This is absolutely correct and should not have been downvoted.
It is the abuse of a position of trust that aggravates this crime relative to that of a simple outlaw street dealer.
Commenters who are concerned with the effect on the convict's reputation and future employability are simply not in touch with reality....this was a grave breach of the basic ethics of the medical profession and seriously harmed the innocent patients involved. There is no return to work after something like this...any more than with a scientist who falsifies data, a teacher who sleeps with minor students, a lawyer who steals from escrow, etc.
I find it highly disturbing that there is more discussion in this thread as to the effect on the doctor's return on investment from his medical degree rather than on the individuals who bodies were damaged by someone they were supposed to be able to trust.
Nobody is "concerned" about the convict's reputation and future employability. You are misreading people's statements and thus misunderstanding their points. Namely, that the justice system serves a greater purpose than simply making you and me feel better and causing harm to perpetrators.
What point is there in discussing the so-obvious-it-goes-without-saying good-bad polarity of this situation? If we myopically give in to our emotions, rather than dispassionately examine the best course of action, then we'll miss an opportunity to improve the system and deter future incidents.
Stated another way, by attempting to redirect the course of this conversation, you are saying that virtue signaling by pitying current victims and demonizing the perp is more important than preventing future victims. If anything is highly disturbing, it's that.
You're missing the point because you don't understand the gravity of the crime.
A minimum wage fast food worker is constantly observed by a phalanx of cameras that will incriminate her should she attempt to steal five dollars from the till, but a surgeon in an operating room performs an infinitely more consequential task with nary a recording device in sight. Why? The immense trust and responsibility invested by society in medical doctors.
There is a common misconception that a medical license is basically just a reward for a demonstration of technical mastery, much as a developer job flows from passing a coding interview. But in reality the technical aspect is only secondary; the primary purpose of all those years of training is to ensure that the student understands the fullness of the obligations associated with the profession and is properly disposed to accept them.
In a case like this, the person understood and accepted those grave obligations, as well as all the privileges that came with them, only to toss them out the window when the opportunity arose to make a few extra dollars. That is what is being punished here. Four years is hardly too long, or cruelly retributive.
Well you yourself said it reflected the same kind of "emotional thinking" that led to millennia of "torture and abuse". What I am trying to show is that there are plenty of good reasons for this kind of punishment (whether or not one accepts a retributive component to justice). It is not simply a knee jerk insensitive reaction.
I never complained about the punishment, nor did I equate the punishment itself to emotional thinking. What I called emotional and dangerous was the unsupported claim that the punishment wasn't enough to be an effective deterrent and should therefore be increased.
And that is the claim I was contesting. You seem to have an odd intuition that a line of argument that does not reduce to a computing problem is "emotional". Even if one does not believe in retributive justice at all, an adequate deterrent is still going to be in proportion to the seriousness of the crime. It's not something that admits of a resolution by facts and figures alone.
What you are saying here is an order of magnitude milder in its certitude than koolba's assertion that the given punishment was "hardly a deterrent" and "barely a slap on the wrist." In addition, you are comparing this doctor's punishment to the seriousness of this doctor's crime, whereas the koolba unreasonably compared this doctor's punishment to the sum total of the harm caused by an entire epidemic of which this doctor played only a negligible part.
So yes, I stand by my claim that the original poster's point was an emotional reaction.
Had koolba instead said something like, "An adequate deterrent should be in proportion to the crime committed, and I believe 4 years in prison falls below that standard for reasons X, Y, and Z," then I would not have called that a knee-jerk emotional reaction. But he didn't.
"People cared" maybe plays a bigger role than you realize here. There were stronger social norms back then about the role of medical care in society. Most hospitals were community or religious owned, physicians were content with merely above average professional salaries, and you never saw any kind of advertisement that ended with "ask your doctor about X".
I think it's naive to assume the 16.5%-of-GDP octopus we've created wouldn't figure out a way to profit from the removal of all regulations.
You also wonder how much consolidation has had to do with the erosion of social norms. An owner of a community practice might feel constrained in a different way than an employee at a healthcare company.
