A couple of months ago, I made an acquaintance with a provincial carpenter. This was rather convenient, since I would soon need to furnish my new apartment. I could either get a good quality but MDF-based factory made bed for around $300, or I could pay him $500 and get a very high quality bed (with drawers) made out of solid wood for $500, with a tabletop for my planned electric table thrown in for free. Why not, let’s support the artisanal economy. He said it would be ready within a couple of weeks.

It’s been more than a month now and it’s doubtful that I am ever going to see the furniture I ordered. As it turned out, he had been diagnosed with Stage I lung cancer half a year ago, though he seemed hale enough when I met him (during our one hour meeting, he managed to smoke a couple of cigarettes, which I suppose explains many things in retrospect). But since then, the illness appears to have taken a turn for the worse, transitioning into the metastatic phase. He has been hospitalized for the past week. Lung cancer is one of the worst cancers out there, and survivability at Stave IV is less than 1%. Assuming those diagnoses were accurate, he’ll likely be gone in another few months.

Obviously, I am not going to press him for the furniture, or to return the money, which I have more or less written off at this stage.

However, this episode did provoke me into taking a look at Russian cancer survival statistics (which are a good proxy for healthcare quality).

I have heard a surprisingly frequent amount of praise for the Russian healthcare system from resident expats. It is certainly much cheaper, and there’s less far less hassle with relatively trivial procedures such as treating a broken arm. It’s very cheap and often entirely free.

However, it was always to be expected that performance was much lower on the more complex operations, such as treating cancer, on account of (1) much lower levels of funding than in the developed world – about 10x lower per capita than in the US, and 5x lower than in the UK; (2) low salaries making medical careers unattractive for the best human capital – for instance, the typical Russian anesthesiologist gets 35,000 [$500] rubles per month (70,000 [$1,000] in Moscow), whereas salaries of $10,000+ per month are not uncommon in the US; (3) correspondingly low level of English language knowledge (which is relevant since almost all scientific production of any value has long occurred in English).

In previous years, I hadn’t been able to find anything particularly interesting, since it’s usually the rich/OECD countries that participate in such comparative studies – though in fairness, I didn’t look particularly hard for them. But this time round I was luckier and managed to locate some relevant papers.

* Goss, Paul et al. – 2014 – Challenges to effective cancer control in China, India, and Russia



  • 33% cancer mortality in the US – well funded, mostly private medicine.
  • 40% cancer mortality in the UK – well funded, mostly socialized medicine.


Note that the NHS, the so-called “best healthcare system in the world”, has some of the worst cancer survival rates in the developed world. So we can view the 30%-40% cancer mortality interval as the global medical technological frontier.

  • 60% cancer mortality rate in Russia – poorly funded, mostly socialized medicine.

Furthermore, as the Lancet article points out, there are issues with statistical quality in certain regions, which makes the 60% figure a lower bound. So true cancer mortality would be somewhere in the 60%-70% range.

Or to put it in simple figures: One third of American cancer sufferers die; two thirds of Russian cancer sufferers die.

Same picture according to another study I tracked down.

* Allemani, Claudia et al. – 2015 – Global surveillance of cancer survival 1995–2009 analysis of individual data for 25 676 887 patients from 279 population-based registries in 67 countries (CONCORD-2)


Figures for Russia pertain to Arkhangelsk oblast only. I assume it will be around average for Russia.

Also worth noting that data for non-developed countries is pretty poor in general, e.g. I also encountered this criticism of the Brazilian data (which shows remarkably good performance for a country with its development level).

Still, it’s pretty clear that Russia is a severe laggard relative to the developed world, coming last out of the surveyed European countries (though almost catching up to Latvia by 2005-2009).


Breaking an arm – probably better to do that in Russia. Getting lung cancer – it had better be in the US.

So one can see how American expats who broke an arms or whatever don’t have to go through the agonizing insurance reimbursement process would prefer Russia. For the really serious diseases, they can go back to the US or pay for elite level service in Moscow (which is also far cheaper than in the US but financially inaccessible for 90% of Russians).

This has nothing to do with the collapse of the Soviet Union. Back then, complex procedures were inaccessible in principle for 98% of the population. The mass healthcare sector was severely underfunded and many “hospitals”, especially in the rural areas, didn’t even have basic amenities such as hot running water. The USSR did boast of having some of the highest numbers of hospital beds per capita. Staying in a hospital for days on the cheap was (is) easy and often actually required, which is the direct opposite of more rational Western practice.

My impression is that the Soviet system basically trundled on largely unchanged after the USSR’s collapse, as in many other spheres of life. All countries ration healthcare one way or another. In the US, things go smoothly, but at the cost of huge insurance premiums; in the UK, there are endless scandals about waiting lines; in Russia, people without the means to get elite private treatment but with Soviet era connections are obsessed with pushing their ailing relatives into the more elite state-run hospitals, which are typically reserved for the military and high officials but treat ordinary civilians “on the side.” In the next few years, this system is going to get pumped with much more money – as military spending is cut, healthcare spending is projected to double in the next 5 years of Putin’s (presumably) last term.

So I assume these numbers are going to improve in the next few years regardless. Though perhaps there would be even more improvements if more of the system was to be privatized (there’s not even any need for a specifically American system; the Germans perhaps do it better, with free competition between providers while subsidizing and regulating insurance plans – though either are far better than the NHS). But that’s a political no go in Russia.

Anatoly Karlin is a transhumanist interested in psychometrics, life extension, UBI, crypto/network states, X risks, and ushering in the Biosingularity.


Inventor of Idiot’s Limbo, the Katechon Hypothesis, and Elite Human Capital.


Apart from writing booksreviewstravel writing, and sundry blogging, I Tweet at @powerfultakes and run a Substack newsletter.


  1. Interesting about Japan and lung cancer. Two times better treatment than everybody else. They also have two times lower rate of lung cancer than the US while smoking much more. Otoh they have lots of stomach and liver cancer. Must be the sushi and fermented veggies or something. Perhaps the bacteria that also makes them not fat.

  2. Boswald Bollocksworth says

    It’s a horrible disease. I almost wonder if it is worth treating it, because it almost always kills you within a year or so and the chemo and radiation are dreadful. I lost someone to cigarettes, saw it first hand.

    How old is your carpenter?

  3. Russian cancer survival statistics

    Thanks for the post.

    Also it could be useful to publicize more overall disease rates. Expectedly, levels are linked very directly to pollution.

    Yaroslavl has a lot of publicity about the topic, as linked to ecological crisis.

    Breaking an arm – probably better to do that in Russia. Getting lung cancer – it had better be in the US.

    In America, they also include health service when you begin working. You still have to pay money, but it is very good value because the job will pay for a proportion of the health service.

    So my brother (who has a health problem – although not cancer fortunately), has been in America for almost two years.

    I cannot remember exactly, but I believe he pays maybe $10,000 a year for the health service.

    He receives an amazing level of tests there (they email regularly him the different levels of every kind of vitamin and mineral in his blood). On the other hand, the diet in America is unhealthy (but modifying this is only your personal responsibility).

  4. Although, some of the unique, healthy variables in Japan – like certain diets of regions like Okinawa – will be dying out now.

    I was watching some reports on YouTube about this topic a few months ago.

    This one report watched, is interesting about Okinawa – watch in the end the reporter becomes pessimistic about the young generation who are not following traditional diets.

  5. Sorry to hear about your carpenter, poor guy. Begs the question of smoking in Russia though. You may have covered it years back before I started reading but it’d be an interesting one if you haven’t.

  6. It’s improving overall (falling slowly). Partly, as price of cigarettes is increasing, and smoking bans.

    I think more it is salvation through technology – introduction of electronic cigarettes and nicotine gum, is a miracle in this topic

  7. Do Russians realize America’s waging warfare against them (I doubt it), this basic realization would prove them wonders.

  8. Kratoklastes says

    Call me a monster, but I find it hard to muster much sympathy for anyone who gets lung cancer from smoking tobacco.

    The cancer->smoking link is a ‘known known’, and has been that way since before almost all currently-living adults were born.

    The link (and the causative mechanism) was categorically proved in 1939-1941 by the Nazis, ten years before Richard Doll’s work (published in 1950).

    Part of the reason that lung cancer survival rates are so poor, is because a very large proportion of lung cancer sufferers continue to smoke cigarettes after their diagnosis (and during their treatment, for fuck’s sake!).

    People are entitled to kill themselves using any method they like – choosing a habit where the ’embedded option’ is a (very) high probability of a slow, lingering, painful death from lung cancer strikes me as weird… but I’m not in the business of making people’s decisions for them.

