[Split Thread] Life expectancy statistics in the USA [Archive]

BeAChooser

11th August 2009, 05:00 PM

You've got to ignore the actual standards the WHO used to rank health care systems:

Unlike you, Joe, I haven't ignored that topic AT ALL. I've discussed it specifically several times on this forum ... sometimes in discussions WITH YOU. For example, not too long ago I posted the following TO YOU during a discussion when you brought up the topic of WHO rankings (http://forums.randi.org/showthread.php?t=148345&highlight=healthcare+interventionists&page=3 ):

http://www.voiceofthetimes.net/index.php?option=com_content&task=view&id=1014&Itemid=2

Healthcare interventionists frequently cite the World Health Organization's World Health Report 2000, which studied the performance of 191 countries' healthcare systems — and awarded the U.S. a dismal rank of number 37.  

While the WHO rankings are touted as an objective measure of the relative performance of healthcare systems, in reality they depend on a number of ideological or logically incoherent assumptions.

 ... snip ...

Some people are happy to give up a few potential months or even years of life in exchange for the pleasures of smoking, eating, having sex, playing sports, and so on. The WHO approach, rather than taking people's preferences as given, deems some preferences better than others, and then praises or blames the health system for them.

 Those who cite the WHO ranking to justify greater government involvement in the health system — like the plans pitched by the leading Democratic presidential candidates — are assuming what they're trying to prove.   The WHO healthcare ranking system does not escape political bias. It advances ideological assumptions that most Americans might find questionable under the guise of objectivity.

http://www.jewishworldreview.com/0807/stossel082207.php3?printer_friendly

Why the U.S. ranks low on WHO's health-care study

By John Stossel

...snip ...

So what's wrong with the WHO and Commonwealth Fund studies? Let me count the ways.

The WHO judged a country's quality of health on life expectancy. But that's a lousy measure of a health-care system. Many things that cause premature death have nothing do with medical care. We have far more fatal transportation accidents than other countries. That's not a health-care problem.

Similarly, our homicide rate is 10 times higher than in the U.K., eight times higher than in France, and five times greater than in Canada.

When you adjust for these "fatal injury" rates, U.S. life expectancy is actually higher than in nearly every other industrialized nation.

Diet and lack of exercise also bring down average life expectancy.

Another reason the U.S. didn't score high in the WHO rankings is that we are less socialistic than other nations. What has that got to do with the quality of health care? For the authors of the study, it's crucial. The WHO judged countries not on the absolute quality of health care, but on how "fairly" health care of any quality is "distributed." The problem here is obvious. By that criterion, a country with high-quality care overall but "unequal distribution" would rank below a country with lower quality care but equal distribution.

http://smartgirlnation.com/2009/06/01/popular-ranking-unfairly-misrepresents-the-us-health-care-system/

In summary, therefore, the WHO ranking system has minimal objectivity in its “ranking” of world health. It more accurately can be described as a ranking system inherently biased to reward the uniformity of “government” delivered (i.e. “socialized”) health care, independent of the care actually delivered.

And as anyone can see looking at that thread, your response was to simply ignore all that I posted about the WHO study and instead go on regurgitating some false claims about things I never said.

Sorry Joe, but your so-called WHO *standards* aren't about rewarding good health care but rewarding socialism. What's called "Distribution of Financing" is nothing but a "fairness" factor that necessarily makes countries that rely on private payment look inferior to socialized systems. And the "Distribution of Health in the Populations" index is a second helping of this "fairness" doctrine. Both actually have nothing to do with the quality of the health care provided by a system. Both of them inherently favor socialist systems ... even if the people in those systems are dirt poor as a result (like they often are in Cuba) and receive inadequate health care. As long as it's "fair". :rolleyes:

In fact, suppose that a country currently provides everyone the same quality of healthcare. And then suppose the quality of healthcare improves for half of the population, while remaining half get the same health care as before. This is unambiguously an improvement in the health care of the country, yet this change could cause the country to fall in the WHO rankings due to the distribution index. Which illustrates how flawed and illogical the WHO methodology is, Joe.

Now for those who really are interested, this and many other flaws in the WHO study are discussed here:

http://www.cato.org/pubs/bp/html/bp101/bp101index.html

The author correctly concludes:

The WHO health care ranking system does not escape ideology. On the contrary, it advances ideological assumptions under the guise of objectivity. Those interested in objective measures of health system performance should look elsewhere.

:D

Dymanic

11th August 2009, 06:34 PM

We have far more fatal transportation accidents than other countries. That's not a health-care problem.

Similarly, our homicide rate is 10 times higher than in the U.K., eight times higher than in France, and five times greater than in Canada.

When you adjust for these "fatal injury" rates, U.S. life expectancy is actually higher than in nearly every other industrialized nation.
I don't mean to be a pest about this, but I'm still not seeing the numbers backing this up. "Far more fatal transportation accidents than other countries" appears to be at least a bit of an exaggeration; "somewhat above the OECD median" would be more accurate. The homicide rate comparisons may be accurate for all I know; still haven't found reliable sources for other OEDC countries. But both traffic fatalities and homicides together represent a pretty miniscule portion of the all-causes death rate in the U.S. -- maybe a couple of percent. As strong as this argument would be if properly supported, I'd think you would want to do a better job of providing that support. If you can, that is.

Architect

12th August 2009, 12:05 AM

kellyb

12th August 2009, 12:06 AM

:DI don't mean to be a pest about this, but I'm still not seeing the numbers backing this up. "Far more fatal transportation accidents than other countries" appears to be at least a bit of an exaggeration; "somewhat above the OECD median" would be more accurate. The homicide rate comparisons may be accurate for all I know; still haven't found reliable sources for other OEDC countries. But both traffic fatalities and homicides together represent a pretty miniscule portion of the all-causes death rate in the U.S. -- maybe a couple of percent. As strong as this argument would be if properly supported, I'd think you would want to do a better job of providing that support. If you can, that is.

bump
:D

Rolfe

12th August 2009, 03:20 AM

BAC quotes Stossel (http://en.wikipedia.org/wiki/John_Stossel), but of course the latter has very strong political views and is by no means an independent and expert authority (and I'm only using the Wiki link because it's easy, his own website is full of similar stuff). So, I ask myself, why aren't we seeing any figures to back up the homicide/vehicle death claim? Are we just to take Stossel's word for it?

Not on a bet. Remember this?

Stossel solves the healthcare crisis with capitalism (http://forums.randi.org/showthread.php?t=136102)

When examined in its entirety, that programme was a mish-mash of lies (about universal healthcare systems), non-sequiturs (about "food insurance") and apparently real horror stories about the US healthcare system, for which Stossel presented no workable solution.

After having dissected that one in detail, if John Stossel told me it was raining I'd look outside to check.

Rolfe.

Architect

12th August 2009, 11:37 AM

Aha, I'd forgotten about that one! Nice call.

back2basics

12th August 2009, 12:26 PM

So the U.S has a higher homicide rate. But it has lower rates of deaths on the roads. More people eat burgers in the U.S, but not so much the deep fried mars bars. People don't binge drink as much in the U.S there are far fewer deaths due to alcohol abuse.

So let’s see your figures cause this argument really needs fleshing out. I would suggest the numbers equal out more than the lopsided view that homicides in America make your figures look worse, when homicides are only a small part of it. Looks like a faith based argument to me, unless you have some cold hard facts?

jimbob

12th August 2009, 12:30 PM

But not all the US life expectancy differences can be explained by differences in gun ownership...

A significant part can be, but that is not all:

Note that this is quite an old post that I am quoting

I think the point is that the US could be getting far more value for the money it spends, or spend less money and redistribute good-quality care to everyone (while ensuring that people are still free to buy excess care if they want). The only thing holding them back seems to be ideology, and that ideology seems to be based on misunderstanding and misinformation.

Linda
Yup: some further evidence from an earlier thread:

The US state alone spends more of its GDP on healthcare than the UK: for as system that is far form universal.

Here is where I got the 6.6% figure (for 2004)

Medicaid costs a larger percentage of GDP than the NHS does the British taxpayer.
(44.7% of 14.7%=6.6%) was public, as opposed to the UK's (83.4% of 7.7%=6.3%) of GDP Source:

OECD Health Data 2007 - Frequently Requested Data (http://www.oecd.org/document/16/0,2340,en_2649_34631_2085200_1_1_1_1,00.html)

The death rate is higher in the US too, and not all can be explained by higher gun ownership:

I have found one estimation (http://www.allbusiness.com/finance-insurance/insurance-carriers-related-activities/523667-1.html), in what seems like an appropriate journal.

Thank for for your research.

"The United States thus suffers from a life expectancy gap of 1.7 years."

Now add 1.7 years to your previous stats and tell me were we are.

Keep in mind that this is only one factor to be considered.

"These deaths account for 26.86 percent of the U.S. males' excess mortality when compared to peer nations, and 8.7 percent of the racial gap between black and white males in the United States."

So, yes Jerome, it is significant, but only explains about a quarter of the difference between the US and the other thirty-four other richest countries.

In fact I am surprised at the magnitude of the effect, but it still leaves 74% unexplained by gun-deaths.

In answer to the assertion that the rest of the world is freeloading on the US medical research, which is lowering death rates, a lot of the mortality and morbidity is preventable with better primary healthcare.

fls

12th August 2009, 12:34 PM

jimbob

12th August 2009, 12:37 PM

Oh, and might as well quote Tsukasa Buddha's OP from that thread too: (EDIT my post#24)

The study, entitled "Measuring the Health of Nations: Updating an Earlier Analysis," was written by researchers from the London School of Hygiene and Tropical Medicine. It looked at death rates in subjects younger than 75 that could have been prevented by timely and effective medical care.
The researchers found that while most countries surveyed saw preventable deaths decline by an average of 16 percent, the United States saw only a four percent dip.
The non-profit Commonwealth Fund, which financed the study, expressed alarm at the findings.
"It is startling to see the US falling even farther behind on this crucial indicator of health system performance," said Commonwealth Fund Senior Vice President Cathy Schoen, who noted that "other countries are reducing these preventable deaths more rapidly, yet spending far less."
The 19 countries, in order of best to worst, were: France, Japan, Australia, Austria, Canada, Denmark, Finland, Germany, Greece, Ireland, Italy, Netherlands, New Zealand, Norway, Portugal, Spain, Sweden, the United Kingdom and the United States.
Linky (http://afp.google.com/article/ALeqM5hGPrKA627R1svhAL7yih15Ap-bFg)

But we have teh best healthcare in the world!!

Clearly the solution is to let the free market take its course and get rid of government regulations like all those countries did...

BeAChooser

12th August 2009, 12:53 PM

"Far more fatal transportation accidents than other countries" appears to be at least a bit of an exaggeration; "somewhat above the OECD median" would be more accurate.

It's not an exaggeration at all. Here is a chart based on World Health Organization and US Department of Health and Human Services statistics (http://up-ship.com/blog/?p=3507 ) that shows the death rate due to transportation accidents in the US in 2000 was 15.3 per 100000. The transport death rate in Canada is only 9.3 per 100000, in Germany it's 10.1 per 100000, in Sweden it's 4.9 per 100000 and in the UK it's 6 per 100000. "Far more fatal transportation accidents" is indeed a correct description when the fatal transportation accident rate in the US is 3 times that in Sweden, nearly two and half times that in the UK and 50% higher that in Germany or Canada. "Somewhat above the OECD median" is NOT more accurate.

The homicide rate comparisons may be accurate for all I know; still haven't found reliable sources for other OEDC countries.

Well according the link above (one would hope WHO is reliable, right?), the US homicide rate is 7.3 per 100000, compared to 1.4 per 1000 for Canada, 0.9 per 100000 for Germany, 1.2 per 100000 for Sweden and 0.7 per 100000 for the UK. In other worlds, the homicide rate in the US is 10 times that in the UK.

But both traffic fatalities and homicides together represent a pretty miniscule portion of the all-causes death rate in the U.S. -- maybe a couple of percent.

But as Ohsfeldt and Schneider showed (see Table 1.5 in their presentation), you need not make more than a couple percent change in life expectancy statistics to move the US to the top of the life expectancy list.