>Heath care has gotten vastly better over time. Look at 5 year cancer survival rates for example.
No. These rates are affected by more screening procedures. Some nipped a potentially fatal cancer in the bud, others just found and removed something that wouldn't have killed the person.
To first order there is no change in the effectiveness of cancer treatment as compared to 50 years ago.
That's demonstrably false. Early screening is useful, but that's also a medical procedure.
Really what we care about is cancer deaths at a specific age AKA what % of 15 year old people die of cancer and that really has dropped. Even beyond that the absolute rate of cancer deaths in the US peaked in 1990 216 per 100k vs 2015 at 158 per 100k. Which is a massive drop even over 1950's pre screening and younger population numbers of 193 per 100k.
PS: Stomach cancer is flat out much less common because we understand a major cause now. Cervical cancer rates will similarly drop from the HPV vaccine.
> Even beyond that the absolute rate of cancer deaths in the US peaked in 1990 216 per 100k vs 2015 at 158 per 100k. Which is a massive drop even over 1950's pre screening and younger population numbers of 193 per 100k.
>PS: Stomach cancer is flat out much less common because we understand a major cause now. Cervical cancer rates will similarly drop from the HPV vaccine.
Yes...lots of progress in infectious disease treatment, very little with cancer treatment.
Lung cancer has not changed overall numbers all that much from 1990. https://seer.cancer.gov/statfacts/html/lungb.html So, no it's not responsible for the massive drop in cancer deaths by age group.
I included HPV and Stomach cancer in a PS specifically because they are minor changes to overall numbers. Sunscreen also impacts the rates people get cancer, but it's a very minor effect.
And lung cancer is not the only cancer caused by smoking.
In any case, cancer death rates and changes in risk factors do not speak directly to the claim about treatment effectiveness. If you are diagnosed with cancer, you are basically every bit as f'ed today as you were 50 years ago, except in the special case that your cancer happens to be one of those that never would have been noticed back then.
Notice that Male at the bottom of the cart women are only down 17%. That makes the impact on overall numbers significantly lower. It's also a chart of deaths, what you want to support the idea that treatment is useless is a chart of new cases.
Also, see that huge drop in Prostate and Colorectum cancer. Yea, that has nothing to do with smoking it's almost completely related to better treatment making a huge difference.
And again, we are not looking at equivalent populations. The older the US population the worse cancer numbers look in absolute terms.
So, even the chart you are using to support your argument actually supports mine.
PS: To account for a 25% drop in cancer deaths lung cancers could have hit zero in that cart and it would still not be enough.
I'm not sure I follow. Screening detects cancer that is already there, hopefully in early stages when it might be treated more easily. In both cases, cancer is already present.
I included that as a PS specifically because they don't change overall numbers much. Yes, it's true some cancers are becoming less common, but ~50% of the population get's cancer it's very common even if the numbers are shifting around slightly.
Thanks for clarifying what you intended when you meant screening, which is differentiated from screening for cancer itself, which is how I read your upthread comment "[s]ome nipped a potentially fatal cancer in the bud".
>Unless one can follow a cohort over time, there is no way of accurately estimating the probability that a subclinically detected abnormality will naturally progress to an adverse outcome. The probability of such an outcome is mathematically constrained, however, by the prevalence of the detected abnormality. The upper limit of this probability can be derived from reasoning that dates to the 17th century, when vital statistics were first collected. If the number of persons dying from a specific disease is fixed, then the probability that a person with the disease will eventually die from it is inversely related to the prevalence of the disease. Therefore, given fixed mortality rates, an increase in the detection of a potentially fatal disease decreases the likelihood that the disease detected in any one person will be fatal..... Lead-time and length biases pertain not only to changes that lower the threshold for detecting disease, but also to new treatments that are applied at the same time. Whether or not new therapy is more effective than old therapy, patients given diagnoses with the use of lower detection thresholds will appear to have better outcomes than their historical controls because of these biases. Consequently, new therapies often appear promising and could even replace older therapies that are more effective or have fewer side effects. Because the decision to treat or to investigate the need for treatment further is increasingly influenced by the results of diagnostic imaging, lead-time and length biases increasingly pervade medical practice.