    However part of the tax I pay is pissed away treating people with lung cancer in publicly-funded parts of the health system.

    inb4 someone tries the hackneyed nonsense that the system saves more on net because smokers pay excise taxes, and die before they collect pensions… that furphy is easily demolished by examining the amount of public subsidy for the high-cost treatments that smokers require in their terminal years.

    To be fair, I don’t expect unequal treatment.

    I drink way too much booze, and have done for a couple of years – and I don’t foresee stopping until weed is legalised (then I can arbitrage to something equally-relaxing and less metabolically-damaging – weed tincture).

    If I was to develop a disease that is specifically and incontrovertibly due to my excessive alcohol consumption, nobody should shed a tear – because it’s my own stupid fucking fault… more to the point, the public purse should not be burdened by my stupidity.

    (Protip: most of the putative link between alcohol consumption and life-threatening illness is due to co-morbidities that I don’t have – smoking being the main one).

  9. Oncology is an interesting field. Someone in my hood recently died of lung cancer in her sixties, after being diagnosed with it seven years ago. She was a non-smoker, unlike her dad who smoked heavily at a time when cigarettes weren’t as expensive.

    On the subject of lung cancer, if not already done, y’all should check your family history for colon cancer. If it’s evident, inquire about getting a colonoscopy. When metastasized, the region of the lungs is one of three areas (besides the liver and kidneys) where colon cancer typically travels.

    Memorial Sloan Kettering (MSK) in NYC reports that more people in their twenties are being diagnosed with colon cancer and that a good number of them have no family history of that disease. In the US, there’s a move to push for having a colonoscopy at age 45 as opposed to 50.

    MSK seems to have a good share of Russian speaking patients. Then again, Russian nowadays is one of the more common of foreign languages heard in Manhattan.

  10. Okinawa got McDonald’s even before Tokyo did. At one time, Okinawan men had the longest lifespan in all of Japan. Today, they have the shortest (though Okinawa women are still long living).

    Genes are important, but diet/lifestyle do matter too.

  11. There’s a noticeable number getting lung cancer who don’t smoke. The issue of second hand smoke is why smoking has been banned in a number of areas.

    There’s also the matter of poor air quality, not so much relating to people who smoke.

    As noted, it’s a horrible way to die, leading one to wonder about those who smoke?

    Can understand an occasional cigar.

  12. There’s also the matter of poor air quality, not so much relating to people who smoke.

    After cigarettes, the most widespread causal agent of lung cancer is probably radon gas, a radioactive byproduct of uranium in soil.

  13. the typical Russian anesthesiologist gets 35,000 [$500] rubles per month (70,000 [$1,000] in Moscow), whereas salaries of $10,000+ per month are not uncommon in the US

    $120,000 per year is less than what an experienced NURSE anesthetist makes in the U.S. A typical anesthesiologist (MD) makes around $350,000 a year. Some make much more if they own shares in the practice or are medical directors. Some make less if they don’t take call or work part time.

  14. In US, the most common cancers are skin, breast, and prostate. The rest of the planet begs doctors to stop ‘fighting’ these three cancers, as the increased rate of diagnosis did not lead to better outcomes. In fact, it is fairly certain that what passes as useful tests in US, such as mammography or PSA tests, lead to increased number of unneeded treatments, and make patients often worse off. For example, mammography has a 1 in 500 chances of finding a diseased person and a 1 in 500 chance of hurting a healthy woman. But these needlessly treated healthy women are not merely upset – he bills and infections make them so sick, to the point that there is no difference between today and 40 years ago in life expectancy with breast cancer.

    In America, so called defensive medicine, where doctors fear being sued, transforms such gibberish tests into standard practice, and often laws require insurance to cover them. There’s also decent money to be made by medical staff, device and drug manufacturers, hospital administrators, to the point that there would be mammography excesses even if they were not required to provide them. Every American moron wears a pink ribbon, and likely celebrates Movember mustaches.

    Unsurprisingly, many more Americans die with cancer, but not of cancer. Since their condition is fake cancer, they die of surgical wound infection, depression, and general poverty induced by medical bankruptcy. In contrast, whatever is called cancer by the NHS, is usually actual, severe, deadly cancer. Hence the statistical fluke showing Americans better off in terms of death by cancer.

    Similarly, 50% of US hospital bills are covered by Medicaid, Medicare, Tricare, or another state-run program. State-paid insurance does not completely cover the nation, but pays for the care of most of the most expensive case. Before writing about socialism inferiority, read more about these things.

  15. anonymous coward says

    Though perhaps there would be even more improvements if more of the system was to be privatized. But that’s a political no go in Russia.

    Bullshit, anyone who’s been in Russia for the last few years knows how the healthcare system is being rapidly privatized. (Though it’s not like a switch of nominal ownership really changes anything in how things are done.)

  16. How many doctors in Russian are foreigners, is it common to see a whole bunch of Indians as doctors, likewise are the nurses mostly from Central Asia?

  17. For EastAsian the high rate of stomach, liver and esophageal cancers most probably cause by a gene variant with weak alcohol metabolism, globally 50% of such cases of terminal cancers occur in China. Also high rate for Ashkenazi. On average Europeans have zero percent of such variant.

  18. for-the-record says

    Another apparent victim?

    Head of Russian Military Intelligence Dies at 62 After Grave Illness

    MOSCOW (Sputnik) – Igor Korobov, the chief of the Russian Main Intelligence Directorate, commonly referred to as the GRU, died at the age of 62 after a serious illness on Wednesday, the Russian Defense Ministry said.

    “Col. Gen. Igor Valentinovich Korobov, the head of the Main Intelligence Directorate of the General Staff of the Russian Armed Forces and the deputy head of the General Staff of the Russian Armed Forces, died at the age of 62 after a siege of grave illness,” the Defense Ministry said in a statement.

    The ministry extended its condolences to Korobov’s friends and family. Korobov assumed the position of the head of the Main Intelligence Directorate in early 2016.

    In September, Washington added Igor Korobov to a blacklist under the Countering America’s Adversaries Through Sanctions Act (CAATSA).

  19. He looks like he’s in his 50s. Though people who smoke heavily can often appear older than they are, so it would really suck if he’s in his 40s.

  20. Doctors fearing lawsuits are a good thing. For instance, there have been hundreds of deaths per year in the NHS from MRSA bugs contracted during hospital stays, versus perhaps a dozen in the US. Fear of getting sued helos keeps hospitals disinfected.

    Another, perhaps more plausible explanation of poor NHS cancer survival (relative to not just the US, but Western Europe, too, let us remind ourselves) is that long waiting times result in critical operations getting delayed.

  21. In Moscow and I assume the big cities, yes (though not so much Central Asians as North Caucasians). In the provinces, no.

  22. Basements in homes are tested for that.

  23. Define “privatised”. There are a lot of private options for people who dislike the state provided healthcare, but it’s not like state run medical centers and hospitals are being sold. In my opinion (and I travel a lot to Russia to treat a couple of chronic conditions which are a nightmare to treat in Scandinavia), Russia has an excellent balance between public and private healthcare.

  24. I wonder what the mesothelioma rate is over there, very nasty cancer, it has only a slightly higher survival rate than rabies and is caused exclusively by asbestos. There’s still a lot of the stuff produced, although, in Russia at least, it now seems to only be Chrysotile and used exclusively in non-friable applications (boards shingles etc). Even so, the working conditions at uralasbest are an easy find on YouTube, and that’s in official videos when they’re working to best pracice.

    The uk imported a lot of amosite (much worsethan Chrysotile) from South Africa and used it in insulation and coatings and, as a result, we have more mesothelioma deaths than from road accidents even now. Russia might avoid this in the general population at least if it’s only Chrysotile they’re exposed to though.

  25. Felix Keverich says

    I cannot remember exactly, but I believe he pays maybe $10,000 a year for the health service.

    You mean the insurance? Is it required to buy health insurance in America? Will they just let you die in the street, if you don’t?

    If you lack the insurance, you might never get diagnosis in the first place. This could partially explain why US has better cancer survival statistics. 🙂

  26. Felix Keverich says

    “after a long and serious illness”

    His predecessor died 2 years ago at the age of 58. I’m not one to believe in conspiracy theories, but WTF is going on over there?

  27. You also need to consider the fact that the nhs has quite a restrictive policy on expensive drugs which prolong the life of terminal cancer sufferers, but don’t cure them. This, in itself, will lower “x year” survival rates.

  28. for-the-record says

    but WTF is going on over there?

    Job stress?

  29. Spisarevski says

    Hope your carpenter will manage to beat the cancer.

    in Russia, people without the means to get elite private treatment but with Soviet era connections are obsessed with pushing their ailing relatives into the more elite state-run hospitals, which are typically reserved for the military and high officials but treat ordinary civilians “on the side.”