And you know, Dymanic, it's not just transportation accident and homicide rates that are higher in the US and thus affect life expectancy statistics.

The US also has higher infant mortality rates lowering the life expectancy ranking. But 2007 study by Baruch College economists June and David O"Neill showed why U.S. infant mortality rates are higher ... more low weight births than other countries ... in part because we have significantly more teens having babies. Low birth weight significantly increases an infant's chance of dying. Thus lowering life expectancy statistics.

Life expectancy also depends on personal habits. Americans tend to be a lot fatter than the citizens of other developed countries which increases their risks of heart disease and diabetes. A recent survey reported that 31 percent of Americans are obese, compared to only 23 percent of Britons, 14 percent of Canadians, 13 percent of Germans, 9 percent of the French, and 3 percent of Japanese. But obesity is not caused by the health care system. The Cubans have been getting a diet that has less than half the calories of the US diet for decades. Is it any wonder that has led to a higher life expectancy in Cuba? Is it any wonder that Cuba beats the US in WHO's ranking ... especially since Cuba is a communist nation that the WHO methodology will naturally favor in it's indexes?

There are also more deaths from drug abuse in the US than in other countries. Drug use is not caused by a poor health care system.

Also, some ethnicities have naturally higher life expectancies too. For example, the Japanese, whether they are living in Japan, the US or Europe, have higher life expectancies than Europeans. In fact, people of Japanese descent living in the US have a higher life expectancy than do Japanese living in Japan. That should tell you something. People of African descent have lower life expectancy than people of European descent. Just about anywhere on earth. So the US, with a significantly higher population of such people than Europe, might be expected to have a lower overall life expectancy. Nothing to do with the health care system.

The whole point is that using life expectancy, like WHO did in their ranking, to determine which nation has the best health care system is bogus because life expectancy significantly depends on factors that are not related to the health care system. As pointed out in those sources, measures that truly reflect health system characteristics ... such as looking at cancer survival rates ... show that the US leads in health care, not lags as claimed by Obama's followers.

And I leave you with this:

http://papers.nber.org/papers/w15213#fromrss

Low Life Expectancy in the United States: Is the Health Care System at Fault?

Samuel H. Preston, Jessica Y. Ho
NBER Working Paper No. 15213 Issued in August 2009

... snip ...

Life expectancy in the United States fares poorly in international comparisons, primarily because of high mortality rates above age 50. Its low ranking is often blamed on a poor performance by the health care system rather than on behavioral or social factors. This paper presents evidence on the relative performance of the US health care system using death avoidance as the sole criterion. We find that, by standards of OECD countries, the US does well in terms of screening for cancer, survival rates from cancer, survival rates after heart attacks and strokes, and medication of individuals with high levels of blood pressure or cholesterol. We consider in greater depth mortality from prostate cancer and breast cancer, diseases for which effective methods of identification and treatment have been developed and where behavioral factors do not play a dominant role. We show that the US has had significantly faster declines in mortality from these two diseases than comparison countries. We conclude that the low longevity ranking of the United States is not likely to be a result of a poorly functioning health care system.

Darth Rotor

12th August 2009, 12:58 PM

How is life expectancy a useful metric in this conversation? Is there some inherent value to keeping people alive, regardless of that quality of life?

If you want health care system to think for people, then you seek a system that can't work and that we can't afford.

Bad habits and bad luck kill as easliy as a disease treated to late.

(Full disclosure: I thought Dr Jack Kevorkian was right.)

Segnosaur

12th August 2009, 01:37 PM

One could look at a systematic review comparing specific medical conditions (in order to avoid the problems with differences in baseline risk):

http://www.openmedicine.ca/article/viewArticle/8/1)

Linda

I remember seeing this exact same article posted before in the JREF forums. I had concerns about it before, and nothing that was discussed made me drop my concerns.

Edited to add: If anyone hasn't read the article, let me summarize: The authors went through a bunch of medical journals, and looked for articles that allowed them to compare the outcomes of patients in Canada and the U.S. If an article showed better results under the Canadian system, they 'awarded' the study to Canada. If an article showed better results under the American system, they 'awarded' the study to Canada. The results showed more studies showing superior outcomes under the Canadian system when compared to the American system.

The concerns that I had with this article:

- One of the primary authors (http://en.wikipedia.org/wiki/Gordon_Guyatt) has run multiple times for the NDP, the main 'Socialist' party here in Canada, and the party most opposed to any privitization of health care. Guyatt may have done valuable research in the past, but that doesn't mean that each and every claim made by him should be accepted at face value, especially when the line between true medical science and politics can get blured.

- This is a meta-study. I'm always suspecious of such studies, regardless of topic... How do you know that they didn't just happen to stumble upon (either by accident or purpose) those studies that actually prove their point? They claim to have taken steps to prevent their researchers from bias, however, the fact is that they're still taking a sample of a sample (giving a smaller pool from which to draw results, making it more prone to errors).

- Much of the basis for the claims made in the article (that the U.S. does not have a better medical system) is based on the number of studies showing improved outcomes in Canada. Yet if you look at the studies favouring Canada (Table 3), you'll see that many of their studies are basically repetitions... For example, it points to 5 studies showing Canada's health care system is better at handling renal failure than the U.S. But they're 5 studies showing the same thing! Even if Canadian patients were better treated for renal failure than the American counterparts, the fact that 5 studies repeated the same thing gave more weight to the pro-Canada side than it deserved.

At the very least, the study should have divided the studies into disease categories...

- Very little effort is made to relate the success of treating certain diseases with improved mortality/quality of life. Thus, in that study, a disease that affects only a tiny number of people (such as AIDS) is given as much weight as a diseases that kills a relatively high number of people (such as heart disease).

- In addtion, I had problems with certain individual studies. For example:
* One study showing better results in Canada was restricted to only low income
patients. But if you're trying to analyse the OVERALL health care system, you
can't very ignore what could be a huge portion of your population
* Once study dealt with AIDS; however, success in handling HIV may be due
more to patent law than the quality of health care.

NoZed Avenger

12th August 2009, 01:41 PM

There is an old thread when the WHO study first came out, and I have to agree that some of its metrics were (IMO) either poorly chosen or skewed. I'll try to find it -- there are some valid points in it, but the criteria chosen in the study were not all that impressive.

NoZed Avenger

12th August 2009, 01:47 PM

The original thread I referred to may be lost, I found a partial quote from me on a different one [re: the WHO study]:

. . . [T]he WHO itself states that it ranked countries based on "fairness in financing" -- they explicitly include this as a criteria for their judging. Again, when they use that for a criteria as part of their judging process, how surprising is it when they countires with government-controlled health care end up ranked higher?

They are assuming as true the very thing you are trying to assert -- this is nothing but circular. As a large part of the ranking procedure, the WHO looked at fairness -- not just in access to health care, but in financing -- to attain the goal of "fairness," financing would have to be based on prepayment, rather than payments based on the use of services or risk-related payments. It began the process with criteria that ranked systems based on general taxation as better than those financed through othjer means.

And not only do the ranking not appear to reward countries with faster treatment rates (unless you can show where that is taken into account under responsiveness, I may have missed it), the WHO (for efficiency) explici[tl]y calls for rationing of medical care, something that US citizens have not been to fond of in the past: "all countries need explicit policies to ration interventions."

Responsiveness to the patient seems to rank far behind how the system is financed in terms of weighting:France ranks 1st, but only 16th in responsiveness to patients; Italy ranks 22nd for responsiveness. The US was number one on responsiveness to patients, but ended up right next to Cuba overall. Rankings that measured "equality" of health care distribution and "fairness" in financing were weighted more heavily than responsiveness, and this penalizes countries with diverse populations or that use private insurance.

* * *

My primary criticism is not really directly aimed at the WHO, but if I am hardly a lone voice crying in the wilderness if it were (most of these are online and can be located through a title/author search):

The public versus the World Health Organization on health systems performance. Blendon RJ, Kim M, Benson JM. Health Affairs 2001; 20.

Health Service Goals: Life, death and football; J Health Serv Res Pol, Appleby J.

Sick list: health care à la Karl Marx. Wall Street
Journal, Helms, R. (6/29/2000).

A few more may available only by abstract:

"Decisions about how to weight the importance of the various components of the overall indicator and the sources used to select information on those components reproduce a set of highly questionable assumptions and heavily loaded ideological choices that weaken the scientific credibility of the overall indicator and of the WHO report itself. This transforms the report into a political ideological document that simply conveys and perpetuates the current conventional wisdom in health policy." Navarro, J. ( http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? )cmd=retrieve&db=pubmed&list_uids=11809014&dopt=ab stract

“[T]he composite index for attainment … is based on very little actual data, which is often heavily manipulated to make it usable, and then subjected to a great deal of rather adventurous modelling to fill out the rather large canvas of world health which the report purports to cover. A more virtuousic display of skating on thin ice you are unlikely ever to witness.” Science or marketing at WHO? A commentary on “World Health 2000”. Williams, A. York: Center for Health Economics, 2001.

Methodological concerns and recommendations
on policy consequences of the World Health report 2000. Lancet 2001; 357: 1692; Almeida C, et al.

* * *

The rankings themselves were determined by applying a set of a priori assumptions that need to be examined before the conclusions are accepted. The actual numbers for some countries appear to be "guestimated" in some areas - though not as much for western countries, where better statistics are kept. Some of the weights chosen in making the rankings appear questionable, however. As stated above, for example, a 12 or 18 month wait for an operation does not appear to be considered as part of the overall quality of care as compared to having the government finance the health care system.

That is not to say that specific weaknesses in the US system do not exist, or that the Report does not correctly identify at least some of them. But the rankings appear very suspect, IMO.

I don't want to go back through the WHO study again, but I spent a fair amount of time on it then, and I was not particularly impressed with a large portion of it.

Dymanic

12th August 2009, 02:15 PM

Well according the link above (one would hope WHO is reliable, right?)...
Well, let's hope Ohsfeldt and Schneider are reliable, right? A couple of minor concerns, on a first pass.

Table 1-3, Comparison of Health Outcomes Relatively Insensitive to Health Care System Characteristics, 2000 Shows the U.S. ranked against five other countries on two outcomes (homicides and transport), but the vehicle deaths (at least) look cherrypicked if you compare the results with those listed, say, here:
http://www.nationmaster.com/graph/hea_mot_veh_dea-health-motor-vehicle-deaths

Also, the title of the table says 2000, but the sources say 2004 and 2002 respectively. You could also skew the results a lot by cherrypicking data from different years.

And though it may seem like a quibble, at the bottom of that table, it says "NOTE: Death rate per 1,000" -- but it's not; it's per 100,000. Those extra zeros are important, and though it may just be a typo, it doesn't speak highly of the authors' attention to detail, a highly desireable quality when performing this type of calculation.

Dymanic

12th August 2009, 02:17 PM

How is life expectancy a useful metric in this conversation?
In the context of the broader discussion, it's useful mainly because it's convenient. There are other metrics, but you can only split a thread so many times.

Is there some inherent value to keeping people alive, regardless of that quality of life?For the reason I just mentioned, I don't think we need to get into that here.

stup_id

12th August 2009, 02:44 PM

I just had to make some comments on this pieces (for background info i'm an MD, have visited and actually have close friends in the Health Care systems of Mexico, Spain, United Kingdom, France, Serbia, Turkey, Canada and some other countries after have worked for an International Organisation).

The US also has higher infant mortality rates lowering the life expectancy ranking. But 2007 study by Baruch College economists June and David O"Neill showed why U.S. infant mortality rates are higher ... more low weight births than other countries ... in part because we have significantly more teens having babies. Low birth weight significantly increases an infant's chance of dying. Thus lowering life expectancy statistics.

If you had a comprehensive Health Care system you'd be aware that Teen pregnancy and low weight births are indeed competences of the Health Care providers, Universal Health Care systems elsewhere (for instance in Spain) have the responsability of providing assesment and proper treatment (yes, even abortions.. OMG) about reproductive issues, so as it may not seem to you teen pregnancy and low weight babies in an inclusive Health Care System are completely related. For instance (and I'm aware it lies in the boundaries of ethics for some people) in Serbia, there's a program from government implemented by the neurology department at belgrade, of finding out which people carry the Huntington disease traits in their genome, those within reproductive age and who desire can not only get paid treatment but also are eligible of having free early fetal diagnosis of the disease and the option of aborting the product as many times as necesary to have a healthy baby.

