Health and Social Budget overruns - making the rest moot


#228

It’s only a vaccination for 1 disease. Gonorrhea infection rates are rising in active MSM populations - (and what if the next HIV/AIDS is out there; is there no such thing as personal responsibility? The health system has plenty of other less avoidable demands)

newstalk.com/reader/47.301/84420/0/

I couldn’t read Mullally’s article but she claims MSM are “fastidious” re. safe sex :confused:


#229

You do the same calculation for each additional vaccine that gets brought in; for example Meningitis B was introduced late last year but chicken pox has not although it’s standard n other countries. It’s obviously trickier when people die from not being vaccinated since you need to assign a cost there.

Indeed that’s worrying. We need to do much better on sex ed in school, particularly for LGBT groups. The current system is extremely outdated and has far too much tiptoeing around the issues to try and pretend that teens aren’t already having sex for the benefit of parents and religious patrons.

independent.ie/irish-news/ed … 44076.html

It would probably be far far cheaper to educate properly rather than treat.

Ultimately though it’s pointless to talk about what should have been done – the fact is, you have a high-risk population and you know that X% will become infected. You either treat or you do not. It’s separate to any education.


#230

There is a herd/network effect as well with PrEP. Those on PrEP can’t pass on infections they don’t get, so PrEP for 50% of an at-risk population might stop over 50% of transmission, making it more cost effective again. Like with vaccinations.

As for gonorrhea, really? Curable with antibiotics. Cheap to fix. Who cares?


#231

Cheap to fix right now, but there already exists at least one strain of gonorrhea that is drug resistant.

nhs.uk/news/2011/07July/Page … rning.aspx


#232

This is still not an argument against PrEP. Condoms break and better gonorrhea as a result than HIV.
Smacks of the slut-shaming arguments against introducing the HPV vaccines.


#233

I’m not making an argument against PrEP. I’d rather leave those decisions to the public health specialists.


#234

ah here

blaming religious influence in schools is a red herring

theguardian.com/society/201 … of-chemsex

like many issues (obesity/breastfeeding/fish consumption) in Ireland they mirror those in London/UK as much as any legacy religious influence despite what the usual Irish Times columnist would like to think


#235

Really? Who do you think is teaching abstinence?

irishtimes.com/news/educatio … -1.1677796


#236

I don’t know and don’t give a fuck. I never experienced it and never heard of anyone who did.

Do you genuinely think the idiots you linked to have had a meaningful influence on the Dublin Gay Scene? It’s not a scene I’m familiar with but I’m going to hazard a guess at no.

People know how HIV is spread they just don’t care anymore


#237

Um. OK then. No point in discussing it so…


#238

You made a statement implying that the recent rise of HIV is significantly influenced by the abstinence teaching of certain (fairly fringe) groups in Ireland (correct me if I misunderstood). If you can show a causitive effect I’d like to see it. Link please, as you’re fond of saying.


#240

I read it. I don’t buy the notion that active gay men aren’t aware of the risks because of it. We’re not talking about a 15 year old in Texas who gets knocked up because her boyfriend tells her she can’t get pregnant the first time.

Blaming religious fanatics for everything, [even Chemsex induced HIV :open_mouth: : ] is a cop out


#241

I blame the Pope for chemsex and I blame the Archbishop of Canterbury for the bugchasers


#243

I had a quick look at the study. My point is that even if non-adherence is accounted for, over time adherence will probably fall, given the risk profile of the people we are talking about.

That is why I made the boy racer analogy. We are talking about a high-risk practice consciously undertaken by a very small minority of young men. They are fully aware of what they are doing. No amount of ‘education’ will change this.

I wasn’t aware of the lifetime cost of anti-retrovirals compared to the cost of PrEP. On these grounds the cost-benefit payoff. To be honest Una’s article annoyed me in the first place because she grounded this in a minority rights argument rather than a public finance one.

It may be a hard sell though. The vast majority of taxpayers (straight and gay) are either celibate or monogamous so the ‘Why should I pay for their behaviour?’ argument will spring to mind.


#244

Preventative medicine is odd like that though. Almost nobody would argue against the State paying to treat sexually transmitted diseases, or life threatening obesity, or smoking/bacon-induced cancer, or people who’ve fallen off cliffs whilst rock climbing.

Maybe we feel that’s OK because the “irresponsible” person is suffering.

But would you want the State to pay for free vapes, or diet pills, or personal fitness trainers, or rock climbing supervision?

I think the only way to process it is to ignore morality and look at pure costs/benefits to the State. If the State is going to have to pick up the resulting bill then it makes sense for effective prevention to be funded, if that preventing returns its investment.


#245

I take your point. My point is a little more meta though.

Studies invariably show that preventive medicine is more effective than treatment after the event.

These studies often don’t highlight the fact that:
-People are lazy and often don’t take the treatment
-People get complacent. If the preventive practice appears to be working they stop with the treatment

There are many things about my diet (quantity and quality) that I know are bad for me in the long run. But I still consciously consume them.

Of all the groups I would trust to adhere consistently to preventive medicine, young men on the chemsex scene is pretty low down the list.


#246

Well I have to bow to your superior knowledge of the chemsex scene, but in my experience of dangerous sports, participants both novice and experienced tend to be incredibly careful because they know the risks. Some of them still ended up dead, but not for lack of diligent preparation.


#247

HSE overspending to create €300m financial deficit

irishtimes.com/news/health/ … -1.3211986


#248

You could read that headline in two ways. My first thought was that they are deliberately overspending to create the deficit to secure more funding. But surely they wouldn’t do that.

Money always finds a home. I think of councils that will dig up a perfectly good road and resurface it to use up their budget allocation otherwise they wouldn’t be able to justify receiving the same funding next year.

It’s such a complex monster I can’t begin to get my head around it all.

There are always plenty of incentives to spend more and more but what are the real incentives (professional or personal) to actually saving money? Kudos, promotions, pay rises?

Or is a stick approach being applied at all?


#249

State/Industry Medicine Pricing Agreements, Cost Savings and Counterfactuals: the Case of Ireland

ESRI paper here
esr.ie/article/view/862/181