    In Bulgaria, these tend to be the best institutions – state hospitals with traditions, reputation and enough money for new equipment. The best hospital here is the Military Medical Academy (ВМА) which treats ordinary civilians too – you need to make an appointment in advance and once there, have the doctor call the security at the lobby to let you pass (there is a big waiting area with telephones to the different cabinets), and despite this cumbersome procedure for civilians to even go inside, it’s hugely popular among ordinary people.

    And the most well known “elite” private hospital in the capital (which is Japanese owned no less, called “Tokuda”) is an absolute shitshow, full of incompetent and indifferent doctors.

    In my experience, paying more for private clinics is worth it if it’s something dermal or dental – for example when I go to my dentist I pay about 4 times more compared to the cost for an ordinary dentist who works with the National Healthcare system, but it’s worth it.

    For serious medicine though, these elite state-run hospitals are your best shot, and I suspect this is true for other former communist countries too.

  30. Felix Keverich says

    Is this supposed to be a joke? The dude was working behind a desk – not much stress involved in this activity.

  31. anonymous coward says

    Define “privatised”.

    By that I mean that state-run hospitals are now commercial enterprises that earn their own budgets via private companies that provide mandatory health insurance to Russian citizens. These hospitals also provide commercial services outside the insurance system.

    In practice, there’s now little difference between ‘private’ healthcare and ‘state-run’ healthcare. Theoretically, you can use your mandatory insurance to get serviced at a commercial clinic, and the typical non-mandatory insurance you get from your typical employer is just as crappy as the mandatory insurance.

  32. From a value for money perspective the NHS is pretty good, Yanks spend a fortune on it. The socialists and their NHS sanctification block some sensible reforms like a nominal payment to book an appointment to stop unnecessary over use, or ID checks to stop health tourists.

  33. #FooledByRandomness

  34. Very interesting, thank you.
    Putin has highlighted oncology as a major focus for the healthcare national project from 2018-24, and there should be a lot of resources devoted to it in the near future. I have my doubts about this, as cancer, although devastating, actually affects a relatively small part of the population, and they could probably get better overall public health outcomes for less money. Cancer is expensive for both equipment and medicines.
    Cancer diagnoses are going up quite sharply in Russia because there have been more resources devoted to diagnostic equipment since 2008 or so. One of the reasons for high mortality in Russia is that they tend to pick it up late – partly this is because of a lack of equipment, partly because I suspect that doctors are discouraged from looking for it, because of the ensuing expense. So the focus will be on more diagnosis.
    Next problem though is that the drugs are very expensive, and often not available. This is not the place to discuss whether high medicine prices are justified, but it’s a fact of life for cancer patients, and the bitter reality is that in Russia hard-pressed local budgets are often unwilling to fund expensive treatments even when required by law to do so. I expect all drug purchasing and importing of these sorts of treatments to be centralised at the federal level in the next few years.
    This may cut unit costs, but it also leads to a cookie-cutter approach to treatment, and cancers can be highly individual.
    Bottom line is that you may get a bit of improvement in cancer mortality in the next few years, through the classic Russian approach of throwing money at it, and because this has been targeted at the highest level.
    Finally, a note on stats – apparently the oncology stats system is reasonably good in Russia, because they created an electronic automated system in 1992 or so, so data makes its way to the centre quite efficiently. That said, they wouldn’t be Russian statistics if they weren’t gamed in some way, but the nature of the system is that there are incentives to game them upwards as well as downwards.

  35. Felix Keverich says

    Leading Russian liberal opposition newspaper @novayagazeta echoes @aavst’s information. They say Korobov was so sick, his deputy Igor Kostyukov has been running the agency since the summer.

    lol what’s up with keeping dying people at key positions in the government? Putin so afraid to fire someone? Reminds me of 1980s USSR.

  36. The original comment from dacian is correct though, in that agressive tests in the US cause artificially high five year survival rates. These tests detect many benign tumors that if not treated, would not grow and would not be diagnosed as cancer in a neighboring country with the same culture and diet (i.e. Canada). This means that Canada has lower survival rates, but it is a misleading statistic since they often do not consider benign growths as cancer to be operated. In the US when they are operated on, the person is automatically considered a cancer survivor.

    I just heard a talk from a researcher in a company that developed a protein screen for pancreatic cancer that for sure tells the patient if the tumor is benign or not in a certain percentage of cases. This screen has never been wrong for those tumors identified as 100% benign. There are many where the screen is not 100% sure. The US insurance companies are very interested in it since it means they only have to operate on the 99% certainty and below. Canada is interested in this too, but the savings in the US for the insurance companies are a lot higher.

    The screen also, of course, is good at identifying people whose tumors have a high certainty of being cancerous, and those people are moved to the operating room quicker. But as technologies like this are developed, survival rates should actually go down in the US as those who are not operated on are not considered ‘cancer survivors’. Of course there will be other technologies developed that will increase the survival rate for the unlucky ones from the other end.

  37. If you lack the insurance, you might never get diagnosis in the first place.

    No, you would simply get diagnosed when it was too late to treat you.

    This means survival rates are higher for people who have insurance (most of the US population).

    As with all statistics (education, life expectancy) America’s overall figures are dragged down by sub-populations.

  38. Felix Keverich says

    White Americans are trailing Cuba in life expectancy. It’s an ineffective system, that costs too much money.

  39. Obesity and unsanctioned opioid abuse aren’t the healthcare system.

  40. for-the-record says

    Obviously it was a bit of a joke, but surely the departed Colonel General was indeed in a rather stresful situation — the GRU has been “linked” to various embarrasing “plots” (e.g., Skripal) and incompetencies (Russian Spy Ordered Taxi from GRU HQ) , so it would not seem unreasonable for the one in charge, even sitting behind a desk, to feel a bit of pressure.

    Whether this stressful situation has any relation to his unfortunate grave illness is of course a somewhat different issue. One can’t help but be struck by the timing, however, wouldn’t you agree?

  41. How old are you? Have you worked anything, especially behind a desk?

    Many of the most stressful jobs are office jobs.

  42. the FT defines a perfect market as:

    A market in which buyers and sellers have complete information about a particular product and it is easy to compare prices of products because they are the same as each other etc

    or a fuller explanation here

    and so logically free markets should work better or worse more or less in proportion to how close to a perfect market a particular market is.

    so how close to a perfect market is healthcare?

    …complete information…

    that’s not so say socialized medicine is necessarily better as the huge information imbalance between patients and medical staff is the same in both cases but i think anyone who believes privatized medicine is necessarily better is treating “free markets” as a religion and not taking enough account of the underlying engineering of free markets which makes them work better under the right conditions.

  43. In the next few years, this system is going to get pumped with much more money – as military spending is cut, healthcare spending is projected to double in the next 5 years of Putin’s (presumably) last term.

    The military cuts strike me as quite stupid. It’s not going to make much difference to economic growth if military spending is 4% or 3% of GDP, but cutting it while your enemies are increasing it signals weakness. Just a handful of years ago, Russia’s military budget was $80 billion, now with ruble devaluation and cutbacks it’s under $50 billion. Russia should have an unofficial policy of always spending at least the same share of GDP on defense as the USA, which if were currently following, would put its military budget at around $60 billion.

  44. You are only digging yourself deeper. If you would have googled “mrsa deaths united states”, you’d find the first link, at CDC, stating “Invasive MRSA infections that began in hospitals declined 54% between 2005 and 2011, with 30,800 fewer severe MRSA infections. In addition, the study showed 9,000 fewer deaths in hospital patients in 2011 versus 2005.” That should already put to rest the joke about “tens of deaths”.

    On a wider scale, see helpfully titled “Medical error—the third leading cause of death in the US”. Since anyone over 65 has free hospital care and is strongly encourage to “fight until the end”, it’s getting harder and harder for an American to die quietly at home.

    Re. lawsuits, many states, especially in places with good lawyers (Massachusetts comes to mind), the money lost through lawsuits is always small change. Moreover, malpractice insurance, which is less than one month’s salary, and often mandatory, takes care of the rest. This virtual impunity is another reason why American doctors are easily the richest people in the country. With few exceptions, nurses are at median income, so you can’t get much from suing them. With few exceptions, hospitals are non-profit, so again, suing them is rarely getting you any money. And nurses and hospitals are also required to get malpractice, you get the picture.

    Per the previous paragraph, American healthcare workers have an attitude similar to drivers avoiding fines. Most of them would check boxes if supervised, and would cut corners whenever they feel they could do it. Hence, their results, as described in the first two paragraphs.

    There is probably potential for improvement in Russia. But privatization is not necessarily the way to go. IMHO, from a system POV, the managers should create many middling-pay jobs, so that you don’t get perverse incentives, and doctors are not psychopaths bent on fleecing you. This could in theory be achieved in a variety of ways, private or state-run. But most importantly, it’s the patients who need to step up. Americans do it by spending ever more. Japanese do it by eating less, and getting their elderly to move. French patients are more knowledgeable about risky behaviors and premonitory signs. Each of these is a valid approach, and none of them requires state intervention, nor privatization.