Finally relating to this, low weight birth is not medically a cause, it is a consequence of something, it can be malnourishment or a mother's disease and the extent at which teen pregnancy is relevant is not as much as you'd think, our "modern" standard views may tell us that a 15 years old girl is not prepared for pregnancy but truth is that a few generations ago that was the reproductive age, I wish I could back this up with studies about low weight in teen pregnancy, but you also have to take into account (or at least mention it) that medical attention plays a big role in low weight births, since a significant amount of early births can be prevented or even reverted in the Gynaecology department (google for delivery inhibition, and premature membrane rupture) to make your commentary honest you really have to at least mention it. For my personal experience (not much, just about a 150 births) I do recall low weight being more related to premature birth and I had about 50% of those procedures in girls younger than 17, also remember that post-natal care is also evalued within the child mortality rate and you cannot tell me that Health Care is not responsible for that.

Is it any wonder that Cuba beats the US in WHO's ranking ... especially since Cuba is a communist nation that the WHO methodology will naturally favor in it's indexes?

This sentence really warns me off that you might prefer debating over ideologies and political ulterior motives than accepting other peoples insight, experience and evidence into this topic, I try to be as honest as I can be to myself, and I can tell you that even that I'm a Healthcare profesional I would prefer practicing in Spain, France or UK better than dealing with the current US HealthCare system, I'd really be glad to be proven otherwise, and I'm trying to evaluate the arguments you support here, but if they stem of a partialistic view of things rooted in ideology then I guess it would be futile.

There are also more deaths from drug abuse in the US than in other countries. Drug use is not caused by a poor health care system.

Then again you seem to believe that simply stating things as apart is the whole truth, Drug use is not caused by a poor health care system, nobody debates that, but the outcome of Drug Abuse is indeed a competence of the Health care system, as I told you before in this post, in a comprehensive Health Care System, drug abuse and its rehabilitation fall into the responsabilities of a coordinated action within the Health care providers, and the mortality related to drug abuse (i'm guessing you mean OD not the violence that sometimes accompanies drug abuse) evaluates at least at some level the capabilities of the Health Care to asses emergencies.

Also, some ethnicities have naturally higher life expectancies too. For example, the Japanese, whether they are living in Japan, the US or Europe, have higher life expectancies than Europeans. In fact, people of Japanese descent living in the US have a higher life expectancy than do Japanese living in Japan. That should tell you something. People of African descent have lower life expectancy than people of European descent. Just about anywhere on earth. So the US, with a significantly higher population of such people than Europe, might be expected to have a lower overall life expectancy. Nothing to do with the health care system.

Then how do you explain the consistent life expectancy and almost every other statistical indicator raise that can be assesed in countries such as UK, Spain and France?, are you aware that in the last 15 years immigrant populations of African, Latin American people and Eastern Europe countries have almost doubled?, yet it doesn't seem to affect the data, we would expect at least a negative tendency. One should carefully ask if it is indeed true that this "ethnical differences" are as responsible for the differences in life expectancy in the US, or is the inequality of access to the Medical Care what makes most of the difference.

The whole point is that using life expectancy, like WHO did in their ranking, to determine which nation has the best health care system is bogus because life expectancy significantly depends on factors that are not related to the health care system. As pointed out in those sources, measures that truly reflect health system characteristics ... such as looking at cancer survival rates ... show that the US leads in health care, not lags as claimed by Obama's followers.

I will agree with you that life expectancy is not an ideal tool to assess the Health Care system, but I've given you the reasons why a lot of the factor that you undermine as not related to Health Care indeed are. Is it the fault of the WHO that a lot of those factors that you mention are not related to Health Care system in the US are indeed considered relevant to Health Care to most other industrialized countries in the world?

BTW I'm not an Obama follower, but what I can appreciate of all my travelling, research and work into the topic, I can see a lot of things I would like to you Americans to have regarding Health Care attention, seeing people denying that there is need for a change in your way to take care of your vulnerable people just bogs me out.

Segnosaur

12th August 2009, 03:00 PM

... For my personal experience (not much, just about a 150 births) I do recall low weight being more related to premature birth and I had about 50% of those procedures in girls younger than 17, also remember that post-natal care is also evalued within the child mortality rate and you cannot tell me that Health Care is not responsible for that.

Strangely enough, there may actually be a negative effect to improved neo-natal care and life expectency.

In the U.S., significant effort is made to get babies born prematurely to survive. Many however, do not, and this probably contributes to a decrease in the 'life expectency' statistics.

On the other hand, in other countries (such as Cuba, and some European countries), such medical intervention would not be attempted, and the death would be considered a "fetal death" rather than a live birth/death.

So, ironically, having a superiour system for handling premature births may actually harm the statistics.

http://www.skepticism.net/articles/2002/cuba-vs-the-united-states-on-infant-mortality/

jimbob

12th August 2009, 03:00 PM

BeAChooser:

You seem to be arguing that the lower life expectancy in the US is the result of the US gun laws, which I guess you support, and indicators that are generally considered to be linked with poverty: teenage pregnancy, obesity (to a lesser extent), low-birth weight, and race too.

EDIT: and drug-use

stup_id

12th August 2009, 03:15 PM

Strangely enough, there may actually be a negative effect to improved neo-natal care and life expectency.

In the U.S., significant effort is made to get babies born prematurely to survive. Many however, do not, and this probably contributes to a decrease in the 'life expectency' statistics.

On the other hand, in other countries (such as Cuba, and some European countries), such medical intervention would not be attempted, and the death would be considered a "fetal death" rather than a live birth/death.

So, ironically, having a superiour system for handling premature births may actually harm the statistics.

http://www.skepticism.net/articles/2002/cuba-vs-the-united-states-on-infant-mortality/

Interesting article indeed, I'd have to ask to some of my colleages in Spain and France about the guidelines they have regarding premature birth, having those fragile babies added to the mix might skew the data as for child mortality, what would be interesting to have is the child mortality due to lack of medical attention normalized within the total child mortality I think that indicator would be more more insightful... maybe when I get some spare time i'll look into it.

JoeTheJuggler

12th August 2009, 03:22 PM

The WHO judged a country's quality of health on life expectancy. But that's a lousy measure of a health-care system. Many things that cause premature death have nothing do with medical care. We have far more fatal transportation accidents than other countries.

The sentence I bolded is the problem. The "Overall Level of Health" was based on the disability-adjusted life expectancy but was itself not the sole criterion for their rankings of health care systems. Nor was it the sole criterion related to health outcomes (there was also the Distribution of Health in the Population).

And back to the issue of accidents, I still contend that mortality by accidents is, in part, a reasonable criterion for evaluating a health care system. Emergency services are an important part of the system.

For that matter the prevalence of accidents can even be seen as an outcome of the portion of a health care system related to education and public health. (As very simplistic examples: the AMA's position on seatbelt and helmet use or cigarette smoking, or public health departments promoting hand-washing and immunization programs.)

fls

12th August 2009, 04:00 PM

I remember seeing this exact same article posted before in the JREF forums. I had concerns about it before, and nothing that was discussed made me drop my concerns.

Edited to add: If anyone hasn't read the article, let me summarize: The authors went through a bunch of medical journals, and looked for articles that allowed them to compare the outcomes of patients in Canada and the U.S. If an article showed better results under the Canadian system, they 'awarded' the study to Canada. If an article showed better results under the American system, they 'awarded' the study to Canada. The results showed more studies showing superior outcomes under the Canadian system when compared to the American system.

I think there's a typo? If study outcomes showed a benefit to a US centre(s), then it counted as a study showing benefits to the US, not Canada.

The concerns that I had with this article:

- One of the primary authors (http://en.wikipedia.org/wiki/Gordon_Guyatt) has run multiple times for the NDP, the main 'Socialist' party here in Canada, and the party most opposed to any privitization of health care. Guyatt may have done valuable research in the past, but that doesn't mean that each and every claim made by him should be accepted at face value, especially when the line between true medical science and politics can get blured.

That is why I referenced published study results, rather than an opinion piece from one of the authors. I don't know the political affiliation of the other 16 authors.

- This is a meta-study. I'm always suspecious of such studies, regardless of topic... How do you know that they didn't just happen to stumble upon (either by accident or purpose) those studies that actually prove their point? They claim to have taken steps to prevent their researchers from bias, however, the fact is that they're still taking a sample of a sample (giving a smaller pool from which to draw results, making it more prone to errors).

Exactly. Which is why there are strict criteria to follow when finding and selecting the studies.

- Much of the basis for the claims made in the article (that the U.S. does not have a better medical system) is based on the number of studies showing improved outcomes in Canada. Yet if you look at the studies favouring Canada (Table 3), you'll see that many of their studies are basically repetitions... For example, it points to 5 studies showing Canada's health care system is better at handling renal failure than the U.S. But they're 5 studies showing the same thing! Even if Canadian patients were better treated for renal failure than the American counterparts, the fact that 5 studies repeated the same thing gave more weight to the pro-Canada side than it deserved.

I'm not sure why you think that their claim is based on the number of studies, as it isn't. If they had wanted to, they could have claimed superiority for Canada, given that there were more studies which demonstrated superiority (even if you group them by disease), and that the meta-analysis showed a statistically significant benefit. That they did not do so reflects their caution in drawing conclusions. However, if they didn't find it reasonable to draw conclusions about the superiority of Canada's outcomes, it would have to be even more unreasonable to then attempt to conclude that the US was superior.

At the very least, the study should have divided the studies into disease categories...

- Very little effort is made to relate the success of treating certain diseases with improved mortality/quality of life. Thus, in that study, a disease that affects only a tiny number of people (such as AIDS) is given as much weight as a diseases that kills a relatively high number of people (such as heart disease).

But that would be answering a different question than the one that was asked. It's usually considered reasonable for a study to answer the question that was asked, rather than answering a different question. :)

- In addtion, I had problems with certain individual studies. For example:
* One study showing better results in Canada was restricted to only low income
patients. But if you're trying to analyse the OVERALL health care system, you
can't very ignore what could be a huge portion of your population

As was mentioned in the discussion, there is a strong association between socio-economic status and health. It makes sense to look at indicators which are sensitive to health status. Also, you seem to be suggesting that individual studies be excluded on the basis of arbitrary criteria. Aren't you attempting to do just what you suggested earlier would invalidate the results?

* Once study dealt with AIDS; however, success in handling HIV may be due
more to patent law than the quality of health care.

You'd better not let Beerina hear you say that. :)

Linda

Rolfe

12th August 2009, 04:56 PM

I remember that thread too. As I recall, we agreed to call it a fair fight and merely to state that the US outcomes were "no better" than other countries.

It's not just straight life expectancy though, it's infant mortality and a bunch of other things.

I think I'll leave this to Linda, it's not my area of expertise.

Rolfe.

UNLoVedRebel

12th August 2009, 06:38 PM

So, I ask myself, why aren't we seeing any figures to back up the homicide/vehicle death claim? Are we just to take Stossel's word for it?
If you've ever been to California, you wouldn't be asking for statistics. It'd be understood.

bpesta22

12th August 2009, 06:59 PM

I have data at the state level that may (or may not) be interesting:

The % gunowners in each state correlates:

.76 (huge!) with the % of votes cast for McCain,
-.25 with violent crime,
.00 with state IQ,
.36 with poverty rates,

.37 with divorce rates
.42 with teen pregnancy rates,
.32 with rape rates
-.67 with the % of state residents with BA degrees,

.54 with the % of protestants in a state,
-.22 with the % of godless people in a state,
.43 with how religious the state is,
.33 with smoking rates,

-.26 with the starbuck's to walmart ratio in a state,
-.42 with income inequality (gini coefficient).

