is routinely ignored in decisions both about treatment for demonstrated disease and about primary prevention of disease. It is ignored, though, in entirely different ways. Medical treatments are paid for even if they are cost-ineffective; in fact, the Medicare program has been blocked from even considering cost-effectiveness in determining whether to cover the costs of treatment. For example, treatment of metastatic lung cancer may cost $800,000 per QALY, but it is typically provided. In sharp contrast, primary preventive services are often withheld even if they are highly cost-effective. For example, the Diabetes Prevention Program, a lifestyle-training program focused on exercise and nutrition that costs only $14,000 per QALY, is covered by only some health insurance plans; Medicare is not among them.

http://www.nejm.org/doi/full/10.1056/NEJMp1516534

Julie Rubicon

That afternoon, looking out across the salt flats, she trembled with certainty. “They know.”

They don’t, I assured her. They can’t.

“They will. They’ll look at the logs. We’re gonna get in trouble. We’re gonna go to jail.”

“I don’t think there’s any law against this,” I said. How could there be a law against something that’s not possible?

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Vegan Eating Would Slash Food’s Global Warming Emissions

Adopting a diet in line with the global guidelines could avert 5.1 million deaths per year by 2050, while 8.1 million fewer people would die in a world of vegans who do not consume animal products, including eggs and milk.

When it comes to climate change, following dietary recommendations would cut food-related emissions by 29 percent, adopting vegetarian diets would cut them by 63 percent and vegan diets by 70 percent.

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Daily Table sells healthy food at a deep discount

In keeping with its mission, Daily Table sells produce at rock-bottom rates. Its bananas sell for 29 cents per pound, and apples go for 69 cents per pound, and those prices are about half of the U.S. city average price…

While there is currently only one location, the company plans to open additional stores in both the greater Boston area and in cities across the country.

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The Greatest Diet Myth of All

David Katz: The Greatest Diet Myth of All

These days, the most common take-away about diet and health is that everything we thought we knew about diet and health is a myth. As best I can tell, however, the notion that reputable journalistic platforms are interested in getting at a reliable, stable truth about diet and health is the myth.

Maciej Ceglowski: What Happens Next Will Amaze You

If we’re going to have networked devices, we need a foolproof way of disconnecting them. I don’t want to have to log in to my pencil sharpener’s web management interface to ask it to stop spinning because some teenager in Andorra figured out how to make it spin all night.

Samsung recently got in hot water with their smart refrigerator. Because it failed to validate SSL certificates, the fridge would leak your Gmail credentials (used by its little calendar) to anyone who asked it. All I wanted was some ice, and instead my email got hacked.

We need an Internet off switch.

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Animal Abuse: Us and Them

The best justification we have for imposing suffering and death on billion of animals every year is that they taste good. We enjoy the taste of meat, dairy, eggs, etc. We get palate pleasure from eating animal foods.

And just how is that different from any other imposition of suffering and death by people like Walter Palmer, Michael Vick, or anyone else whom we label as an “abuser”? The answer is simple; it isn’t any different.

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