  45. Screening due to litigations is extensive in the US, catches a lot of non-dangerous cases which then undergo surgery, and doesn’t do much to improve life quality or life expectancy, while distorting statistics making it look better. At least that seems to be the case with mammography.

  46. Felix Keverich says

    I’m pretty sure that given the choice most Americans would take the Cuban healthcare system over what they have right now.

  47. The idea that early detection is often pointless is taught in first year of US med school as lead time bias. It is a recognized risk. However, that is a theoretical concept, soon to be forgotten. Whatever counts as Continuing Medical Education (often mandated for maintaining their certification), consists of presentations from manufacturers of drugs, devices, and tests. They are never reminded that tests may be not beneficial. Who is going to do the reminding?

    The patients don’t bother their little heads with big words.

    The largest insurer, Medicare, is government-run, and required by law to ignore costs and benefits analysis. By law, US private insurers are limited to 10% profit margins, so their incentive is to ramp up the turnover.

    US hospitals run at a loss, when fewer than 50% of beds are occupied. Many of them operate near that level, so managers push doctors to “diagnose”.

    Even well-meaning doctors are morons when it comes to statistics. You tell them that 2 in a thousand mammographies lead to supplementary successful treatments, and another 2 lead to early, unneeded, death – and they only register the first part. They get a semierection thinking that they can “save 2 lives”.

    Combined with drugs approved on spurios ‘progression-free survival’ nonsense, lead time bias has built millions of mansions. I can’t understand why any other country would want this curse on them.

  48. Thorfinnsson says

    I’m sick of cancer fags.

    Endless whinging about cancer, the march for the cure, etc.

    I once struck out with a girl I was hitting on because she has a pink ribbon tattoo on her wrist (breast cancer advocacy in America). I told her I hate people with cancer. Her mother had breast cancer.


  49. Thorfinnsson says

    There are those of us Americans who aren’t sick losers and do not consume healthcare.

  50. LOL.

    You don’t know the difference between health of people and the healthcare system.

  51. You will get sick, sooner or later. Unless you die of an accident or violence earlier.

  52. These statistics need to be normed for the distribution by types of cancer of the native population. Curability of cancer ranges from very low to nearly 100% for certain kinds of breast cancer, and genetics has much to do with the types of cancer people get and their recovery chances.

  53. In fairness Thorfinnsson strikes me as a live fast die young leave a beautiful corpse kind of guy.

  54. Thorfinnsson says

    Getting sick would be an admission of personal failure I could never recover from

    Would have no choice in such an unlikely event but to take the Japanese way out

  55. Felix Keverich says

    And you’re a stubborn hohol, who loves arguing.

    Poll after poll shows that Americans are profoundly dissatisfied with their healthcare system

    They want some form of universal healthcare, which has been adopted in every civilized country by now.

  56. The NHS is a bloody shit-show. But to the modern Brit, it is their deity!

    I once sat with a group of Brits, and this girl joins us – I hadn’t met her before, but she belonged to the group. She was almost in tears, and started to complain bitterly, anguish in her voice. She – in her mid 20s – had been diagnosed with a degenerative neurological disease that would slowly eliminate her bodily abilities and cognitive functions. There was medication to stall the decline, but the NHS would not pay for it. It was cheaper to have her spend the remaining years of her life in a nursing home, rather than give her the medication every month.

    I was shocked.

    But even more shocking was the reaction of the other Brits. They rounded on her, admonishing her to imagine how horrible the person MAKING THAT DECISION TO LEAVE HER TO DIE must be feeling.

    I was aghast.

    The girl weakly replied that, yes, yes, certainly…

    A few years later I saw her wedding pictures on Facebook. She was beaming from a large black, full-body support wheelchair which served as a severe backdrop for her pink chiffon dress. She wasn’t yet 30.

  57. Thorfinnsson says

    This rather sounds like a rational decision by the NHS, if brutal.

    Was there any chance of her surviving and thriving?

    Could she purchase the medication privately if she so chose?

    No one ever stops to think of the burdens the ill impose on those of us who are not.

    Worth remembering that Britain spends less as a share of its gross domestic product on healthcare than any other developed country bar Singapore.

  58. for-the-record says

    At least that seems to be the case with mammography.

    Also with regard to prostate cancer where 5-year survival rate in US is now 99%.

  59. RadicalCenter says

    If you don’t have insurance otherwise in the USA and you are poor, the taxpayers GIVE you medical insurance called Medicaid.

  60. the public purse should not be burdened by my stupidity.

    No one should be burdened by your stupidity. The world will be a marginally better place once somebody decapitates you with an oversized pair of pruning shears.

  61. Felix Keverich says

    My understanding is that there are strict eligibility criteria for Medicaid, that go beyond being poor: it is primarily a program for children and people with disabilities. The amount of coverage depends on the state you live in, and wherever Republicans have power, they are trying to eradicate it.

    This is not a replacement for a proper government-provided healthcare system.

  62. Toronto Russian says

    Perhaps the bacteria that also makes them not fat.

    But they not only do get fat, they have a regimen for sumo wrestlers that is designed to make you fat (and strong). If a large part of the population is slim it’s rather because of disciplined eating habits and lack of cars, not a magical bacteria.

  63. Poll after poll shows that Americans are profoundly dissatisfied with their healthcare system

    Dissatisfaction is common among modern people. It doesn’t mean the system is objectively worse.

    We are discussing the system, not level of dissatisfaction.

    They want some form of universal healthcare, which has been adopted in every civilized country by now.

    People often want things dumbly.

  64. Nope. There is no benefit for NHS and UK to have one additional paralyzed or demented patient. The treatment that you talk about was not a true treatment. Probably, the girl was in denial, and put her hopes on some sort of voodoo, be it completely ‘alternative’, or the sort of crap still approved in US or Germany these days.

    But at this point I stat to repeat myself about how stupid American patients can be.

  65. My understanding is that there are strict eligibility criteria for Medicaid, that go beyond being poor


  66. In New York and California, a family of four gets free healthcare if their annual income is under 34 thousand per year. All US children get free healthcare. All US elderly get free hospital car, and may access poor people’s coverage if they are indeed poor and need help with paying drugs. At times, the US system of charging for healthcare is amazingly progressive.

    The middle class pays more than the poor, and that makes some of them moan. But it’s only a handful of loudmouths, with an extreme sense of entitlement, the sort who also moan about paid maternity leave. They usually afford to pay their normal healthcare, but prefer to “save” on that front. The enormous cars and houses need to be paid somehow, and if that means risking bankruptcy when you break a leg, so be it.

  67. Thorfinnsson says

    Being fat is illegal in Japan. Doctors measure your waistline and if it exceeds a certain amount you get fined.

    I assume sumo wrestlers have some sort of exemption. Or perhaps they simply put up with the fine.

  68. My memory is not perfect for what he said, but he said something like personally he has to pay around $10,000, but it might be higher (he might have said $15,000 each year).

    But health insurance policy itself costs far more than this (maybe $30,000 or more per year). Employers pay most of its price, so the employee only pays something like $10,000 a year.

    But he has a health condition since in his childhood, so he is happy with this health insurance system. It’s one of the main reasons, in his decision, that he may continue working in America and not go home.

    There is just one thing that he disliked, which is they performed a lot of unnecessary scans which are unrelated to his health condition (which had been diagnosed already in childhood), and which are ridiculous to use with young people. These scans themselves (CT scans) slightly increase risk of developing cancer.

  69. They’ll just spend the savings on administrative overhead (while continuing to send medical communications exclusively via paper letters) and mansions for Somalis and their broods anyway.

  70. There is no benefit for NHS and UK to have one additional paralyzed or demented patient.

    There is, if treatment is more expensive than long-term care for a paralyzed or demented person. Of if treatment extends quality of life for a couple of years and the person becomes paralyzed eventually anyways. Of if treatment has, say, a 5% chance of success. For patients and their loved ones USA’s system is better even though it is inefficient and expensive. I’d want expensive treatment for myself, my kids or wife or parents even if there was less than a 5% chance of recovery. I’m willing to pay higher insurance for that.

  71. Similar dental care experiences in the US as well, in terms of quality care not covered, over the going thru the motion subpar treatment.

  72. You seem to want to believe very much, in “Just World Hypothesis”.

    A lot of, if not most, health problems are outside any personal control.

    Think about many of the artificial factors which today, are increasing risk of disease in general population. Imagine you were born somewhere with high air pollution like Chelyabinsk or Beijing. The average person does not have any control in the decisions which created the situation which exposed them to risk.