UNLoVedRebel

12th August 2009, 07:03 PM

bpesta22

12th August 2009, 07:03 PM

Hmm...
Well, the CDC has motor vehicle traffic deaths in the U.S. at around 43,000 for 2008 (14.6 per 100,000 population), and firearm deaths at around 30,000 (10.3 per 100,000 population). The total death rate: 810.4 deaths per 100,000. I don't easily find sources I like with recent numbers from other countries, particularly for homicides, but the OECD median for motor vehicle looks to be 9.3 per 100,000. That's certainly better than in the U.S., but it looks like you'd have to monkey with the numbers pretty heavy (cherry pick the years or something) in order to get it to skew life expectancy by very much. I could be wrong.

At the state level:

% gun ownership correlates:
.61 with traffic death rates (pretty smegging large), but
-.07 with drunk driving deaths, and
.31 with the % of people who drive solo to work and
-.69 with the % of active physicians.

BeAChooser

12th August 2009, 11:19 PM

Table 1-3, Comparison of Health Outcomes Relatively Insensitive to Health Care System Characteristics, 2000 Shows the U.S. ranked against five other countries on two outcomes (homicides and transport), but the vehicle deaths (at least) look cherrypicked if you compare the results with those listed, say, here:
http://www.nationmaster.com/graph/he...vehicle-deaths

Just because they only named Canada, Germany, Japan, Sweden and the UK in Table 1-3 doesn't mean they cherry picked anything. France, Belgium, Italy, Ireland and any other country you probably think they should have included in Table 1-3 (which, by the way, was probably put there just to show some examples) were in fact included in their analysis as clearly indicated by Table 1-5. There was no cherrypicking that I can see. :D

Also, the title of the table says 2000, but the sources say 2004 and 2002 respectively.

It isn't unusual for reports to use the latest available data which may be from years earlier than the publish date. And if you think these authors cherrypicked the data by not using more recent data, then by all means, prove to us that data of this type was put out in a more recent WHO report than the one in 2004.

And though it may seem like a quibble, at the bottom of that table, it says "NOTE: Death rate per 1,000" -- but it's not; it's per 100,000. Those extra zeros are important, and though it may just be a typo, it doesn't speak highly of the authors' attention to detail, a highly desireable quality when performing this type of calculation.

Noted. But can you prove they actually used 1000 in the calculations? I haven't seen any claims of that by critics in the various reviews of their work.

And by the way .... in the same vein ... what does Obama's claiming that through his efforts the expected cumulative 10 year debt increase has gone from $9.3 trillion to $7.1 trillion (a savings of $2.2 trillion) ... which I've proven is absolutely and completely false based on what the March CBO report states ... say about Obama and his staff's reading comprehension and attention to detail? :D

BeAChooser

13th August 2009, 12:22 AM

If you had a comprehensive Health Care system you'd be aware that Teen pregnancy and low weight births are indeed competences of the Health Care providers, Universal Health Care systems elsewhere (for instance in Spain) have the responsability of providing assesment and proper treatment (yes, even abortions.. OMG) about reproductive issues

But whether a teen gets pregnant in the first place and decides to have the baby instead of an abortion is clearly more influenced by culture and other societal factors than the presence of UHC. You seem to be under the mistaken impression that health issues aren't taught in US schools or by US doctors, that US teens have no exposure to advertising designed to encourage wise choices, that they have no ability to get contraceptive advice and devices, that they have no ability to get free abortions even without parental consent, that they get no help if they are pregnant and decide to keep the child. Nothing could be further from the truth. You are just spinning to avoid the fact that life expectancy stats are in fact influenced by infant mortality rates that are NOT purely a function of the adequacy of the health care system.

Finally relating to this, low weight birth is not medically a cause, it is a consequence of something,

It is both a consequence and a cause. In 15 years olds, it can be a consequence of the girl's small stature. And low weight can be the cause of the baby's subsequent non-viability.

More important, there are different standards as to what is reported as a case of infant mortality between countries. The US reports many cases that other countries never even consider a viable person. In other words, they don't count that death in their mortality rates because they don't consider that child as ever having been alive. A 2006 article in U.S. News & World Report said "The United States counts all births as live if they show any sign of life, regardless of prematurity or size. This includes what many other countries report as stillbirths. In Austria and Germany, fetal weight must be at least 500 grams (1 pound) to count as a live birth; in other parts of Europe, such as Switzerland, the fetus must be at least 30 centimeters (12 inches) long. In Belgium and France, births at less than 26 weeks of pregnancy are registered as lifeless. And some countries don't reliably register babies who die within the first 24 hours of birth. Thus, the United States is sure to report higher infant mortality rates. For this very reason, the Organization for Economic Cooperation and Development, which collects the European numbers, warns of head-to-head comparisons by country."

I'm trying to evaluate the arguments you support here, but if they stem of a partialistic view of things rooted in ideology then I guess it would be futile.

So are you trying to claim that the WHO ranking system is ideology free? Or that anything I noted about Cuba is wrong? :D

Drug use is not caused by a poor health care system, nobody debates that, but the outcome of Drug Abuse is indeed a competence of the Health care system

Drug users have a nasty habit of not using a health care system even if it's free. Except perhaps as a way to score free drugs. They have a nasty habit of ruining their bodies in a variety of ways. And the fact remains that the US has a more serious drug problem than many UHC countries and that translates into increased serious medical problems leading to death ... many of which even the best health care system couldn't prevent. Which means life expectancy statistics affected by this factor may not be a reliable indicator of the health care systems quality.

as I told you before in this post, in a comprehensive Health Care System, drug abuse and its rehabilitation fall into the responsabilities of a coordinated action within the Health care providers, and the mortality related to drug abuse

You seem to be under the mistaken impression that none of that goes on in the US. That when someone suffers an overdose, no help arrives. That they are just left to die on the streets. Nothing could be further from the truth. IF there is more reticence on the part of drug users to seek medical care in the US, that's not a reflection of the medical system but the laws against drug use ... which may differ from those in Europe.

Originally Posted by BeAChooser
Also, some ethnicities have naturally higher life expectancies too. For example, the Japanese, whether they are living in Japan, the US or Europe, have higher life expectancies than Europeans. In fact, people of Japanese descent living in the US have a higher life expectancy than do Japanese living in Japan. That should tell you something. People of African descent have lower life expectancy than people of European descent. Just about anywhere on earth. So the US, with a significantly higher population of such people than Europe, might be expected to have a lower overall life expectancy. Nothing to do with the health care system.

Then how do you explain the consistent life expectancy and almost every other statistical indicator raise that can be assesed in countries such as UK, Spain and France?

I'm unclear what you are asking here.

are you aware that in the last 15 years immigrant populations of African, Latin American people and Eastern Europe countries have almost doubled?

So what. European countries still, as a percent of total population, have a much smaller segment of the population who are black than America. Over 13 percent of the US population is black. In 2006 they were only 3 percent of the UK population. France and Germany are both about 8 percent black. So if the life expectancy of black people is genetically disposed to be lower than other ethnic groups, the US life expectancy will be lowered in comparison to the UK, France and England as a result. Nothing to do with the health care system.

yet it doesn't seem to affect the data, we would expect at least a negative tendency.

Not when the black population is still only a small portion of the population. It just means your life expectancy will grow slower than it might have otherwise. But you still started from an higher baseline life expectancy relative to ours because you did not have the same percentage of blacks as the US. And you still don't.

or is the inequality of access to the Medical Care what makes most of the difference.

Or it could be that blacks do not engage in as many beneficial behaviors as whites. Older blacks engage in less physical activity than older whites. They are more likely to be obese. They are more likely to still be smoking if they ever smoked.

I can see a lot of things I would like to you Americans to have regarding Health Care attention

And there are a lot of things I'd like to see you Europeans have and do differently. But C'est la vie. :D

Dymanic

13th August 2009, 06:59 AM

Just because they only named Canada, Germany, Japan, Sweden and the UK in Table 1-3 doesn't mean they cherry picked anything. France, Belgium, Italy, Ireland and any other country you probably think they should have included in Table 1-3 (which, by the way, was probably put there just to show some examples) were in fact included in their analysis as clearly indicated by Table 1-5. There was no cherrypicking that I can see.I'll split the difference with you there. I agree that Table 1-3 was presented as a sample of the data used in the analysis, but it was a pretty biased sample; of the top 17 countries for vehicle, they didn't include a single one of the top 9 besides the U.S.; of the ones they did include, all but one (Germany, #10) are at the very bottom (and the UK isn't even among the top 17). So they very obviously cherrypicked what they showed in that chart. That alone suggests a bias which causes me to question their ability to objectively analyze the data.

It isn't unusual for reports to use the latest available data which may be from years earlier than the publish date. And if you think these authors cherrypicked the data by not using more recent data, then by all means, prove to us that data of this type was put out in a more recent WHO report than the one in 2004.I understand that -- one of the first things I ran into is that the most recent data on vehicle deaths isn't always from the same year as the most recent data on homicides, or the data from one country isn't always from the same year as that from another, so you often find yourself forced to select the data. I suspect that the outcome of the analysis could be influenced quite a bit by the way that selection was performed.

But can you prove they actually used 1000 in the calculations?I'm not suggesting that they did -- but your question raises another point; perhaps the most salient one: we can't actually see their work, can we?

Having said all that, it does seem reasonable that discrepancies in rates of these kinds of deaths between the U.S. and other OECD countries do make life expectancy a weak indicator of quality of health care; wondering why it never occurred to me before, in fact. I can agree with this:

"Cannot reliably conclude U.S. system performance “on average”is markedly worse than other large, high-income nations with diverse populations."

Segnosaur

13th August 2009, 09:00 AM

Edited to add: The authors went through a bunch of medical journals, and looked for articles that allowed them to compare the outcomes of patients in Canada and the U.S. If an article showed better results under the Canadian system, they 'awarded' the study to Canada. If an article showed better results under the American system, they 'awarded' the study to Canada.
I think there's a typo? If study outcomes showed a benefit to a US centre(s), then it counted as a study showing benefits to the US, not Canada.

Yeah, you're right, it was a typo.

The concerns that I had with this article:

- One of the primary authors (http://en.wikipedia.org/wiki/Gordon_Guyatt) has run multiple times for the NDP, the main 'Socialist' party here in Canada, and the party most opposed to any privitization of health care. Guyatt may have done valuable research in the past, but that doesn't mean that each and every claim made by him should be accepted at face value, especially when the line between true medical science and politics can get blured.
That is why I referenced published study results, rather than an opinion piece from one of the authors.

The peer-review process is the best method we have for disseminating scientific knowledge, but it is not a perfect process. Mistakes do get made.

I don't know the political affiliation of the other 16 authors.

Well, at least two of them (Lexchin, Yalnizyan) has written for the Canadian Center for Policy Alternatives, a 'left wing' think tank. Another 2 of them (Himmelstien, Wollhandler) are American doctors who were pushing for a single-payer Universal health care system in the U.S.

And that's just a quick check. I haven't found any sort of indication that any of the authors had either 'conservative' leanings, or favoured for-profit private sector health care.

Exactly. Which is why there are strict criteria to follow when finding and selecting the studies.

As I pointed out before, that 'strick criteria' were not part of the published studies.

Also, AND MORE IMPORTANTLY, the fact that this study involves selecting only a handful of articles from THOUSANDS of possibilities leads to a higher probability that, just by chance, they selected the articles that prove their point.

Its kind of like tossing a coin... if you toss a coin 100 times, you're pretty assured that you'll get a good chance of heads and tails appearing roughly the same number of times. But if you then take those 100 coin tosses, and select only 3 of those tosses, you could very well find that you've picked the 3 cases where those coin tosses all ended up heads.

I'm not sure why you think that their claim is based on the number of studies...

How about the fact that they publish a table specifically counting the number of studies 'in favour' of each country's medical system, AND devote several paragraphs to it.

- Very little effort is made to relate the success of treating certain diseases with improved mortality/quality of life. Thus, in that study, a disease that affects only a tiny number of people (such as AIDS) is given as much weight as a diseases that kills a relatively high number of people (such as heart disease).
But that would be answering a different question than the one that was asked. It's usually considered reasonable for a study to answer the question that was asked, rather than answering a different question. :)

And what exacty is the question do you think it was supposed to have asked? "Can a bunch of biased researchers find articles that proves their point"?