>There is another complication that these more powerful imaging modalities can lead to that wasn’t discussed in the paper, stage migration. This is a phenomenon that occurs when more sophisticated imaging studies or more aggressive surgery leads to the detection of tumor spread that wouldn’t have been noted in an identical patient using previously used tests. This phenomenon is colloquially known in the cancer biz as the Will Rogers effect. The name is based on Will Rogers’ famous joke: “When the Okies left Oklahoma and moved to California, they raised the average intelligence level in both states.” This little joke describes very well what can happen in cancer. What in essence happens is that technology results in a migration of patients from one stage to another that does the same thing for cancer prognosis that Will Rogers’ famous quip did for intelligence. Consider this example. Patients who would formerly have been classified as, for example, stage II cancer (any cancer), thanks to better imaging or more aggressive surgery, have additional disease or metastases detected that wouldn’t have been detected in the past. They are now, under the new conditions and using the new test, classified as stage III, even though in the past they would have been classified as stage II. This leads to the paradoxical statistical effect of making the survival of both groups (stage II and III) appear better, without any actual change in the overall survival of the group as a whole. This paradox comes about because the patients who “migrate” to stage III tend to have a lower volume of disease or less aggressive disease compared to the average stage III patient and thus a better prognosis. Adding them to the stage III patients from before thus improves the apparent survival of stage III patients as a group. The converse is that patients with more disease that was previously undetected, tended to be the stage II patients who would have recurred and done more poorly compared to the average patient with stage II disease; i.e., the worst prognosis stage II patients. But now, they have “migrated” to stage III, leaving behind stage II patients who truly do not have as advanced disease and thus in general have a better prognosis. Thus, the prognosis of the stage II group also ends up appearing to be better with no real change in the overall survival from this cancer.
That's a problem if you want to compare the effectiveness of specific treatments. AKA, is doing A, or B, better than C. Or even more basically are screenings useful?
If you want to look overall you can look at the number of people dying at each age of each type of cancer independent of both diagnosis and treatment. AKA how many 43 year old women died of breast cancer. That also has some problems for people that died of cancer before it was detected as cancer, or people who died of suicide or related complications but not necessarily cancer on it's own. Even more critical is reduction in the rate people get cancer in the first place.
Still we are not talking about a small gap, when you start seeing a 30+% drop for a wide range of cancers it's easy to see that yes treatments are extremely useful. Even if you only get an extra say 2 years that's still 2 years to die of a car crash and not cancer.
Nice idea, but how realistic is it? Most patients are not scientifically-literate, some are flat out incapacitated.
For all the stories about heartless insurance companies denying to pay for things, perhaps they should actually be more strict. As in, refuse to pay for anything unless there is 1) rock-solid (i.e. double-blind, placebo-controlled) evidence that it helps 2) for a specific, objectively verifiable indication 3) when provided by a doctor whose track record is demonstrably non-inferior to that of other practitioners. But for all three of those things, no $.
I would be interested in buying insurance like that.
In the US system you agree to pay any bills the insurance will not cover prior to receiving treatment.
Which is an obvious opportunity for improvement. When a giant hospital and a giant insurance company get in a knife fight over whether a procedure is covered, the patient shouldn't be the loser.
(Maybe some sort of system where if the provider states that something is medically necessary then they are on the hook if insurance denies the claim)
>Maybe some sort of system where if the provider states that something is medically necessary then they are on the hook if insurance denies the claim
Not only should a provider be legally prohibited from trying to collect payment for unnecessary treatment, they should be held responsible for complications. Even unnecessary x-rays can cause cancer.
