If you think about it, all screening programs are luxury medical care. After all, an apparently healthy individual undergoes the screen to find a condition that early treatment can affect favorably when one considers net benefit and cost per life-year saved. Very very few such programs are demonstrably helpful and cost-effective. Even with a generous medical budget. As Vinay correctly points out, the homeless have vastly higher priorities than undergoing a dubious screen.
Dr. Prasad. Like others I agree 1000%. I helped run a homeless nonprofit for veterans and an earlier one for the needs of children in homeless families. You know what the kids wanted and needed? Clean jeans and shirt, toothpaste and toothbrush, and sneakers. Why? So that they didn't have bad breath and could look ok and fit in when they went to school. Yes, some, maybe many homeless families enroll their kids in public schools. How'd we know? We asked them. The veterans were a tougher crowd. They needed all sorts of medical care from dental to wound healing to mental health, but they distrusted the U.S. govt who abandoned, no discarded them and they really distrusted the VA. Part of the govt that didn't have the resources to treat them like human beings in need. Today Captain hope is Hope Supply and it still exists run by its cofounder. http://www.hopedonation.org/
The concern I have is that the motivation the authors had was not related to benefitting the homeless but rather to find guinea pigs they could recruit for drug trials.
1000% agree with your analysis. I always go back to the money - who thought it was a good idea to spend money on this (and who's money was it?). I tried to dig and find out if it was NIH/gov't grant...I don't have access to the full pub so it may be listed there in the fine print. Even if it was a $2M grant, imagine how much food, clothing, showers, dental visits, etc it could provide.
I’ve been meaning to subscribe since I found you on SS 6 months ago. After reading your recommended response to JAMA homeless lung cancer screening I couldn’t wait to subscribe. Anything we can do to give you more influence will help all patients (what we are supposed to do). But will help docs too
Thank you for this........you have to wonder if anyone involved in this had even a moment of such clarity as you did.......and if so, maybe just lacked the courage to call BS.........
Was there any control for patients who smoked or lived near industrial pollution centers? The whole enterprise sounds dubious from the start. I hate to be a broken record, but the IRB should have never approved this study. Where the H—- is the IRB and why aren’t they doing their sentinel job?
The smallest detail of why this is a hot circle of garbage, but...
"People who were *ever* homeless?" Was there really such a small p of "actually unhoused people" that we needed to muddy the waters?
What are you proving? That having ever in your life been homeless, even if your life no longer resembles this, changes your risk profile? (Which, now that I hear it out loud in my head, is not a ridiculous statement- but I'm certain it wasn't the argument they were trying to make).
Having an undifferentiated bunch of people who are not actually currently homeless seems like a hot beef injection of healthy user bias.
If you want to spend some money on homeless people for a medical intervention, I think dental care could be the most bang for the buck. Blood pressure screening, mental health screening and addiction treatment all require ongoing treatments and buy in. But dental care can potentially fix a painful ongoing problem in one day. If you’ve ever had a bad toothache, you know how much that could affect your quality of life. Untreated dental infections can be dangerous too. Even if Medicaid pays for dental treatments, people frequently can’t find dentists that take it. But dental work is boring.
Having studied bioethics, this so called study gets awfully close to a principle by which we should not include “vulnerable” populations in research. Bottom line: waste of resources, useless data, and immoral disdain for people in need used for the benefit of unscrupulous researchers.
This all makes sense as you look at the institutions these "investigators" are at - Harvard, Mass General, NYU. Common sense is not in the curriculum. Sad that this is what those lofty bastions of medical education are now pumping out. What a waste of time and money.
If you think about it, all screening programs are luxury medical care. After all, an apparently healthy individual undergoes the screen to find a condition that early treatment can affect favorably when one considers net benefit and cost per life-year saved. Very very few such programs are demonstrably helpful and cost-effective. Even with a generous medical budget. As Vinay correctly points out, the homeless have vastly higher priorities than undergoing a dubious screen.