As was mentioned in the discussion, there is a strong association between socio-economic status and health. It makes sense to look at indicators which are sensitive to health status.

But if you're using this as evidence about how well a helth care system works, you have to consider how it works for EVERYBODY.

Once study dealt with AIDS; however, success in handling HIV may be due
more to patent law than the quality of health care.
You'd better not let Beerina hear you say that. :)

Not saying the Canadian patent system is better or worse... Canada basically made a 'deal' with drug companies to make pharmicuticals cheaper here. (Otherwise, Canada may have decided to just ignore patent laws, and the drug companies would be out even MORE money.) I figured the big drug companies use their big profits that they make off U.S. patients as their main income, while anything earned from other countries is just an added bonus.

It could be argued that if the U.S. government did the same thing (i.e. force drug companies to lower their prices, or risk loosing all patent protection) then its possible that companies would reduce their research and development, since they would have less chance to obtain any profit.

BeAChooser

13th August 2009, 11:06 AM

I'll split the difference with you there. I agree that Table 1-3 was presented as a sample of the data used in the analysis, but it was a pretty biased sample

Again. Can you show that actually affects the final results ... which did include seven of the top ten? You can call that sample "cherry picked" but I could suggest you are *nit picking* in an effort to find *anything* with which you can attack the reality that small differences in life expectancy aren't all that good a measure of the difference in quality between health care systems.

And say ... perhaps your 2002 source for the data (GECD) isn't the end all in data? Here's another list, not just for motor vehicle accidents but for all transport related deaths: http://www.medicine.ox.ac.uk/bandolier/booth/Risk/trasnsportpop.html . It apparently uses 2004 data from what would appear to be very credible sources. It lists the following crude transport related mortality rates per 100,000 population:

US 16.14
UK 5.94
France 8.89
Germany 7.38
Spain 12.38

Notice that France's mortality isn't nearly as high as it is in your table and Spain, which isn't even listed on your table, apparently should be. But both are still significantly less than the US rate.

In any case, I'm sure someone on the WHO side of this issue would have rerun the calculation made by the Ohsfeldt and Schneider and published their results by now ... if they actually could show a different result than what O&S found. But all I hear is {crickets}. :D

And by the way, I notice that the OECD also has 2008 data on obesity, as a percentage of the adult population (http://stats.oecd.org/Index.aspx?DataSetCode=HEALTH# ):

US 32
Belgium 12.7
France 9.4
Japan 3.0
Luxembourg 17.1
Netherlands 10.9
Sweden 9.8
UK 23.0

Clearly, Americans are significantly more obese than people in UHC countries. And recent studies show that obesity has a very strong impact on life expectancy. For example:

http://www.sciencedaily.com/releases/2009/03/090319224823.htm

ScienceDaily (Mar. 20, 2009) — A new analysis of almost one million people from around the world has shown that obesity can trim years off life expectancy.

The Oxford University research found that moderate obesity, which is now common, reduces life expectancy by about 3 years, and that severe obesity, which is still uncommon, can shorten a person’s life by 10 years.

So again, we find a factor that isn't just a function of the health care system that makes using small differences in life expectancy between countries useless as a measure of the relative quality of the health care systems. :D

I suspect that the outcome of the analysis could be influenced quite a bit by the way that selection was performed.

You appear to be accusing the authors of deliberately manipulating the study. That's a serious accusation. Since I haven't found anything in the literature to suggest they did that, I think you should prove that claim before going further with this. Otherwise, we might conclude you are grasping at straws to avoid facing the reality that life expectancy was a very poor measure on which to base health care system rankings.

I'm not suggesting that they did -- but your question raises another point; perhaps the most salient one: we can't actually see their work, can we?

Sure you can. Contact the authors. I'm certain they would be glad to describe in detail what they did. I haven't heard anyone claim the authors have been withholding their work for review. In fact, I believe they published a book with considerable detail in it. Nothing is stopping you or others from going out and buying it then reduplicating their analysis using your own set of data.

Having said all that, it does seem reasonable that discrepancies in rates of these kinds of deaths between the U.S. and other OECD countries do make life expectancy a weak indicator of quality of health care; wondering why it never occurred to me before, in fact. I can agree with this:

"Cannot reliably conclude U.S. system performance “on average”is markedly worse than other large, high-income nations with diverse populations."

Good. It is reasonable which is why I find the continued mention of the WHO rankings as proof the US health care system is inferior so frustrating ... in a forum filled with so-called skeptics. :D

Marc39

13th August 2009, 01:53 PM

that hasnt to do with UHC, its just that chips n fish are healtier but less tastefull than a tripple whopper with freedomfries. :rolleyes:

Maybe, maybe not, depending on the amount of oil/fat infusing the fish. Plus, unless the fish is caught wild, vis-a-vis farm-raised (most fish consumed today is farm-raised), you are likely ingesting pollutants, growth hormones, antibiotics and coloring agents along with the fish.

Toke

13th August 2009, 02:07 PM

It is strange, I have been in England (Felixstowe) repeatedly, but never found a place that could make good fish&chips.:D

13th August 2009, 02:23 PM

It is strange, I have been in England (Felixstowe) repeatedly, but never found a place that could make good fish&chips.:D

because the only brit that can cook is Jamie Oliver.

:boxedin:

Marc39

13th August 2009, 02:29 PM

It is strange, I have been in England (Felixstowe) repeatedly, but never found a place that could make good fish&chips.:D

Best to avoid the pubs and go to places that only do fish. Brady's is the place for fish & chips...

http://www.bradysfish.co.uk/

jimbob

13th August 2009, 02:39 PM

Back On topic:

Obeisty, violence, drug-use, teenage pregnancies, and low birthweight, are all correlated with poverty.

All the supposed confounding factors that BeAChooser has mentioned, could be argued to be symptoms of grosser inequality than other OECD countries. Teenage pregnancies are certainly targeted by successfull health and social welfare systems.

What about the examples that Rolfe posted where people in the US were refused treatment because of their economic status?

What about Ducky's story?

What about the 2-million medical bankruptcies a year, 75% of which originally had insurance, but which was inadequate?

Talking about who would and wouldn't have a chance in various healthcare systems, I posted about this on another thread.

Here is the link to the article. (http://crooksandliars.com/susie-madrak/we-already-have-death-panels-if-you-c) These individual stories are all from that article (the first one), or the subsequent comments.

You have no idea what it’s like to be called into a sterile conference room with a hospital administrator you’ve never met before and be told that your mother’s insurance policy will only pay for 30 days in ICU. You can't imagine what it's like to be advised that you need to “make some decisions,” like whether your mother should be released “HTD” which is hospital parlance for “home to die,” or if you want to pay out of pocket to keep her in the ICU another week. And when you ask how much that would cost you are given a number so impossibly large that you realize there really are no decisions to make. The decision has been made for you.

My best friend from High School, Joel, died of kidney failure 6 years ago. I was out of touch with him and had no idea he was ill. I get back home and I hear he is about gone. We needed $7000 to keep him alive. I had $2000 in the bank. We started going door to door. he died the next morning.

He used to work in the hospital that turned him away.

My brother lost his job and his health insurance.
He has been diagnosed with COPT.
He won't qualify for public aid for another year. He applied for SS disability a year ago and his lawyer told him it will be another two years. By then - without care - he could be dead.
This is government bureaucrats deciding to let my brother die.

treatment for cancer. It is very expensive. Fortunately, we have Medicare and a good coinsurance from my husband's 40 years as a union employee. Even with that some treatment was denied by the co-insurer. Hopefully, all will turn out ok anyway. I asked someone in the billing department of the oncology department what happens when people without insurance have this disease. She said they are in bad shape, since there is a limited amount of charity care at most hospitals. So,friends, the death panel is in full swing. It's just got a different name....the uninsured.

A friend of mine, married, employed (but no beautiful employer insurance), and mother of a teenaged daughter, was suffering from a severe, debilitating disorder that had her bedridden. She is too poor to afford private insurance (though as a pre-existing condition, it probably wouldn't be covered anyway), and not quite poor enough to qualify for Medicare, so short of literally making her family poorer to qualify her only option was to wait until she was having difficulty breathing so could go to the ER where they can't turn her away.

$500,000+ of open-heart surgery later, they tossed her out of the hospital four days later because she couldn't afford to stay. It's obviously impossible for her to pay this bill, so I can only assume they will have to declare bankruptcy.

Of course, it wouldn't have cost $500,000 if she'd been able to go to the doctor and get a proper diagnosis and surgery a year or two earlier, but--hey--can't afford to pay for that, too bad!

Now, a follow-up surgery is going to be required if she's actually to, you know, go on living. Except she can't get that, because she can't pay for it. And it's not like you can use the "ER loophole" to schedule surgery.

There's your damn death panel.

I was in the same situation three years ago, and I'm born and raised a US citizen. Bedridden, unable to work, about to lose my insurance, slowly wasting away, and Blue Cross (now Anthem) refused to pay for expensive diagnostic tests or continued interim treatment to keep me alive. My options were A) Use my life savings to pay for the tests myself. Or B) Move to Japan where my wife is originally from where they would cover the tests and treatment.

How long is it going to take the US people to wake up to the fact that this simply doesn't happen in any other civilised country?

Rolfe.

Marc39

13th August 2009, 02:44 PM

Back On topic:

Obeisty, violence, drug-use, teenage pregnancies, and low birthweight, are all correlated with poverty.

Most of those issues "correlate" to some of the wealthiest families I know. French food is very fattening.

bpesta22

13th August 2009, 03:12 PM

One thing that's clear; everything is an intercorrelated mess. In fact, one can create subdomains of well being (crime, health, income, etc) and then show that these factor into a single general factor of well-being.

Getting at which variables in the nexus are causal would be pretty hard to do.

jimbob

13th August 2009, 03:16 PM

Most of those issues "correlate" to some of the wealthiest families I know. French food is very fattening.

I thought I was stating something as controversial as "rain falls from the sky"...

However:

http://www.google.com/search?client=opera&rls=en&q=correlation+obesity+poverty&sourceid=opera&ie=utf-8&oe=utf-8

http://goliath.ecnext.com/coms2/gi_0199-6227596/Correlation-between-high-risk-obesity.html

Article Excerpt
Objective: Obesity is a major health problem among children and adolescents which is potentially affected by socioeconomic status (SES). The high risk group (HRG) comprises those youths with a body mass index (BMI) between the 85th and 95th percentile (at risk for overweight) and [greater than or equal to]95th percentile (overweight). We sought a potential link between the HRG and SES.

Methods: Public schools in Chesterfield County, Virginia measured BMI among students in kindergarten and third, seventh, and tenth grades. We assessed SES based on eligibility for the National School Lunch Program and the percentage of the school-age population living in poverty based on per capita income from the 2000 Census.

Results: From 28 to 38% of children and adolescents were in the high risk group. Low SES had robust and highly significant correlations with HRG status with r-values ranging from 0.565 to 0.842, P < 0.0001.

Conclusions: Low SES appears to be an important factor in childhood and adolescent obesity.

http://scholar.google.com/scholar?client=opera&rls=en&q=correlation%20teenage%20pregnancy%20poverty%20&sourceid=opera&oe=utf-8&um=1&ie=UTF-8&sa=N&hl=en&tab=ws

http://www.popline.org/docs/1036/093680.html

Abstract:

Adolescent pregnancy or sexually transmitted disease (STD) reduction has not occurred, despite sexuality education and abstinence programs, and intensive publicity and community initiatives. An obstacle to adolescent pregnancy, STD, and childbearing prevention is the assumption that adolescent sexuality is a closed system of activity among peers. When a nation is consumed with the preoccupation of condoms versus chastity debates, and is ignoring high poverty levels and abuse of the young, adolescent girls will seek escape from harsh childhoods in early family formation with young adult men. There is a high correlation between poverty rates and teenage birth, AIDS, and STD rates. Schools are not able to produce magical solutions to teenage pregnancy when adult lawmakers abnegate their responsibility to provide for youth well-being. Adolescent pregnancy will occur regardless of the expansion of curative programs such as school-based clinics; fundamental changes in assumptions, attitudes, and policies are needed. Beneficial aspects of programming appear to be fact-based sexuality and contraceptive education, counseling and referrals for youths with histories of child abuse, and child care classes and flexible school schedules for parenting students.