> "3) when provided by a doctor whose track record is demonstrably non-inferior to that of other practitioners"
This is interesting. I think there will always be a somewhat normal distribution of medical skill among doctors so how do we decide whose track record is good enough to preform which procedures? We probably don't need top preforming doctors to implement every procedure but then how do we decide which procedures warrant a top doctors time? And if there is a shortage of qualified specialists in a region or if something is particularly urgent isn’t an under achieving doc better than no doc at all? Maybe. Maybe not. I think there is a lot of gray area here. I guess ideally the hope would be that the distribution of skill among doctors is really narrow so the difference between top docs and bottom docs is not that pronounced. Even still, I think there are some interesting problems around ranking/rating doctors against one another.
Right, it's not easy and there are adverse selection issues when you start incentivizing doctors to avoid complex cases that are more likely to involve complications. And the scientific basis for a given procedure is likely more important than minor variations in doctors' technical competence levels.
That said, insurers have better insight into this than almost anyone else. If they see a young person with almost no medical claims go in for an elective foot surgery with Doctor Lexus, and then all of a sudden that person is attending physical therapy and filling opioid prescriptions every month, that's a bad sign. If it happens more than once, insurers should feel empowered to go ahead and shut the good doctor down. But this does not happen.
C'mon people...this is not science, this is fortune telling. They are just doing a bunch of huge multiparameter curve fits, which are going to pick up signal from all sorts of things that have nothing to do with biology no matter how big their sample size is. These people will tell you with a straight face that a bunch of markers that just happen to be associated with "Northeast European ancestry" are also predictive of "Polka dancing ability," and their papers are shuffling and repackaging thousands upon thousands of nonsensical little tidbits exactly like that. Life experience doesn't just "average out." Do better.
Do you believe statistics aren't real math? I'm not sure why the complaint. Sure it may be inaccurate, but as others said, along questions like: "do you have X heritage?" are already used as predictors for certain diseases. Genetic investigations just gets a little closer to the base truth, even if no one knows exactly which genes are doing which things.
But genetics may or may not be the "base truth" in regard to disease risk. It's difficult to tease out the effects of genes as opposed to environment. When your model has thousands or millions of genetic loci this only gets harder.
Some GWAS studies thats definitely true, but ultimately if the only signal you're picking up from the genetics is someones ancestry (haplotype) and that is enough to confer accurate predictions then Im not sure what your problem is? Thats great, plenty of people in the US for example have no understanding about what their genetics might confer because they might not even know where their genetic heritage comes from.
>"Increasingly, banks recognized the value of tellers enabled by information technology, not primarily as checkout clerks, but as salespersons, forging relationships with customers and introducing them to additional bank services like credit cards, loans, and investment products."
Was this written before the Wells Fargo scandal came to light?
Hard to be optimistic when the "silver lining" is that people who were once employed to do necessary work have since been reassigned to trawl for opportunities to make easy money at the expense of the gullible and vulnerable.
Sadly this appears to be yet another theme in technological advancement--the proliferation of scams. Just look at how much social media advertising comes from multi-level marketing schemes.
Turn the competition knob to 0, everyone slacks, turn it to 11, everyone cheats. In a slowly evaporating pool of jobs, it will head to 11 very quickly.
That behaviour describes my biggest pet peeve with banks. I don't want product offers from you. You take my money, make money with it, and pay me interest (a whole < 1%). That's our relationship, fuck off with your "credit card protection free trial period".
originally they made money by the margin between the profit they make on wise investments and the amount they pay in interest for the privilege of investing money for them. those days are long gone.
The Wells Fargo scandal does not represent the banking industry as a whole. Believe it or not, but the products sold by the banking industry in general have an investment return greater than 0%.
Investing human capital in providing those products results in a net increase in overall human productivity.
For ten years I've been able to place a ACH transfer at one bank by 6 pm and have it available in my other bank by 8 am the following morning. It has never taken "3-5 business days". Anyone claiming there are large inherent delays in that setup is full of baloney.
Yes there are some dispute/reversal windows that I have never had experience with, but if you are just transferring money between your own accounts this should not be a serious issue.
> For ten years I've been able to place a ACH transfer at one bank by 6 pm and have it available in my other bank by 8 am the following morning. It has never taken "3-5 business days".