Dr. Prasad. Like others I agree 1000%. I helped run a homeless nonprofit for veterans and an earlier one for the needs of children in homeless families. You know what the kids wanted and needed? Clean jeans and shirt, toothpaste and toothbrush, and sneakers. Why? So that they didn't have bad breath and could look ok and fit in when they went to school. Yes, some, maybe many homeless families enroll their kids in public schools. How'd we know? We asked them. The veterans were a tougher crowd. They needed all sorts of medical care from dental to wound healing to mental health, but they distrusted the U.S. govt who abandoned, no discarded them and they really distrusted the VA. Part of the govt that didn't have the resources to treat them like human beings in need. Today Captain hope is Hope Supply and it still exists run by its cofounder. http://www.hopedonation.org/
The concern I have is that the motivation the authors had was not related to benefitting the homeless but rather to find guinea pigs they could recruit for drug trials.
Pretty certain you hit the nail on the head. Sad but likely the honest truth.
1000% agree with your analysis. I always go back to the money - who thought it was a good idea to spend money on this (and who's money was it?). I tried to dig and find out if it was NIH/gov't grant...I don't have access to the full pub so it may be listed there in the fine print. Even if it was a $2M grant, imagine how much food, clothing, showers, dental visits, etc it could provide.
Here's a publication I'd love to get your take on: Community-Based Cluster-Randomized Trial to Reduce Opioid Overdose Deaths https://www.nejm.org/doi/full/10.1056/NEJMoa2401177?query=TOC
The amount of NIH taxpayer money spent on this is staggering. According to this Fact Sheet, $87 MILLION was awarded to 4 institutions https://healingstudy.uky.edu/sites/default/files/2024-01/HCS-UK%20Fact%20Sheet.pdf and if this is the outcome (study above)...well, what a complete and utter waste of money.
Probably sponsored by GE, Philips, or Siemens. I truly wish research was printed on toilet paper so it wouldn’t go to such waste.
I’ve been meaning to subscribe since I found you on SS 6 months ago. After reading your recommended response to JAMA homeless lung cancer screening I couldn’t wait to subscribe. Anything we can do to give you more influence will help all patients (what we are supposed to do). But will help docs too
Thank you for this........you have to wonder if anyone involved in this had even a moment of such clarity as you did.......and if so, maybe just lacked the courage to call BS.........
Was there any control for patients who smoked or lived near industrial pollution centers? The whole enterprise sounds dubious from the start. I hate to be a broken record, but the IRB should have never approved this study. Where the H—- is the IRB and why aren’t they doing their sentinel job?
The smallest detail of why this is a hot circle of garbage, but...
"People who were *ever* homeless?" Was there really such a small p of "actually unhoused people" that we needed to muddy the waters?
What are you proving? That having ever in your life been homeless, even if your life no longer resembles this, changes your risk profile? (Which, now that I hear it out loud in my head, is not a ridiculous statement- but I'm certain it wasn't the argument they were trying to make).
Having an undifferentiated bunch of people who are not actually currently homeless seems like a hot beef injection of healthy user bias.
If you want to spend some money on homeless people for a medical intervention, I think dental care could be the most bang for the buck. Blood pressure screening, mental health screening and addiction treatment all require ongoing treatments and buy in. But dental care can potentially fix a painful ongoing problem in one day. If you’ve ever had a bad toothache, you know how much that could affect your quality of life. Untreated dental infections can be dangerous too. Even if Medicaid pays for dental treatments, people frequently can’t find dentists that take it. But dental work is boring.
Having studied bioethics, this so called study gets awfully close to a principle by which we should not include “vulnerable” populations in research. Bottom line: waste of resources, useless data, and immoral disdain for people in need used for the benefit of unscrupulous researchers.
This all makes sense as you look at the institutions these "investigators" are at - Harvard, Mass General, NYU. Common sense is not in the curriculum. Sad that this is what those lofty bastions of medical education are now pumping out. What a waste of time and money.
I realize you dont read comments but this was a brilliant post
Thank you, as always, for being the voice of reason. Just because we CAN do these screenings doesn’t mean we should. Where is the benefit?