EDIT: I can't be bothered to spend any more time googling at the moment... Maybe later.

Marc39

13th August 2009, 03:44 PM

Gregoire

13th August 2009, 06:38 PM

:rolleyes:I just had to make some comments on this pieces (for background info i'm an MD, have visited and actually have close friends in the Health Care systems of Mexico, Spain, United Kingdom, France, Serbia, Turkey, Canada and some other countries after have worked for an International Organisation).

If you had a comprehensive Health Care system you'd be aware that Teen pregnancy and low weight births are indeed competences of the Health Care providers, Universal Health Care systems elsewhere (for instance in Spain) have the responsability of providing assesment and proper treatment (yes, even abortions.. OMG) about reproductive issues, so as it may not seem to you teen pregnancy and low weight babies in an inclusive Health Care System are completely related. For instance (and I'm aware it lies in the boundaries of ethics for some people) in Serbia, there's a program from government implemented by the neurology department at belgrade, of finding out which people carry the Huntington disease traits in their genome, those within reproductive age and who desire can not only get paid treatment but also are eligible of having free early fetal diagnosis of the disease and the option of aborting the product as many times as necesary to have a healthy baby.

Finally relating to this, low weight birth is not medically a cause, it is a consequence of something, it can be malnourishment or a mother's disease and the extent at which teen pregnancy is relevant is not as much as you'd think, our "modern" standard views may tell us that a 15 years old girl is not prepared for pregnancy but truth is that a few generations ago that was the reproductive age, I wish I could back this up with studies about low weight in teen pregnancy, but you also have to take into account (or at least mention it) that medical attention plays a big role in low weight births, since a significant amount of early births can be prevented or even reverted in the Gynaecology department (google for delivery inhibition, and premature membrane rupture) to make your commentary honest you really have to at least mention it. For my personal experience (not much, just about a 150 births) I do recall low weight being more related to premature birth and I had about 50% of those procedures in girls younger than 17, also remember that post-natal care is also evalued within the child mortality rate and you cannot tell me that Health Care is not responsible for that......

Thank you for the points you have made.

However, you are assuming a lot with your statements. You are assuming that a pregnant teen actually goes to a healthcare provider prior to delivery. In my discussions with OB GYN's and public health professionals, I learned the biggest risk of infant mortality is lack of prenatal care.

Now why don't teens go to seek care before delivery? The OB GYN residents I talked to in one city told me it was NOT because of no access to care. They stated they saw large numbers of Medicaid patients who had their healthcare paid for by the government who did the right thing and came in for care when they were supposed to. These teens certainly would have qualified for Medicaid, but many of the teens told the residents they just didn't think they needed to (even after being told to do so during a previous delivery.)

Obviously, this is a complicated story and so there will never be only one answer. I'm sure there were plenty of teens who just simply did not understand.

But still, is that all the fault of the healthcare system? I guess it depends on your definition of the term "healthcare system". I mean some here seem to think our high incidence of obesity indicates a problem with the "US healthcare system".

In France, they pay women to show up for their prenatal appointments? Is this a good strategy? Would this have unintended consequences?

But then how far do you go? I don't think it is simply a matter of education.......America's obesity problem could be helped if the government banned the selling of junk food and outlawed cigarettes. Manditory exercise would probabably help too... anyone want to ban restaurants from having a drive-thru ....... :rolleyes: /sarcasm

BeAChooser

13th August 2009, 08:33 PM

Obeisty, violence, drug-use, teenage pregnancies, and low birthweight, are all correlated with poverty.

But which came first? You seem to be suggesting that those things result from poverty but I suggest it's just the opposite ... that decisions regarding those things ... how much and what you eat, how much you exercise, whether you take the easy road and steal as a source of income or get an education and work your way up, whether you take drugs, whether you waste your money on vices and the now instead of saving for the future, whether you have teenage or out of wedlock sex, whether you use protection, etc. etc. etc. ... cause you to become or remain poor. And for the most part, they have nothing to do with the quality of the health care system. They are a matter of personal responsibility.

All the supposed confounding factors that BeAChooser has mentioned, could be argued to be symptoms of grosser inequality than other OECD countries.

GARBAGE. For all the supposed unfairness in the United States, I haven't heard that Americans are burning hundreds of cars a night much of the year ... as they are in France.

And for all the supposed equality in OECD countries, poverty rates are almost as large as they are in the US in many instances. For example, according to

http://en.wikipedia.org/wiki/List_of_countries_by_percentage_of_population_livi ng_in_poverty

here are the percentage of people in the US and various OECD countries living below the poverty line:

United States - 12-13 percent
United Kingdom - 14 percent
France - 6 percent
Germany - 11 percent
Belgium - 4 percent
Canada - 10-11 percent
Ireland - 7 percent
Spain - 20 percent

And those OECD figures probably look better than they really are in comparison to the US simply because OECD countries do not have anywhere near the problem with illegal immigration that the US does ... and most illegal immigrants are dirt poor. Remember, 2.6 to 6.6 percent of the US population is comprised of illegal immigrants (http://www.npr.org/templates/story/story.php?storyId=5365863 ). But only 0.3 to 0.6 percent of France's population is made up of illegal immigrants (http://news.bbc.co.uk/1/hi/world/europe/4537455.stm ). That alone might account for the difference between our two countries poverty rate. And only 1.2 percent of the German population is made of illegal immigrants. If they had 2.5 to 6 times as many so they were comparable to us, Germany might even have a higher poverty rate than the United States. These facts demolish your claim.

fls

14th August 2009, 06:32 AM

The peer-review process is the best method we have for disseminating scientific knowledge, but it is not a perfect process. Mistakes do get made.

So what? Unless you are suggesting that this process is more likely to have broken down when it involves studies whose results you don't like...

Well, at least two of them (Lexchin, Yalnizyan) has written for the Canadian Center for Policy Alternatives, a 'left wing' think tank. Another 2 of them (Himmelstien, Wollhandler) are American doctors who were pushing for a single-payer Universal health care system in the U.S.

And that's just a quick check. I haven't found any sort of indication that any of the authors had either 'conservative' leanings, or favoured for-profit private sector health care.

It is difficult to find Canadian doctors who work within this field who favour for-profit private sector health care. :)

As I pointed out before, that 'strick criteria' were not part of the published studies.

The authors spend about a third of the paper outlining the procedure that is recommended for systematic review and then detailing how they followed those criteria - all done while blinded as to whether or not the specific studies would support any particular bias they may or may not have (which is also part of the criteria).

Also, AND MORE IMPORTANTLY, the fact that this study involves selecting only a handful of articles from THOUSANDS of possibilities leads to a higher probability that, just by chance, they selected the articles that prove their point.

They selected all the studies that were relevant to the question, not a sample of those studies. And again, the reviewer was blind as to the study result when figuring out whether the study was relevant to the question.

Its kind of like tossing a coin... if you toss a coin 100 times, you're pretty assured that you'll get a good chance of heads and tails appearing roughly the same number of times. But if you then take those 100 coin tosses, and select only 3 of those tosses, you could very well find that you've picked the 3 cases where those coin tosses all ended up heads.

You have an equal chance of picking the 3 cases where those coin tosses all ended up tails. Unless you think that chance favours a particular bias, this criticism is irrelevant. Let's say that the 3 cases you picked out were the results where the coin happened to land on the ground instead of the table. Unless you think that coins that land on the ground are more likely to be heads a priori, you haven't found a way to bias the results.

How about the fact that they publish a table specifically counting the number of studies 'in favour' of each country's medical system, AND devote several paragraphs to it.

It is reasonable to expect them to present the specifics of their results. It would be quite odd if they hadn't provided the numbers, or if they hadn't gone through the numbers in detail. It certainly doesn't mean that they were trying to convey some subtle message that contradicted what they said explicitly.

And what exacty is the question do you think it was supposed to have asked? "Can a bunch of biased researchers find articles that proves their point"?

"Are there differences in health outcomes (mortality or morbidity) in patients suffering from similar medical conditions treated in Canada versus those treated in the United States?"

If we are wondering how much of the differences in health outcomes are due to differences in medical care vs. other factors, it is useful to try and document how much of the difference is due to differences in medical care. Each study in this systematic review serves as part of a sample of medical care. The question, when using this sample to answer the questions posed in this thread, is whether this can be taken to be a representative sample. If the sample was selected in a way that has nothing to do with the question under consideration, then it is more likely to be representative. This reflects the discovery that a random sample from a population provides a much better representation than a selected sample. If you try to select your sample based on the factors you are trying to study, you are much more likely to draw a biased sample. In this case, the authors chose all of the studies which compared outcomes between the US and Canada for specific medical conditions. They had no input into which conditions were studied a priori. So this was effectively like choosing the results from the 3 coins which landed on the floor instead of the table.

But if you're using this as evidence about how well a helth care system works, you have to consider how it works for EVERYBODY.

Yes. And we know from sampling research that we can form conclusions from samples drawn from a population. And that trying to draw 'representative' samples instead of drawing random samples is more likely to introduce bias.

Not saying the Canadian patent system is better or worse... Canada basically made a 'deal' with drug companies to make pharmicuticals cheaper here. (Otherwise, Canada may have decided to just ignore patent laws, and the drug companies would be out even MORE money.) I figured the big drug companies use their big profits that they make off U.S. patients as their main income, while anything earned from other countries is just an added bonus.

It could be argued that if the U.S. government did the same thing (i.e. force drug companies to lower their prices, or risk loosing all patent protection) then its possible that companies would reduce their research and development, since they would have less chance to obtain any profit.

That is an argument that is made for allowing excessive profit, but does it really hold up? The amount that pharmaceutical companies spend on R&D is less than the amount they spend on marketing and less than the amount they direct to profits. If pharmaceutical companies are truly committed to R&D, they have a lot more money available for this use than they currently take advantage of. Also, the kind of R&D that we are interested in (novel products for conditions which affect death, disability, and disease) are more likely to come from non-pharmaceutical research, while PhARMA concentrates more on developing me-too drugs or on preparing novel drugs for the market. It doesn't look like any of us get much in the way of value for the excessive money directed towards PhARMA. See Marcia Angell's, "The Truth About Drug Companies" for information on this topic.

Linda

Segnosaur

14th August 2009, 09:43 AM

The peer-review process is the best method we have for disseminating scientific knowledge, but it is not a perfect process. Mistakes do get made
So what? Unless you are suggesting that this process is more likely to have broken down when it involves studies whose results you don't like...

No, I'm sure its quite possible that there are studies that have favoured my point of view (maybe not in this subject but in others) that are also flawed. However, with only a limited human life span, I can only spend a certain amount of time examining things in detail. If I'm going to change my opinion on something, I want the evidence to be rock-solid, and as such I'll spend more time analyzing something that challenges my ideas.

Did you know there was actually a peer-reviewed study published in a journal (it was a small one, but it was legitimate) that 'proved' prayer helps in medical outcomes? The study was incredibly flawed, but it still got published.

The fact that you don't seem to accept that there are flaws with this study speaks volumes about your own bias.

It is difficult to find Canadian doctors who work within this field who favour for-profit private sector health care. :)

Really? And you're basing that on what exactly?

A poll of physicians by the Angus Reid Group that was conducted for the CMA revealed that 78% of respondents believe it would be acceptable to charge user fees, or charge patients or their private insurance companies to compensate for shrinking government transfers.
http://www.collectionscanada.gc.ca/eppp-archive/100/201/300/cdn_medical_association/cmaj/vol-153/issue-4/0453.htm

The incoming president of the Canadian Medical Association says the country's public health-care system is headed for crisis, but a greater role for private health care could be the right prescription.
http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20070823/cma_privatization_070823?s_name=&no_ads=

Respondents (urologists participating in the study) believed that a parallel private heath care system would shorten wait times and improve access to care (74%), improve outcomes for those with private health care (58.8%), would not impair the outcomes of those without private health care (74.2%) and would not interfere with the accessibility of
health care for most Canadians (73.3%).
http://www.cuaj.ca/cuaj-jauc/vol3-no3/07-policy-mayson-jun-09.pdf

So, I had no problem finding evidence of doctors working in the Canadian system who were not opposed to private health care involvement. Wonder if any of them were contacted by the authors of your paper?
As I pointed out before, that 'strick criteria' were not part of the published studies.
The authors spend about a third of the paper outlining the procedure that is recommended for systematic review and then detailing how they followed those criteria - all done while blinded as to whether or not the specific studies would support any particular bias they may or may not have (which is also part of the criteria).