    Probably, looking at this outside time, the main factor determining health will be the year you were born. Someone born in the 20th century, will be exposed to far higher risk of disease, compared to someone born in the 21st century. And – we can only assume – people born in the 22nd century will have far less exposure to risk again.

    You can then assume, that people born in the 21st century are “stronger” than people born in the 20th century? No, it’s just a question of luck in what epoch you were born.

  73. Somewhat related, the case for living until 75:

    Another story if you’re still enjoying life past 75, in good health and with sufficient financial means.

  74. Administrative overhead would be included in NHS spending.

  75. You can go private and pay the extra that way.

  76. This never really happened did it?

  77. Thorfinnsson says

    I happen to believe that you can move out of Chelyabinsk and Beijing.

  78. “The bureaucracy is expanding to meet the needs of the expanding bureaucracy.”

    I was amazed at the surfeit of pen pushers of all kinds in the NHS coupled with technological obsolescence (no email option in the Current Year!) and their incompetence at getting any procedures done (not my experience, but a close acquaintance had some lurid stories about waiting for hours for updates to go from one department to another on the same wing in the same building).

    Another example – I did three tests there (not going into more details) when I stayed in London for a few months in 2016. The lab somehow managed to lose all the results for one of them. Many other anecdotes.

    While some of the doctors are very good (in the elite central London hospitals, anyway) I was constantly amazed by the bureaucratic ineptitude. I strongly suspect it’s a sort of mass make work/affirmative action scheme, which taxpayers have to subsidize instead of actually useful things such as a greater variety of drugs.

    PS. More whining. Getting data from your own tests is a real chore. They want to hoard it and try to fob you off with self-serving fake concern about your privacy, etc. I have an easier time getting my own health information from Soviet-Russian hospitals!

  79. Bragadocious says

    Do you really trust Cuba’s statistics? I certainly don’t. They have a massive incentive to lie. (We may be oppressive communists but check our healthcare!) And don’t you find it odd that Cuba, almost unique among all developing nations, seems to have ready made stats for researchers?

  80. Bragadocious says

    My understanding is that there are strict eligibility criteria for Medicaid, that go beyond being poor: it is primarily a program for children and people with disabilities

    You’re an idiot who knows absolutely nothing.

  81. You have significant deficiencies in understanding written text.

    I repeat: “There is no benefit for NHS and UK to have one additional paralyzed or demented patient.” You cannot refute that phrase with “There is a benefit for UK, if the soon-to-be-disabled gets a longer healthy life.” If she has a longer healthy life, she is not a disable yet. The benefit you talk about is accrued only because there is one fewer disabled people.

    I will also repeat for the benefit of saner readers: if you go for a mammography, you have a 0.2% chance of being rescued from untimely death, and a 0.2% chance of being killed by the doctors. “5% chance of success” is in fact 0 – not even 0.2%! Paying more to get zero net benefit is stupid.

  82. But muh freedom to “choose” and to die early, in an expensive hospital! Why do you spoil the dream of our resident US supremacist with facts?

    In any country of the world, not only in UK, you have the “option” of getting the first airplane to a private hospital, as long as you have the money. That 10% of Brits already take that option, through BUPA and others, without having to leave their home towns is a detail that should not impede him. Considering that 25% of Americans are on Medicare, 25% are on Medicaid, and 12% are uninsured, the difference in percent privately insured between US and UK is modest. But again, why bother with facts?

    Next, I will add that ‘commie’ Brits live 2 years longer than Americans, and supremacists going to explain that McCain died on the cross for our freedoms. He is more concerned with spiting the poor than with his healthcare. If that means paying more, just to show who is the rich, he will do it.

    He’d do many things, except learning to read.

  83. A lot of adults are trying to escape from Chelyabinsk to other cities, partly for the reason of pollution scares.

    A lot of people are emigrating from polluted cities.

    I noticed something funny with Israel, that disproportionate amounts of young people there are, literally, people from Chelyabinsk (escaping as far as the Middle East!).

    But let’s say your family live in an ecologically failed area of Chelyabinsk or Yaroslavl (or Beijing). The youngest you can leave, is when you are 18 years old, so you are going to have 18 years of additional risk exposure with no personal responsibility.

    That is, outside your locus of control.

    Similarly, if your mother drinks alcohol and smokes cigarettes while she is pregnant.

    Similarly, if you have genetic predispositions to certain diseases.

    The majority of your health risk situation, is determined by variables outside your control. And that is just determining your risk profile. (You can also have the healthiest lifestyle and be unlucky).

  84. The big problem with cancer is that it doesn’t get diagnosed often enough, soon enough. It’s an organizational problem, not a money problem.

    The cost of medical malpractice insurance and the prospect of getting sued is always on the minds of US doctors.

    Trial lawyers exist to attack or exploit exceptional cases where there is neglect, discrimation, or outright incompetence. This can act as a corrective feedback loop in the healthcare system. Law suits can also give large corporations chances to buy off lawyers via out of court settlements. Lawyers that hang on (shark) for large jury awards might get harpooned (shot down) in the appellate courts.

  85. Disabled or demented people, still have the same right for having as normal as possible life, as any healthy person. It’s generally just a result of bad luck in those cases anyway, so you cannot say they “deserve” less access to treatment for their condition, than you or I.

  86. I’ve seen (often searching for topics) how the NHS provides a lot of free, sceptical information on the internet, about every kind of health study.


    If you read at the end of these articles, it says “Analysis by Bazian”.

    Bazian is a private company, which is owned by The Economist.

    So NHS has extra money, to pay to The Economist to write these reports, which are available as a kind of gift to the world.

  87. I wonder how will you react when you learn that NHS does not own nor operate hospitals and doctor’s offices.

    NHS merely pays for health services of many kinds, and sets standards for their contractors.

    In theory, generalist doctors compete for patients, and hospitals compete for those doctor’s referrals. Doctors are true businessmen, owning their practices. Hospitals are owned and budgeted by foundation trusts, a form of non-profit. Muh communism squared.

    In practice, patients and doctors choose based on geographic reasons, NHS standards are a major uniforming force, and many trusts are losing money faster than they should. Nevertheless, NHS would not hire employees to write their public service announcements, given that it does not employ the doctors.

  88. I strongly suspect it’s a sort of mass make work/affirmative action scheme, which taxpayers have to subsidize instead of actually useful things such as a greater variety of drugs.

    Even if there were a greater variety of drugs, how would they be controlled, purchased, administered, or distributed without the bureaucracy? It seems strange that I would defend something as often nightmarish as the NHS seems to be, but I have a reason for doing so.

    Bureaucracy is to management exactly what derivatives are to finance. For example, oil futures contracts allow producers to sell into a market that is not exclusively determined by immediate consumption needs. They allow primary oil consumers (e.g. refineries) to lock in a stream of raw material at a known cost. By enabling interested parties to buy and sell forward, to hedge, and to plan, oil futures provide the liquidity, the working capital, and the risk dispersion without which a large-scale petroleum based economy would not be possible. In the absence of these futures, all transactions would have to be negotiated individually and the entire risk of every transaction would be born exclusively by the consumer and producer, leading to a boutique petroleum industry that would be about as safe and reliable as 16th century shipping, and completely inadequate to the needs of the modern world.

    In a similar manner, the bureaucracy exists to provide a mechanism for addressing a whole bevy of issues—everything from billing problems to liability claims to powers of attorney and beyond—that would otherwise have to be handled in the most piecemeal manner imaginable, by un-specialists and unsophisticated people in various stages of disease and desperation. Is an ordinary man whose wife and child just got wheeled into the trauma unit after an auto accident really properly configured to negotiate payment terms with the surgeon that very hour? Does the surgeon really need to be worrying about who’s paying him when he’s trying to save a mangled life? In other words, if you think dealing with these things within the bureaucracy is inefficient, just try dealing with them without the bureaucracy!

    The essence of derivatives and bureaucracy is this: They are the macrocosmic realities that enable the microcosmic events. Many people seem to think that this additional, cumbersome overlayer of arcane operations could simply be planed off and the individual events would go on just as before, free to carry on at “liberty” from the meddling “system”—but this is not the case. Without the macrocosm, the microcosm could not exist at all; and this notwithstanding the well known and irksome inefficiencies of bureaucracy. The individual seldom sees this side of it, however, and is often trying to take advantage of the system as if he was the only one for whom it existed. When an irate patient tells the receptionist (whose function in the organization is mainly to take calls and make appointments) that she had better go back and get him the doctor RIGHT NOW, he is short-circuiting the mechanism and converting the system into an object for his own private use. The individual may benefit, but he does so at the expense of the system’s operational integrity. Each one of these short-circuiting events eats into the low entropy of the bureaucracy like maggots devouring a corpse, until eventually there is no system anymore and it’s every patient for himself.