You are mistaking ACH for wire transfer (or are not aware of the good faith credit your bank provides). There’s three main ways to send money between accounts:
- wire transfer with immediate delivery
- wire transfer with next day delivery (likely what you are mistakenly thinking is ACH)
- ACH which takes the previously mentioned several days (for making sure there isn’t a return for reasons other than stolen account). ACH is essentially “writing a check, sans paper”.
The first two are essentially direct bank-bank transfers. The latter goes through a clearing house as described and has a clumsy (in modern terms) process with lots of unneeded delays.
Banks will many times credit the money to your account much faster, but they do that for two reasons.
- they have an existing relationship with you and know your risk profile
- they sometimes also send an electronic request to the other bank confirming fund availability. Not all banks support this, but when they do, generally banks will overlook some extra risk from the previous bullet (as in, you don’t have available funds to claw back).
Happy to provide much more technical details if you insist, but Google could trivially do that for you.
> Anyone claiming there are large inherent delays in that setup is full of baloney.
No need to be derogatory towards others stating facts to you.
"... the ACH system never provides positive confirmation that an ACH debit has gone through successfully. The only response an ACH originator may get is one notifying them of a return. Because of this 'no news is good news' policy, it is wise for originators of ACH debits to wait for 3 additional business days of 'no news' to ship their product to the customer. Though the ACH system is described as a next-day settlement system, in practice, it is not because of this."[1]
So your bank is being optimistic and giving you a credit, assuming that no return will happen. A pessimistic or cautious bank would really have to wait several business days to ensure no returns happen before crediting your account.
No! They are not being "optimistic," they are just following Regulation CC.
Ask anyone on the street when they can get the money from their paycheck direct deposit. Unless they just opened their account, they are not waiting days.
> Ask anyone on the street when they can get the money from their paycheck direct deposit.
That’s because payroll isn’t sent the day of your payday. Go ask the person who handles payroll at the company you work for, they don’t submit it the day of payday (or even usually the day before). It’s normally submitted several days in advance.
Again...no, it is not. You are confusing different things here. Even if they just learned about it the night before, your bank cannot withhold your direct deposit without breaking the law. Unless there is some special situation like a new account or they suspect fraud.
> Again...no, it is not. You are confusing different things here.
Not to get in a pissing match, but you are the one confusing unrelated things. There’s a reason I’m getting upvoted and you are being downvoted.
1) for credits, the RDFI doesn’t place holds on the funds (except in very unusual circumstances). So your apology here is flawed.
2) read the link provided by @ad_hominem, it very clearly and eloquently explains the time lines involved, by a company doing payroll. Better yet, read the whole series of posts they wrote. (Part 1/2 are linked at the top of the article).
In general, try to understand that your personal experiences might not reflect the “way things work”. There are folks on HN who have generally “been there, done that, have battle scars to prove it” (like me in this specific case) for many topics and you’d be wise to keep an open mind rather than keep fighting against them when they are trying to help you understand.
No...the claim that ACH takes "3-5 business days", "several days", or whatever, is just flat out wrong. I can do ACH (not wire transfer, not "credit") between my totally unrelated bank accounts--whether those be at big banks or tiny little credit unions--with a total delay to myself, the end user, of about 14 hours and change. And that isn't new, it has been the case for well over a decade.
And using ACH delays as an excuse for why people can't get money out of Bitcoin quickly-- the original context of this thread-- is completely disingenuous.
Your personal experience doesn’t mean it’s a fact. As I’ve stated multiple times and you keep ignoring, ideal case, it can take under 12hrs (almost all of my ACH transactions are that window too). That does not mean there aren’t significant amount of exceptions!
>As I’ve stated multiple times and you keep ignoring, ideal case, it can take under 12hrs
I must have missed where you said that. You said I was likely mistaking ACH for wire transfer because mine were happening that fast.
The point stands that "inherent delays" in the ACH system are negligible, on the order of hours.
I reacted strongly to the person claiming otherwise because it was presented as an excuse for people not having access to their money quickly. If people are being told they can't get their money because of "ACH delays", "check is in the mail", "clogged tubes", or whatever, they should not be afraid to call BS!