Yes, they did describe some of their techniques, but they never indicated what words were used in their search, the thought process that went into their 'iterative' techniques, etc.

They selected all the studies that were relevant to the question...,

No, they selected all studies that they happened to find based on their search criteria. For all we know, there could have been 1000 relevant studies that never got chosen because the wording used for the studies caused it to get overlooked in their initial search.

And again, the reviewer was blind as to the study result when figuring out whether the study was relevant to the question.

You have an equal chance of picking the 3 cases where those coin tosses all ended up tails. Unless you think that chance favours a particular bias, this criticism is irrelevant.

Actually, its still quite relevant. They selected (even if they did so 'blind') a subset of all available studies. There is no guarantee that they managed to select all the relevant studies.

Let's say that the 3 cases you picked out were the results where the coin happened to land on the ground instead of the table. Unless you think that coins that land on the ground are more likely to be heads a priori, you haven't found a way to bias the results.

Uhhh... no. I'm not making any prior assumptions.

Lets say you toss a coin 100 times. (same as the fact that they look at multiple studies). Most coin tosses land on the table, but 3 of them land on the ground. Your selection criteria is that ONLY those tosses that land on the ground get counted. You look at the 3, and BY CHANCE they're all heads. Does this mean that all coin tosses would come up heads? No, it doesn't. But because you're sellecting such a small subset of data, you run the risk that your analysis turns up data which is a fluke.

It is reasonable to expect them to present the specifics of their results. It would be quite odd if they hadn't provided the numbers, or if they hadn't gone through the numbers in detail. It certainly doesn't mean that they were trying to convey some subtle message that contradicted what they said explicitly.

The way they presented the results, in my opinion, was deceptive. If you disagree, then fine. (Although I think it indicate a bias on your part...)

"Are there differences in health outcomes (mortality or morbidity) in patients suffering from similar medical conditions treated in Canada versus those treated in the United States?"

If that's the question, fine. The question was not, however "Are there difference in health outcomes for poor patients". If they wanted to write an article covering the health outcomes for poor people, present it as such. But nowhere in the intro or conclusions do they suggest this is anything but a review of genaral outcomes. Its not until you look at the details that you notice that they're looking at at least one study dealing exclusively with poor people.

It is a far different question to ask "Are there differences in outcomes for poor people" than to ask "Are there differences in outcomes for the genearal or average population".

Not saying the Canadian patent system is better or worse... Canada basically made a 'deal' with drug companies to make pharmicuticals cheaper here. (Otherwise, Canada may have decided to just ignore patent laws, and the drug companies would be out even MORE money.) I figured the big drug companies use their big profits that they make off U.S. patients as their main income, while anything earned from other countries is just an added bonus.

It could be argued that if the U.S. government did the same thing (i.e. force drug companies to lower their prices, or risk loosing all patent protection) then its possible that companies would reduce their research and development, since they would have less chance to obtain any profit.
That is an argument that is made for allowing excessive profit, but does it really hold up? The amount that pharmaceutical companies spend on R&D is less than the amount they spend on marketing and less than the amount they direct to profits.

This may be accurate, but it is not totally relevant.

Even if they do spend a lot on marketing, they still have to decide, prior to doing the research, whether their investments will pay off FOR THE RESEARCH ITSELF. Heck, if you reduce patents, you might make the system worse, since it would ONLY be through marketing that a company could differentiate itself.

I'm certainly not claiming that all drug companies are saints... they're not. They're out to make a profit. But that doesn't mean that their work is not beneficial, nor does it mean we should take steps to eliminate the good stuff that they DO do.

You know, I'm also curious about some of the details about that claim. Yes, I'm sure Phizer spends a sh*tload of money on marketing, probably more than on R&D; but I don't know how that breaks down on a product by product basis. They may spend a lot of money promoting vi*gra, but do all of their product lines get a similar treatment? I could see them producing at least some drugs (that are aimed at a smaller pool of patients) where they plan to recoupe their investment based on an actual need for the drug rather than on how well the drug is marketed. (Again, I have no proof of that; I'm just curious about some of the details of that claim.)

Oh, and by the way... speaking of profits, its quite possible that claims of "excessive" profits by pharmiceutical companies may be wrong....
Those measures (of profibility), however,
treat most R&D outlays as expenditures rather than as
investments that add to the value of a firm. Thus, they
omit from a firm’s asset base the value of its accumulated
stock of knowledge. For R&D-intensive industries, such
as pharmaceuticals, that omission can significantly overstate
profitability.
http://www.cbo.gov/ftpdocs/76xx/doc7615/10-02-DrugR-D.pdf

Not that I don't think drug companies are extremely profitable, just that the numbers are a bit more complex.

fls

14th August 2009, 11:31 AM

No, I'm sure its quite possible that there are studies that have favoured my point of view (maybe not in this subject but in others) that are also flawed. However, with only a limited human life span, I can only spend a certain amount of time examining things in detail. If I'm going to change my opinion on something, I want the evidence to be rock-solid, and as such I'll spend more time analyzing something that challenges my ideas.

I try to avoid introducing such an obvious bias into my evaluations.

Did you know there was actually a peer-reviewed study published in a journal (it was a small one, but it was legitimate) that 'proved' prayer helps in medical outcomes? The study was incredibly flawed, but it still got published.

There are all sorts of flawed studies which get published. That's why I provided the reference for the actual study, so that we can look at the details in order to determine the extent to which reliable and valid conclusions can be drawn, instead of simply assuming that because it was published in a peer-reviewed setting, what they say must be right.

The fact that you don't seem to accept that there are flaws with this study speaks volumes about your own bias.

But you haven't actually identified any flaws except that you don't like the results and you don't like the personal political viewpoints of a few of the authors. I am happy to discuss flaws, but I'm not going to go along with your assertion that they simply went through and picked out research that showed an advantage to Canada when their description clearly states that they could not do that.

Really? And you're basing that on what exactly?

I wasn't attempting to say anything controversial. While you can find lots of physicians who think that introducing some private elements (like user fees or private-insurance for elective, but medically necessary procedures (Canada has some elements which are unique among those with universal health care systems)), you don't find them recommending a dissolution of UHC to revert to a for-profit private health care system - especially among those who have experience with studying health care systems.

So, I had no problem finding evidence of doctors working in the Canadian system who were not opposed to private health care involvement.

No, you wouldn't. That's not what I meant to refer to.

Wonder if any of them were contacted by the authors of your paper?

Huh? What relevance would that have had to the study?

Yes, they did describe some of their techniques, but they never indicated what words were used in their search, the thought process that went into their 'iterative' techniques, etc.

As they stated in their paper, if you want this information, "interested readers can obtain the detailed protocol for this review from the corresponding author." At some point, you have to make room for the rest of the information. :)

However, in order for this to be relevant, you would need to show how the choice of words or the thought process would preferentially exclude studies showing a benefit to the US system instead of excluding studies which showed benefit to either side, given that the researchers didn't know which was which beforehand.

No, they selected all studies that they happened to find based on their search criteria. For all we know, there could have been 1000 relevant studies that never got chosen because the wording used for the studies caused it to get overlooked in their initial search.

There is a fair bit of research on searching, because this is, of course, an important consideration. Just how good are these methods at finding all the relevant studies? It turns out that these methods are excellent, so that it's highly unlikely that any relevant study was missed, let alone thousands.

Actually, its still quite relevant. They selected (even if they did so 'blind') a subset of all available studies. There is no guarantee that they managed to select all the relevant studies.

Fortunately the likelihood of finding a study is not independent of its relevance. That is, as you go through the iterative process, the only additional studies you find become increasingly irrelevant and would not make the final cut anyway. So you do have some idea as to the possibility that you have missed one or two studies and whether or not they would alter your conclusions. You can certainly guarantee that they didn't miss thousands.

Uhhh... no. I'm not making any prior assumptions.

Yeah, your criticism would only be relevant if you could make prior assumptions.

Lets say you toss a coin 100 times. (same as the fact that they look at multiple studies). Most coin tosses land on the table, but 3 of them land on the ground. Your selection criteria is that ONLY those tosses that land on the ground get counted. You look at the 3, and BY CHANCE they're all heads. Does this mean that all coin tosses would come up heads? No, it doesn't. But because you're sellecting such a small subset of data, you run the risk that your analysis turns up data which is a fluke.

Right. This is the basis of statistical analysis - "what is the chance that this is a fluke"?

The way they presented the results, in my opinion, was deceptive. If you disagree, then fine. (Although I think it indicate a bias on your part...)

It is typical for a meta-analysis to present the information in this manner. I don't know why trying to educate you needs to be considered a bias on my part.

If that's the question, fine. The question was not, however "Are there difference in health outcomes for poor patients". If they wanted to write an article covering the health outcomes for poor people, present it as such. But nowhere in the intro or conclusions do they suggest this is anything but a review of genaral outcomes. Its not until you look at the details that you notice that they're looking at at least one study dealing exclusively with poor people.

I think this simply reflects your inexperience with systematic reviews and meta-analysis. Each study will reflect a different population from which the study participants were drawn. It doesn't make sense to arbitrarily exclude certain populations. As I mentioned before, it starts to guarantee that your results will not be representative. And it then leaves them open to the criticism that the study cannot represent general outcomes because you exclude a substantial portion of the population if you exclude poor people.

I wrote a bit about the effects of drawing from different populations and the difference between random-effects (the method used in this study) and fixed-effects in a different thread, but that information is relevant here, and helps to explain what the authors were doing with their meta-regression.

http://forums.randi.org/showthread.php?postid=4636708#post4636708

It is a far different question to ask "Are there differences in outcomes for poor people" than to ask "Are there differences in outcomes for the genearal or average population".

There was a single study out of 38 which looked at a population of poor people. Many of the studies looked at populations which were restricted in some way, such as age or language. It doesn't make methodological sense to begin to exclude studies on the basis of restrictions. For one thing, it starts to make your sample unrepresentative. You are hardly trying to claim (I hope) that the general population does not include poor people or that their outcomes are not relevant to the discussion.

This may be accurate, but it is not totally relevant.

Even if they do spend a lot on marketing, they still have to decide, prior to doing the research, whether their investments will pay off FOR THE RESEARCH ITSELF. Heck, if you reduce patents, you might make the system worse, since it would ONLY be through marketing that a company could differentiate itself.

I'm certainly not claiming that all drug companies are saints... they're not. They're out to make a profit. But that doesn't mean that their work is not beneficial, nor does it mean we should take steps to eliminate the good stuff that they DO do.

You know, I'm also curious about some of the details about that claim. Yes, I'm sure Phizer spends a sh*tload of money on marketing, probably more than on R&D; but I don't know how that breaks down on a product by product basis. They may spend a lot of money promoting vi*gra, but do all of their product lines get a similar treatment? I could see them producing at least some drugs (that are aimed at a smaller pool of patients) where they plan to recoupe their investment based on an actual need for the drug rather than on how well the drug is marketed. (Again, I have no proof of that; I'm just curious about some of the details of that claim.)

Oh, and by the way... speaking of profits, its quite possible that claims of "excessive" profits by pharmiceutical companies may be wrong....
Those measures (of profibility), however,
treat most R&D outlays as expenditures rather than as
investments that add to the value of a firm. Thus, they
omit from a firm’s asset base the value of its accumulated
stock of knowledge. For R&D-intensive industries, such
as pharmaceuticals, that omission can significantly overstate
profitability.
http://www.cbo.gov/ftpdocs/76xx/doc7615/10-02-DrugR-D.pdf

Not that I don't think drug companies are extremely profitable, just that the numbers are a bit more complex.