    This is not to say that all bureaucracies are sacrosanct and created equal and should never be criticized or improved; but it is to say that renovating a bureaucracy requires massive inputs that our societies may not be able to realistically afford. I doubt that we can even afford the existing scale of our administrative systems in such major areas as healthcare, education, defense, and so on. Long story short, we don’t realize how good we have it now and it’s about to get a whole lot worse.

  89. I strongly suspect it’s a sort of mass make work/affirmative action scheme

    borrowed money funding govt paperwork jobs is the main thing holding up the UK economy imo.

  90. So true, it should be needless to say.
    Sadly, people need to be reminded sometimes …

  91. I will also repeat for the benefit of saner readers: if you go for a mammography, you have a 0.2% chance of being rescued from untimely death, and a 0.2% chance of being killed by the doctors.

    Please cite a source for this claim. The only study I’ve found that even vaguely supports this shows roughly equal mortality rates in women 40-49 who receive routine mammograms vs. those who do not, which is still not even close to being the same thing you are saying (and is besides the point in the US, as USPSTF does not recommend routine screening mammograms before age 50).

  92. What’s the deal with Denmark? Just what’s in their bicycle seats?

  93. The “1 in 500” number of breast cancer deaths prevented by mammography comes from , a study of Swedish women aged 40-74. It so happened that some counties introduces strong recommendations for mammography ahead of the rest of Sweden, thus allowing a comparison between screened and nonscreened.

    Since screening does not extend survival by any meaningful amount, it follows that, in the screened populations, an equal number of women are dying sooner than they should. I wish I could blame their zodiac, but the only thing that makes sense is medical death.

  94. The big problem there is the sanctioned opioid abuse. Permitted by the state and pushed by the health care system.

    It’s interesting to read about how it was introduced and how it’s done. We have the Sackler family, owners of Purdue Pharma, at the bottom of it all; a health care system that has been made hypersensitive to patients reporting ‘pain’; easy prescription of opioids to treat ‘pain’; a cynical health care system; and a population of potential patients where many can’t get a job and want to draw a disability check, at least at first. Then after a while you have a community with ubiquitous access to heroin.

    As an example, I listened to a podcast by a young man who, in a degenerate stage of his life, travelled to some easy spot for picking up oxycodone (aka medical heroin). Arriving at the bus station, he found an affable negro who was trawling for new patients. Upon hearing about his plight this gentleman was very understanding and quickly arranged for a prescription over the phone. Everyone was satisfied, quick and easy. That’s how a ‘pill mill’ can work in practice.

  95. Maybe OT: Mr. Karlin probably knows, but all of you need to know too: the most popular and influential fanfiction in history

    just succesfully crowdfunded its print edition in Russia. Biggest crowdfunding project in Russian history.

    Russia was always place where ideas were taken seriously, the crazier the better. Something tells me this could have more importance in history than all cannon fodder shredded in Donbass or Syria put together.

    In July 2018, a crowdfunding campaign for publishing a three-volume Russian translation of HPMOR was launched on the website[6] The ₽1.086 million goal (approximately US$17 000) was reached within the first 30 hours.[7] The campaign ended on the 30th of September with ₽11.4 million collected (approximately US$175 000) and became the highest funded Russian crowdfunding project (the previous one was for the Ekstsess album by Alisa band), although this record was broken by the Gloomhaven game translation campaign the day after.[8] This is the biggest HPMOR publication project

    Why it matters? These people have IQ, education, money and free time. If Mr. Karlin’s project of new Russian Galactic Empire have to move forward, these are the people he needs to convert to his side. Of course it is temporary – when the Empire stands secure, there will be time for great cleansing, to get rid of “old fighters” and “old comrades” and replace them with newer and better Russians hatched from artificial wombs, but this is still far away.

  96. If Mr. Karlin’s project of new Russian Galactic Empire have to move forward, these are the people he needs to convert to his side

    Maybe AK should write his own Harry Potter fanfiction, except where Гари is a Russian cyborg whose best friends are a Chinese supercomputer and a Ruthenian geneticist and the evil wizard is a Latvian Bolshevik.

  97. Since screening does not extend survival by any meaningful amount, it follows that, in the screened populations, an equal number of women are dying sooner than they should. I wish I could blame their zodiac, but the only thing that makes sense is medical death.

    This is part of the story. The other part is that a lot of people probably needlessly undergo surgeries. How many women are there around with one of their breasts needlessly cut off?

    So without screening you get the same number of people dying, but at least way fewer of those surviving are mutilated.

    And fear of litigation means that a doctor will always decide to mutilate when in doubt, because he cannot be sued for that. The issue is of course that it doesn’t even save any lives at all.

  98. Screening can and has saved lives, no ands, ifs, or buts. It’s also true that some instances involve an inevitable end where screening (at best) might prolong and/or make a terminal condition easier.

    Prostate, breast and rectal cancer situations include an increase in holding off on surgery, in instances when radiation or chemoradiation result in a complete response (the tumor is completely eliminated, with no sign of any metathesis),

    An example:…0.0..0.65.1361.26……0….1..gws-wiz…..0..0i131j0i22i10i30.tV6oN0UnT18

    This radiation oncologist is very big on avoiding surgery via radiation or chemoradiation:

  99. UK acronyms

    NHS = no hope sunshine

    BUPA = brushing uninsured patients aside

    In Britain the UK has become a national religion. while it does have many successes the Brits are blind to its failures, for example bad management, waste , scandals such as Mid Staffordshire = and several others. When problems are pointed out Britons become very defensive and chant the mantra that the NHS is the envy of the world, which it plainly is not.

    An institution which is revered cannot change even when it no longer works as it should, no lessons from other countries are learnt, and smug clinicians wallow in the praise from the public.

  100. Both my parents some/d. One died of bladder cancer, the other is getting treated for throat cancer. It is not just the lungs. Best part is I smoke, too. And my wife as well.

  101. Interesting analysis. A couple of caveats that I think should be added:

    1. The reason people die of cancer after contracting it is not only the failure of treatment of cancer so that the cancer spreads to key organs that are necessary for life or wastes the body away (cachexia) , but also due to a) side effects of the treatment b) the lack of the overall health of the person – a health person can survive longer with metastatic cancer than an unhealthy one on average.

    Earlier deaths can result then not just because the treatment offered is not as effective as elsewhere but also due to the overall health of people not being as good as elsewhere.

    Given Russia’s lower survival rates in general – which may be both due to the healthcare system as well as less healthy lifestyles – it’s not surprising cancer survival rates would be lower as well.

    An illustration of less healthy lifestyles is the case mentioned of the carpenter who has lung cancer continuing to smoke and thereby hastening death vs elsewhere where more time could be bought by simply not doing that (tho one can argue that QoL – Quality of Life – and enjoying whatever time one has left in the manner one chooses, even if it’s killing you, trumps living a bit longer without joy).

    1. Another thing that may effect data is genetics/propensity to get aggressive cancers. For example in Breast Cancer, certain types have a poorer prognosis than others. Triple Negative Breast Cancer (TNBC) has worse recurrence rates and overall survival duration than others. In the US, TNBC accounts for 15-20% of Breast cancers but a third for African Americans. In India, recent papers suggest TNBC accounts for 30% plus of all BCs.

    So even if all treatments are equal, the survival scores from India of Breast Cancer would be lower on average than in the US simply because of the higher prevalence of TNBC within BC.

  102. trumps living a bit longer without joy

    Assuming that smoking provides any net joy at all. I never missed it (though I only smoked occasionally, mostly at parties, while young), and all my friends who gave up smoking told me their quality of life improved after they gave up the habit. It’s just an addiction which punishes you for a while after you gave it up, but with very little if any extra enjoyment over a nonsmoking lifestyle.

  103. I’m not sure where the information about the low impact of cancer comes from. As far as I remember (and according to, it has long been one of the top three killers, next to cardiovascular disorders and external causes.

  104. All this makes me wonder about the culture. In the US, I have certainly noticed less people smoking since I was a boy. Ironically, I think this might be a side effect of the pernicious SJW leftism which grew out of multicult or prosperity, take your pick.

    In the US, I’d say it is probably typical to be shown shocking images related to smoking or chewing tobacco for more than 30 years. It happens in the schools and on TV. It was financed by high taxes on tobacco products.

    Perhaps, they could not pay this level in Russia, or maybe it is psychology. That is another thing in the US: we are told everything is bad for US. From butter to margarine to pumping your own gas.

  105. Attitudes towards smoking are following Western European or US standards with a lag of a couple decades in Hungary (now it’s universally considered bad and far fewer young people smoke than a couple decades ago), and I guess in Russia there might be another decade. So Russia might be where Western Europe was in the 1980s. And maybe Western Europe has also been behind the USA a decade or so.