Sure, but that doesn’t change my point. What about closed accounts, invalid account numbers, or NSF? All three of those cause ACH rejects/reverts without any indemnity, yet weren’t in your list.
Not sure why you got downvoted, I think you're right there. I misspoke when assuming that banks had much leeway in holding those funds (I'm not very familiar with banking regulations).
However I still think it's accurate to not think of the funds as fully clearing for several days given the nature of the protocol, and that regulation simply forces the banks to be "optimistic" in giving a next-business-day credit.
He’s being downvoted because he’s wrong and rather than replying directly to the points made, he tangents off on one small detail and still misses the narrative.
Per Title 12 → Chapter II → Subchapter A → Part 229 → Subpart B → §229.10b(1), in general a bank shall make funds received for deposit in an account by an electronic payment available for withdrawal not later than the business day after the banking day on which the bank received the electronic payment. [0]
So reading that there are several observations.
- first, they say in general, emphasis theirs, and don’t define exceptions explicitly.
- next business day, so that means they are perfectly allowed to be two days delay for a payment initiated by Wednesday night, or up to five days for one initiated Thursday night (Thursday send, Friday received but held, Monday being next business day). If Monday is a bank holiday, then it could even be six days!
- in (2)(i) they further go on to state Payment in actually and finally collected funds. There are a number of reasons that could be delayed.
Ultimately, saying an ACH should always be by next morning is just flat wrong and no amount of experience with your own personal transactions negates that.
> For ten years I've been able to place a ACH transfer at one bank by 6 pm and have it available in my other bank by 8 am the following morning. It has never taken "3-5 business days". Anyone claiming there are large inherent delays in that setup is full of baloney.
I believe in this case your bank 'trusts' you. With banks that I have an existing relationship with I can move money overnight. When I open an account at a new bank it takes days for the money to be available for use. Presumably the new bank does not trust me yet, and thus makes me wait for all of the confirmations to occur.
Typically takes a day but you forgot that there are very small banks. How long it takes to show up in your account has nothing to do with how fast the Feds transferred it to the receiving bank but how automated and fast the receiving bank deposits it in your account. There are also times when it takes longer, weekends and bank holidays can extend that time
“…these large transfers move in steps. Banks have slowed down the process further to reduce the chance of fraud… [the bank] sends transactions in batches during the day to an automated clearinghouse, which sorts them and moves them to the receiving bank in a matter of two to four hours… In many cases, the receiving bank gets the transfer the same day."
So delays are inserted on purpose. Certain banks don't introduce these delays, or have minimum delays, you'll know it when you're using one. USAA and Fidelity are two I've used that don't delay ACH transfers, those have always cleared ACH transfers next day. I even get my paycheck a day early when deposited into one of those accounts.
The other option is your bank keeps a tab of "transfers that are trusted."
> USAA and Fidelity are two I've used that don't delay ACH transfers, those have always cleared ACH transfers next day.
This is because they are crediting you the money before they actually have it confirmed. See my reply below to GP, they are doing this because they are more risk tolerant and/or you are a less risky customer.
Does diminishing returns/low hanging fruit mean anything to you?
Also, from that pool of drugs you're referring to, we've eliminated a number of things that had strong effects but whose side-effects were later found after careful study to not outweigh the benefits.
There is a similar effect from carefully studying devices/surgical interventions--not so much a raft of "new innovations" but rather the culling of a lot of things that were overused or actually harmful. Huge cost savings, big improvements in population health & lots of gored oxen.
It is the abuse of a position of trust that aggravates this crime relative to that of a simple outlaw street dealer.
Commenters who are concerned with the effect on the convict's reputation and future employability are simply not in touch with reality....this was a grave breach of the basic ethics of the medical profession and seriously harmed the innocent patients involved. There is no return to work after something like this...any more than with a scientist who falsifies data, a teacher who sleeps with minor students, a lawyer who steals from escrow, etc.
I find it highly disturbing that there is more discussion in this thread as to the effect on the doctor's return on investment from his medical degree rather than on the individuals who bodies were damaged by someone they were supposed to be able to trust.