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 Post subject: Re: Health and Social Budget overruns - making the rest moot
PostPosted: Sun Apr 23, 2017 11:52 pm 
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Any lad who wants PreP should get it for free, they should be allowed to donate blood too, sure what could go wrong, don't listen to the homophobes

We should also continue to import people from countries with high HIV rates, sure didn't saint Barry also change the rules in the US, and I can't wait until someone I know dies of drug resistant TB, it will be great, just like the 50s again

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 Post subject: Re: Health and Social Budget overruns - making the rest moot
PostPosted: Mon Apr 24, 2017 11:00 am 
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...aaaand another thread derailed as an immigration debate. Well done.

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 Post subject: Re: Health and Social Budget overruns - making the rest moot
PostPosted: Mon Apr 24, 2017 11:05 am 
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Skippy 3 wrote:
It is hard to paraphrase her argument as it is so weakly made. And anyway we all know that a puppy dies every time someone links to one of her articles.


Basically it's a bit like saying to boy racers that it's okay to drive without a seatbelt if you put an additive in your petrol tank every day.

Even if the risk reduction is the same, would you trust them to use it reliably?
And should the state fund it at €500 a month where the alternative is close to free?


The adherence issue is covered by the study. I'm not sure whether you saw my comment immediately prior to yours, but the study shows that HIV infection rates are significantly lowered among people who were prescribed the drug. In other words, this includes whatever non-adherence rate there is in the real world.

In terms of whether the State should fund it, set aside the moral question and look at it as a cost-benefit. You have a high-risk population and you know that without PrEP, X% will become infected. Would you rather treat them all prophylactically @ €500/month for a few years while they're young and irresponsible, or would you rather treat the infected % for the rest of their lives with HIV anti-retrovirals at €2000/month (or whatever- cannot find good numbers for Ireland but apparently the lifetime average cost of treatment is around €500,000). You'd need to know all the variables like how many years they're likely to remain high-risk etc but it's not a complicated calculation. Much like the cost-benefit for vaccinations.

Of course you could add in the moral issue -- if you can stop people from contracting an incurable disease with a simple and easy treatment, is it moral to not to it, at any price? I don't know the answer.

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 Post subject: Re: Health and Social Budget overruns - making the rest moot
PostPosted: Mon Apr 24, 2017 11:34 am 
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Mantissa wrote:
Skippy 3 wrote:
It is hard to paraphrase her argument as it is so weakly made. And anyway we all know that a puppy dies every time someone links to one of her articles.


Basically it's a bit like saying to boy racers that it's okay to drive without a seatbelt if you put an additive in your petrol tank every day.

Even if the risk reduction is the same, would you trust them to use it reliably?
And should the state fund it at €500 a month where the alternative is close to free?


The adherence issue is covered by the study. I'm not sure whether you saw my comment immediately prior to yours, but the study shows that HIV infection rates are significantly lowered among people who were prescribed the drug. In other words, this includes whatever non-adherence rate there is in the real world.

In terms of whether the State should fund it, set aside the moral question and look at it as a cost-benefit. You have a high-risk population and you know that without PrEP, X% will become infected. Would you rather treat them all prophylactically @ €500/month for a few years while they're young and irresponsible, or would you rather treat the infected % for the rest of their lives with HIV anti-retrovirals at €2000/month (or whatever- cannot find good numbers for Ireland but apparently the lifetime average cost of treatment is around €500,000). You'd need to know all the variables like how many years they're likely to remain high-risk etc but it's not a complicated calculation. Much like the cost-benefit for vaccinations.

Of course you could add in the moral issue -- if you can stop people from contracting an incurable disease with a simple and easy treatment, is it moral to not to it, at any price? I don't know the answer.

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)

http://www.newstalk.com/reader/47.301/84420/0/

I couldn't read Mullally's article but she claims MSM are "fastidious" re. safe sex :?

Quote:
Men who have sex with men are already far more fastidious when it comes to their sexual health compared with straight men, so let there be no judgment there either. PrEP works, and forward-thinking health services are cottoning on


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 Post subject: Re: Health and Social Budget overruns - making the rest moot
PostPosted: Mon Apr 24, 2017 11:42 am 
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slasher wrote:
It's only a vaccination for 1 disease.

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.

slasher wrote:
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)

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.

http://www.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.

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 Post subject: Re: Health and Social Budget overruns - making the rest moot
PostPosted: Mon Apr 24, 2017 11:44 am 
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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?


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 Post subject: Re: Health and Social Budget overruns - making the rest moot
PostPosted: Mon Apr 24, 2017 11:51 am 
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poohbear wrote:
As for gonorrhea, really? Curable with antibiotics. Cheap to fix. Who cares?

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

http://www.nhs.uk/news/2011/07July/Page ... rning.aspx

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 Post subject: Re: Health and Social Budget overruns - making the rest moot
PostPosted: Mon Apr 24, 2017 11:54 am 
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Eschatologist wrote:
poohbear wrote:
As for gonorrhea, really? Curable with antibiotics. Cheap to fix. Who cares?

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

http://www.nhs.uk/news/2011/07July/Page ... rning.aspx


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.


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 Post subject: Re: Health and Social Budget overruns - making the rest moot
PostPosted: Mon Apr 24, 2017 12:16 pm 
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poohbear wrote:
This is still not an argument against PrEP.

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

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 Post subject: Re: Health and Social Budget overruns - making the rest moot
PostPosted: Mon Apr 24, 2017 12:25 pm 
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Mantissa wrote:
slasher wrote:
It's only a vaccination for 1 disease.

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.

slasher wrote:
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)

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.

http://www.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.



ah here

blaming religious influence in schools is a red herring

https://www.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


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 Post subject: Re: Health and Social Budget overruns - making the rest moot
PostPosted: Mon Apr 24, 2017 12:50 pm 
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slasher wrote:
ah here

blaming religious influence in schools is a red herring

Really? Who do you think is teaching abstinence?

http://www.irishtimes.com/news/educatio ... -1.1677796

Quote:
On Track was written by three people linked to Youth Defence: Linda Gorman, Carolyn O’Meara and Susan Scanlan.

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 Post subject: Re: Health and Social Budget overruns - making the rest moot
PostPosted: Mon Apr 24, 2017 1:30 pm 
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Mantissa wrote:
slasher wrote:
ah here

blaming religious influence in schools is a red herring

Really? Who do you think is teaching abstinence?

http://www.irishtimes.com/news/educatio ... -1.1677796

Quote:
On Track was written by three people linked to Youth Defence: Linda Gorman, Carolyn O’Meara and Susan Scanlan.

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


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 Post subject: Re: Health and Social Budget overruns - making the rest moot
PostPosted: Mon Apr 24, 2017 1:41 pm 
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slasher wrote:
Mantissa wrote:
slasher wrote:
ah here

blaming religious influence in schools is a red herring

Really? Who do you think is teaching abstinence?

http://www.irishtimes.com/news/educatio ... -1.1677796

Quote:
On Track was written by three people linked to Youth Defence: Linda Gorman, Carolyn O’Meara and Susan Scanlan.

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


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

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 Post subject: Re: Health and Social Budget overruns - making the rest moot
PostPosted: Mon Apr 24, 2017 1:47 pm 
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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.


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 Post subject: Re: Health and Social Budget overruns - making the rest moot
PostPosted: Mon Apr 24, 2017 2:02 pm 
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I really don't think there's any point in discussing further. You also don't seem to have read the last link I posted which discusses how non-fringe these groups are.

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