  106. i think the problem with healthcare is it’s very far from a perfect market due to the imbalance of knowledge/power between patient and doctors and also sick people aren’t entirely rational actors and this leads to problems however it’s organised.

    for example if you have a chronic disease like diabetes with an entire industry profiting from managing the symptoms then privatized healthcare will resist a cure – especially a cure they can’t make money off like changing diet – whereas a socialized system that wants to save money would jump at the chance of a cure.

    on the other hand privatized healthcare minimizes bureaucracy because it eats into their profits while socialized medicine over time becomes buried under a mountain of bureaucracy.

    so i’m wondering if the “solution” to the healthcare argument is similar to the solution to the argument of democracy vs monarchy i.e. kyklos – maybe institutions that by their nature have no stable optimal solution but instead always decay to one of two or more dystopian outcomes just need to be cycled – you go with option A knowing it will decay over time and then when it does you replace it with option B for a while knowing it will decay in time and then when it does you go back to A again etc.

  107. Thorfinnsson says

    I take a dynastic view of responsibility.

    If your parents are losers you probably are too.

    And yes, I do believe in the just world hypothesis.

  108. Well I respect your heritage and ancestral faith in the holy texts of Vedanta and Bhagavad Gita, with its implications of re-incarnation and karma.

    But even if we believed in re-incarnation, you’re still going to have random DNA-replication errors, idiots driving into you, lightening strikes (maybe we can integrate Zeus or Thor into the Vedas?), and every other accident of fate.

    Really, belief in ‘just world’, can lead to some Gnostic belief that man is being punished under the rule of a demiurge, or as Schopenhauer writes – that this is a “penal colony”.

  109. I was amazed at the surfeit of pen pushers of all kinds in the NHS coupled with technological obsolescence

    It’s true.

    Not just the UK. I had the disprivilege to work as a health administrator a few years back in Canada, another nation with free health care. Talking to some ex co-workers recently little has changed.

    Everything is manual and technology is very slow to adapt that bureaucracy has ballooned to embarrassing levels. I sometimes wonder if this is a problem in other public-sectors (city transportation, police, etc.) or just health.

    I strongly suspect it’s a sort of mass make work/affirmative action scheme

    You are 100% right. About the “mass make work” anyway considering 80% of non-medical staff were old white ladies. The hospitals we administered at the time constantly had visits from politicians who were trying to get the old-ladies votes (because everyone else was actually doing work and couldn’t leave to do a meet-and-greet with whatever ass clown decided to run for MP or mayor).

    Of course these (current or future) politicians would talk heavily about what they were going to do for the public sector. A lot of (PAID) union faggots would show up too (which a lot of the old school bureaucracy exists because of them… again due to some of those unionized employees being nearly fucking ancient and should have long retired and are unwilling to, or can’t, understand technology).

    And while I know this sounds ageist…. generally speaking white old ladies don’t adapt technology very well (unless it’s some illiterate shit like twiddling your thumb like a console player on facebook or some gay crap like that).

    I’m sure they can wipe out a good 60% of all administrative/bureaucratic jobs in the health field with tech but I don’t know what impact that would have on the economy if a bunch of elderly ladies didn’t have money to blow on plebeian shit like tickle-me-elmos for their grandsons (do they still sell those?)

    And while I would have nothing against them if they did a full days work, when I was working there and would take glances at their desks I would see them just surfing the net looking at clothing to buy from The Bay (Canadian version of Sears), and basically just getting paid to do nothing save the half dozen calls they may have to do.

    Free healthcare. It’s not really free. And it’s not really healthcare. Just stick with Dr. Google and a stolen prescription pad (yes I know in the rest of the world buying medication is a simple visit to the pharmacy, but in Canada antibiotics are prescription required… yes… shocker…so you can imagine how much harder it is to get anything else).

    By the time I left I saw bureaucracy create such conditions in hiring practices as to allow low-quality “doctors” to practice in the hospitals. “Doctors” who, 20 years ago, wouldn’t be trusted to drive a cab or even mow a lawn….

    I also saw the union grow to such strength that they stopped the introduction of automation due to the argument of “destroying jobs” (we were trying to introduce a handful of small fridge-sized rovers to carry medication from the pharmacy to units as opposed to porters who have to come at 5AM, if they didn’t call sick) . Because low-tech portering is cool. But I guess it can be argued a strong union is due to weak management in an organization. Remember. Jobs > Healthcare Quality

  110. in Canada antibiotics are prescription required

    Like in most of the civilized world. Is there a civilized country where they aren’t?

    And that’s a good thing. Antibiotics destroy your gut flora and incorrect dosage could lead to resistant strains. Also, not all antibiotics are the same, some illnesses require different ones than some others.

  111. JohnnyWalker123 says

    If you’re going to take Antibiotics, also take a Probiotic and eat Probiotic-rich foods (like Kefir and Kombucha). That will maintain the integrity of your gut flora.

  112. There’s a recent study which casts doubt on it. Your gut flora takes several months to recover, but if you eat probiotics, the bacteria from the probiotics will colonize your gut and your gut flora won’t be able to recover, or at least will take much longer.

  113. Philip Owen says

    A few years ago, I looked at unhealthy life expectancy for Russia and the UK. In Russia it was about 18 months and the UK 3 years. So once you fall ill, good quality medicine buys you 18 months.The rest of your life is lifestyle and public health measures not treatment.

  114. Philip Owen says

    Nobody in NHS hospital administration gets sacked for incompetence or laziness. Even Aneurin Bevan, the man who put it together thought he had made a mistake removing local councillors from the system. There aren’t even any votes in good local supervision. There are too many layers from the political level to the front line.

  115. Don’t forget the prebiotic element which is necessary for the probiotic matter to effectively survive.

  116. Learn to read.

    You wrote:

    “There is no benefit for NHS and UK to have one additional paralyzed or demented patient.” ”

    I replied “There is, if treatment is more expensive than long-term care for a paralyzed or demented person.”

    I did not write, ““There is a benefit for UK, if the soon-to-be-disabled gets a longer healthy life.”

    Reflect on the difference and we will continue the discussion. If you are capable of doing so.

  117. Considering that 25% of Americans are on Medicare,

    Oops –,%22sort%22:%22asc%22%7D


    25% are on Medicaid,

    Oops again.


    and 12% are uninsured



    Dacian can’t figure out basic facts and makes arguments. Well, it takes a certain sort to feel good about the NHS compared to the US system.

  118. feel good about the NHS compared to the US system.

    UK also has some famous private health services, which are probably as advanced as anything in America – have you seen Harley Street in London?

  119. I wonder how much of the obesity differential between USA, Western Europe, and Eastern Europe is explained by smoking rates. My guess is, most of it.

  120. Hmm. Okinawans live longer because of genes . . . Oh no! They don’t. They live longer because of environment. Isn’t that funny. Because on here, all the idiots believe everything is inherited. And yet, when you start eating McDonald’s, you die. You must have inherited McDonald’s.

  121. I’d say mostly all those statistics, are not lies or damned lies–they are statistics!!!!

  122. You are an idiot.

  123. If they knew what it was.

  124. So the Japanese live longer and have socialized medicine. Totally contradicts the thesis. But what the heck. All this guy wants to do is stick it to the Communists. Even though Russia isn’t communist and its medical care is privatized. So he calls non-communism communism and wins again! With idiots, that is.

  125. Russia’s health care and life expectancy and everything else suffers horribly from the shock therapy plunder, the stripping bare of the entire country by the American locusts in the 1990s. Countries do not recover quickly from such devastation. Central Asia still hasn’t fully recovered from Genghiz Khan. How do you expect Russia to bounce back so soon from Sachs Khan and Yeltsin Khan?

  126. Of course Cuba’s statistics are true. If understated. The US is the liar. Always is. Always was. You’r an American, aren’t you? See, proved my point (you won’t get it).

  127. OK, dickhead, you think that my argument, that most of the US healthcare is paid by the government, just like in UK, is somehow invalidated by the fact that I name three-state run programs, and some approximate percentages. After my unfortunate rounding, thee three programs added up to 62%, whereas you precise numbers add up to “only” 44%.

    What if we include in the list of state-run healthcare programs the 9 million children (another 3%) covered by SCHIP? What if we add the 1% of the nation served by the military hospitals, the 3% of the country being military relatives cared for by Tricare, and 3% cared for by the VA? What about the 1% cared for by Indian Health Services? I could go on, but I don’t have time for your crap.

    Some of these people are insured by multiple such schemes. Many even have supplementary coverage from private insurers. It’s besides the point. The sickest half of US is cared for by the government. Most of the rest benefit from subsidies, and from the economies of scale brought on by Medicare. Private insurance is not the custom in US. It’s more likely for an American to have government-provided insurance, than private insurance.

    Just like in UK.

    Except Brits don’t need to hide it from the stupider citizens.

  128. JohnnyWalker123 says

    Inulin powder is a good source of Prebiotics.

    The only problem is that Prebiotics enable both “good” and “bad” bacteria to flourish. So it can be tricky, as you only want to feed the “good” bacteria.

    Some people like to consume a Probiotic supplement, an Omega 3 Fish oil, a polyphenol-rich food (such as a blueberry shake), a Probiotic food (such as Kefir), and Inulin all at the same time. It’s basically a mass-scale infusion of “good” bacteria into your gut, with the proper fertilizer to sustain the health of the bacteria and offer protection during the digestion process.

  129. Antibiotics was just an example. Replace it with psychiatric drugs, painkillers, hypertension medication, etc…

    I’m just saying. In some countries a small stop to a pharmacy is all you need (at least to buy the generic version). In others a doctor visit is required (and almost always they’ll write a brand name on your prescription… because you know… we’re made of money).

    Gotta milk it man.

  130. JohnnyWalker123 says

    The goal is to help the best-quality “good” bacteria colonize the gut. The problem is that we don’t fully understand which bacteria are the most beneficial for us.

    When you consume an Antibiotic, often the gut flora take months to recover. Sometimes the gut flora never fully recover.

    Geographically isolated tribes often have strains of bacteria that aren’t found in the rest of the world. Medical researchers have speculated that this is because the lack of Antiobiotic exposure enables these isolated populations to maintain the diversity of their flora.

    Many researchers believe that the increase in autoimmune disorders might be linked in with Antibiotic overuse.

    So it’s advisable to minimize Antibiotic use.

    However, if you’re going to use Antibiotics, it can be beneficial to take a Probiotic supplement. A Probiotic supplement can enable you to recover “good” bacteria more quickly and squeeze out the proliferation of “bad” bacteria. Unfortunately, the Probiotic might also squeeze out the proliferation of existing “good” bacteria strains.

    So when you take a Probiotic supplement, you want a mix of high-quality strains. The problem is that we don’t always know which strains are the most beneficial.

    So the best strategy is to minimize Antiobiotics, while consuming a Probiotic supplement and certain foods (Kefir, Kombucha, Kimchi). Then also take an Omega 3 fish oil supplement, a polyphenol-heavy food, and maybe Inulin.

  131. There’s a certain heart surgeon turned nutritionist who really pushes polyphenols. He’s anti-wheat grass juice, claiming the body doesn’t absorb its nutrients.…0.0..0.68.650.11……0….1..gws-wiz…..0..0j0i131.qL7XdplEJf0

    It’s a fine line, inclusive of better probiotic supplements and knowing when and how much to take regarding all supplements, foods and drinks. I was recently informed that green tea isn’t good to take on an empty stomach because its acid level can upset the stomach. On the other hand, it’s recommended to take apple cider vinegar on an empty stomach.

    Beet juice does for me as claimed in terms of feeling more energized and improving athletic performance. Its makeup though is prone to giving a good number the runs.

  132. by the American locusts


  133. psychiatric drugs, painkillers, hypertension medication

    Not very good examples either. These are often dangerous drugs which are not advisable to take based on self-diagnosis.

  134. Before taking antibiotics you need preserve you bacteria culture. Probably you need keep as maple of your poop in a jar for future regeneration. The problem is how do the replanting.

    Hitler’s physician had pills made for AH from a poop of some Bulgarian peasant. German medicine was way ahead in this area.

  135. Does Parkinson’s Begin in the Gut?
    A growing body of evidence links the neurodegenerative disease to the gastrointestinal tract, opening new possibilities for treatment

    The microbiome, immunity, and schizophrenia and bipolar disorder

    Gut microbial communities modulating brain development and function

    Gut Bacteria May Influence Infant Intelligence

    So it is not genes but whatever is in your poop.

  136. So the Japanese live longer and have socialized medicine. Totally contradicts the thesis.

    No, it doesn’t, because race is real.

    The Japanese in 2016 had a lower life expectancy (84 years) than Asian-Americans in all but a couple of American states in 2010 (average – 86.5 years).

    [In fairness, though, I suspect that has more to do with Asian-Americans leading healthier lives than Japanese. Certainly there’s less smoking, and probably less stress].

    Even though Russia isn’t communist and its medical care is privatized.

    No, the great bulk of it is state-owned.

    Russia’s health care and life expectancy and everything else suffers horribly from the shock therapy plunder, the stripping bare of the entire country by the American locusts in the 1990s.

    An urban legend.

    As I have demonstrated many times, Russian life expectancy collapsed in the 1990s primarily on account of soaring alcohol consumption (namely vodka bingeing), which in turn was a result of specific policy decisions such as winding down Gorbachev’s anti-alcohol campaign and removing the vodka monopoly.

    Countries where alcohol over-consumption was not a problem to begin with (ex-USSR Muslim and Caucasian countries) did not suffer a significant LE decline, and quickly recovered. Contrary to leftist propaganda, it was also the countries where neoliberal shock therapy was implemented quickest, such as Poland and Estonia, where LE did not dip by much, and/or quickly recovered.

  137. you think that my argument, that most of the US healthcare is paid by the government, just like in UK, is somehow invalidated by the fact that I name three-state run programs, and some approximate percentages.

    I just show that you consistently lie about facts to support your arguments. Which makes your arguments rubbish.

  138. I told her I hate people with cancer.

    Are you serious? Really?…what a callous and stupid thing to say…and to think! 🙁

  139. It’s a horrible disease. I almost wonder if it is worth treating it, because it almost always kills you within a year or so

    Esophageal cancer is almost invariably a death sentence, as is pancreatic cancer. Lung cancer usually kills but not invariably. The ratio of deaths annually to new diagnoses is currently 0.66. I’m acquainted with a woman diagnosed in 1986, at age 39. She’s still alive.

  140. Dacian Soros says

    You seem to be the sort that confuses allegiance to the nation with allegiance with allegiance to a piece of cloth. You’d by upset if you’d hear that somebody burns a US flag, but would not mind if tens of millions of Americans die early. Hence, your government has to hide it from you that it pays for the poorer and the worse off. The mere thought drives you nuts, apparently.

    If your brainwashing is so thorough, how about throwing some autistic fits at The Saker’s post on uselessness of US military?

  141. Philip Owen says

    What American locusts? Yeltsin was extremely nationalist about Russia’s privatizations. Very few foreigners had access. The two most notable were Bill Browder and the Harvard University Endowment Fund. Looting by foreigners didn’t happen.

    1) Rouble was overvalued. Assets were expensive.
    2) Pretty much every business was an underinvested wreck.

    Russia would have done much better to allow foreign investment. It would have produced investment inphysical structures , technology transfer and an upgrade of management standards, not to mention tax payments.

  142. You seem to be the sort that confuses allegiance to the nation with allegiance with allegiance to a piece of cloth. You’d by upset if you’d hear that somebody burns a US flag, but would not mind if tens of millions of Americans die early.

    Thanks for demonstrating that in addition to being dishonest you are also an idiot.

  143. Blahblahblah. You say socialized medicine is bad. It causes higher cancer rates. But Japan has lower cancer rates and socialized medicine. Sorry. You can’t have it both ways.

    And I like how all your arguments are environmental and not genetic. Drinking and smoking, in case you didn’t know, is nurture, not nature.

    You are just a big bag of contradictions. Look it up. It’s a Marxist word. They would say you can’t help it. You’re a capitalist. Therefore you must contradict yourself. There is no way out for you. Sad.

  144. I admit to being several decades removed from junior high school biology class, but I seem to remember being taught that bacteria, in your poop or wherever else, also have genes.

  145. Sure they have genes. So next time you will want to do a swab test for your genes DNA test do not do it in your mouth. The genes that drive you are in your ass.

  146. The genes that drive you are in your ass.

    Sure they have an effect. But what do you base your assertion that the genes in your mouth have zero effect?

  147. Toronto Russian says

    There are numerous accounts of travellers who lost weight outside the US from lifestyle changes unrelated to smoking. Also, the good old times when women weren’t obese? Smoking was unladylike and restricted to women of ill repute. The big propaganda push for female smoking only happened in 1929:

  148. Up until a few years ago, such would be injected. No more with the advent of poop pills:…0.0..0.70.672.11……0….1..gws-wiz…..0..0j0i131j0i10.n4MMrR04YZ4

    As I understand, the issue remains just what kind of poop pill and how much dosage for the given condition.

  149. What’s the deal with Denmark? Just what’s in their bicycle seats?

    So much for the Nordic utopia, eh?

    My guess would be lower rates of early detection.