I don't think that anyone is suggesting that patents not be issued or that only nominal protection be provided. Or that there is value to the knowledge/treatments gained through their activities. But a large chunk of the difference in costs between the US and other countries goes to paying for drugs. And so it makes sense to ask whether Americans are buying extra benefit and how much, and also whether reducing those costs would be harmful.

Linda

stup_id

14th August 2009, 11:37 AM

:rolleyes:

Thank you for the points you have made.

However, you are assuming a lot with your statements. You are assuming that a pregnant teen actually goes to a healthcare provider prior to delivery. In my discussions with OB GYN's and public health professionals, I learned the biggest risk of infant mortality is lack of prenatal care.

Thanks for your reasoned reply, and you are absolutely right, biggest risk of infant mortality is lack of prenatal care, and then I would have to resort to an anecdotical evidence and something that just "sounds logical" i'm afraid, I strongly suspect that pregnant women countries with UHC are more prone to to their prenatal care, consultations and all that because they are used to regard all those things as free and a right they have as citizens. Even if there are programs to get free medical attention for pregnant women in the US, as you have already mentioned (and setting aside the issue about if they are indeed high quality programs and everyone has access) I think in some cases the pregnant teen may not be aware of it, and would be less likely to use those services as someone who has regarded receiving medical care for free as the norm. (well, not for free but paid in taxes. :) just in case someone gets picky). As I mentioned before this is only an intuition but i'm strongly positive about this statement, I have met many friends from Spain and France who are as used to visit the doctor whenever something strange happens to them, as if it was the most natural thing in the world.

(BTW: Being a physician I know sometimes this can be a pain in the ass, but I prefer 20 people to come waste a little of my time to refer to an strange headache they been having, than to have to diagnose a brain tumor in any of them because they "hold it" until they could)

:rolleyes:
Now why don't teens go to seek care before delivery? The OB GYN residents I talked to in one city told me it was NOT because of no access to care. They stated they saw large numbers of Medicaid patients who had their healthcare paid for by the government who did the right thing and came in for care when they were supposed to. These teens certainly would have qualified for Medicaid, but many of the teens told the residents they just didn't think they needed to (even after being told to do so during a previous delivery.)

Obviously, this is a complicated story and so there will never be only one answer. I'm sure there were plenty of teens who just simply did not understand.

But still, is that all the fault of the healthcare system? I guess it depends on your definition of the term "healthcare system". I mean some here seem to think our high incidence of obesity indicates a problem with the "US healthcare system".

And you are right again, it would be dishonest from me to state that Health Care is responsible for teens not seeking medical atention, but what I'm very positive about is that if you had a universal care this number will at least increase. Then of course there are other reasons as to why they behave this way and I truly don't know to which extent universal coverage would change this, i can only offer as before anecdotical evidence about people I've met in Europe who remember setting up their appointments by their own with the OB GYN as early as 14 years old and it being the "normal" thing to do

:rolleyes:
In France, they pay women to show up for their prenatal appointments? Is this a good strategy? Would this have unintended consequences?

I don't know, I would have to ask about this when a french friend of mine comes online, but I don't think so, without seeking to repeat myself again I strongly suspect they show up for prenatal appointments more often because Health Care is something they give for granted as if it is "there" when you need it

:rolleyes:
But then how far do you go? I don't think it is simply a matter of education.......America's obesity problem could be helped if the government banned the selling of junk food and outlawed cigarettes. Manditory exercise would probabably help too... anyone want to ban restaurants from having a drive-thru ....... :rolleyes: /sarcasm

Yep, the slippery slope all over again, but Health Care coverage is not about forbiding things, is about giving everybody the fundamental right to regain health, thinking that this will make them "less responsible and thoughtful of the consequences of their lifestyle" seems insensitive and ilogical to me, first of all, because no matter how good was your medical attention even if you recover from a condition your health always suffer, I don't think that there are a lot obese people who would go "ohh what the heck, If they can bring me back from a hearth infarction why whould I care about eating another big mac?", most likely it is people being human and not thinking in long-term standards.

You make very good points and lastly you just hit the softspot, education is the only way to go... and an intricately woven topic with all regarding to health

Segnosaur

14th August 2009, 12:46 PM

However, with only a limited human life span, I can only spend a certain amount of time examining things in detail. If I'm going to change my opinion on something, I want the evidence to be rock-solid, and as such I'll spend more time analyzing something that challenges my ideas.
I try to avoid introducing such an obvious bias into my evaluations.

So, you honestly expect me to believe that you go through each and every study that you've ever read, both ones you like and ones you dislike, and analyse each and every one in fine detail to look for errors?

You'll have to forgive me for being a bit, ahem, skeptical.

But you haven't actually identified any flaws except that you don't like the results...

Actually I feel I have. The fact that you seem to be quite happy dismissing those "flaws" doesn't make them any less, well, flawed.

...and you don't like the personal political viewpoints of a few of the authors.

I pointed out the political viewpoints of the authors as one of the reasons to be skeptical of the paper. Had I not found other things in the paper that I did not like, then I would not have been as distrustful of the results (political leanings of the writers aside).

It is difficult to find Canadian doctors who work within this field who favour for-profit private sector health care.
Really? And you're basing that on what exactly?
I wasn't attempting to say anything controversial.

Well, your statement that it is 'difficult' to find doctors supporting for-profit private sector health care mades it seem like virtual all of the medical community thinks that our medical system should remain entirely government run. That's the point that I was addressing... many in the medical community DO think that some sort of private involvement is beneficial. (Wonder why the authors didn't include any of THOSE doctors when writing their paper.)

Perhaps that wasn't what you meant to say. Maybe you actually just meant it as a joke when you suggested that doctors favouring private health care options are rare. But that's not the way it came across.

While you can find lots of physicians who think that introducing some private elements (like user fees or private-insurance for elective, but medically necessary procedures (Canada has some elements which are unique among those with universal health care systems)), you don't find them recommending a dissolution of UHC to revert to a for-profit private health care system - especially among those who have experience with studying health care systems.

Except if you look at the authors of the article, pretty much everyone I've looked at would be against ANY sort of private sector health care involvement.

As they stated in their paper, if you want this information, "interested readers can obtain the detailed protocol for this review from the corresponding author." At some point, you have to make room for the rest of the information. :)

Early on, you claimed you tried to 'avoid bias' (supposedly by treating ALL material skeptically). Considering you seem to support this article so much, did YOU make any effort to obtain the detailed protocol? After all, if I'm to believe that you do everything you can to avoid bias, you must have a copy of the protocol right when you first read the article.

If you didn't, you'd be a hipocrite.

(Of course, could also point out that since web space is pretty cheap now adays, they COULD have easily posted a copy of their protocols on line, without cluttinging up the remainder of their article.)

However, in order for this to be relevant, you would need to show how the choice of words or the thought process would preferentially exclude studies showing a benefit to the US system instead of excluding studies which showed benefit to either side, given that the researchers didn't know which was which beforehand.

No, you wouldn't. As I pointed out before, because your taking a small subset of data, you introduce chances of deviations caused by the effects of random samples.

Fortunately the likelihood of finding a study is not independent of its relevance. That is, as you go through the iterative process, the only additional studies you find become increasingly irrelevant and would not make the final cut anyway. So you do have some idea as to the possibility that you have missed one or two studies and whether or not they would alter your conclusions. You can certainly guarantee that they didn't miss thousands.

Blind faith. That's good.

It is typical for a meta-analysis to present the information in this manner. I don't know why trying to educate you needs to be considered a bias on my part.

No 'education' is needed. I have been involved in research before. But thanks alot for the condesention.

I posted my general dislike of Meta-analysis prior to that, in ALL areas of study. This particular study does nothing to change my opinion.

There was a single study out of 38 which looked at a population of poor people. Many of the studies looked at populations which were restricted in some way, such as age or language.

Language would not likely be relevant. Neither would age, assuming you were dealing with the same age ranges on both sides of the border.

However, income IS relevant. I have no problem admitting that there is a disparity between the health care available to people in the U.S. due to income. Including a study that looks at poor people only does introduce a bias, even if that particular article was selected blindly.

It would be like including studies based on the mortality due to polar bear attacks...

I don't think that anyone is suggesting that patents not be issued or that only nominal protection be provided. Or that there is value to the knowledge/treatments gained through their activities. But a large chunk of the difference in costs between the US and other countries goes to paying for drugs. And so it makes sense to ask whether Americans are buying extra benefit and how much, and also whether reducing those costs would be harmful.

You're right, you didn't suggest that patents not be issued. But the benefit that Americans could get in the future is not relevant to why I brought the issue up...

Just to remind you, the issue was that one of the studies pointed out better outcomes for Canadian AIDS patients. I pointed out a possible cause, namely that current lower drug prices in Canada, that have nothing to do with the issue of private vs. public health care might be the cause of better survival in Canada, and as such it wouldn't be fair to count it as support for public health care.

Yes, I do realize that you need to avoid any sort of 'bias', but its also necessary to eliminate any sort of external factors when comparing outcomes, so you're not comparing apples with oranges.

Darth Rotor

14th August 2009, 01:16 PM

And say ... perhaps your 2002 source for the data (GECD) isn't the end all in data? Here's another list, not just for motor vehicle accidents but for all transport related deaths: http://www.medicine.ox.ac.uk/bandolier/booth/Risk/trasnsportpop.html . It apparently uses 2004 data from what would appear to be very credible sources. It lists the following crude transport related mortality rates per 100,000 population:

US 16.14
UK 5.94
France 8.89
Germany 7.38
Spain 12.38

Notice that France's mortality isn't nearly as high as it is in your table and Spain, which isn't even listed on your table, apparently should be. But both are still significantly less than the US rate.

BAC, is it possible that these numbers reflect the fact that in Europe, they take the train more often? Europe's population, urban and suburban laydown, traffic density and rail system present the traveler with a different risk profile than the traveler in the US is presented iwth.

DR

Dymanic

14th August 2009, 01:31 PM

BAC, is it possible that these numbers reflect the fact that in Europe, they take the train more often?I don't see how that matters, in this context.

BeAChooser

14th August 2009, 01:33 PM

BAC, is it possible that these numbers reflect the fact that in Europe, they take the train more often?

Possible, but does it really matter?

fls

14th August 2009, 02:15 PM

So, you honestly expect me to believe that you go through each and every study that you've ever read, both ones you like and ones you dislike, and analyse each and every one in fine detail to look for errors?

You'll have to forgive me for being a bit, ahem, skeptical.

You make it sound onerous. :)

I do scrutinize studies that support my opinion with the same detail as I scrutinize studies which don't. Many studies do not require scrutiny in fine detail, though. For example, a study for a therapy which is not controlled or blinded doesn't really need to be read at all.

http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1705173&blobtype=pdf
http://emedicine.medscape.com/article/773527-overview

I realize it is unusual for people to doubt their own beliefs, so I understand your skepticism.

Actually I feel I have. The fact that you seem to be quite happy dismissing those "flaws" doesn't make them any less, well, flawed.

You stated that you think some studies should be arbitrarily excluded. However, given that this reduces validity and reliability, the authors can hardly be faulted for avoiding this practice. You stated that you think that the authors cherry-picked studies based on the results despite the description of a procedure which clearly prevents this possibility. And you stated that they may have missed relevant studies despite using a technique which we already know provides excellent performance when it comes to finding relevant studies.

I pointed out the political viewpoints of the authors as one of the reasons to be skeptical of the paper.

Because someone with political viewpoints in agreement with yours can be assumed to have performed flawless research?

Had I not found other things in the paper that I did not like, then I would not have been as distrustful of the results (political leanings of the writers aside).

Is it your opinion, then, that health outcomes due to medical care are better in the US, and that because this paper failed to find this result, it should be distrusted? What if the results for Canada and the US had been switched, and the main author was David Gratzer? Would the research design then be acceptable? Or is this then one of those situations where you wouldn't have bothered analyzing the study at all?

Well, your statement that it is 'difficult' to find doctors supporting for-profit private sector health care mades it seem like virtual all of the medical community thinks that our medical system should remain entirely government run.

I didn't mean to give that impression.

That's the point that I was addressing... many in the medical community DO think that some sort of private involvement is beneficial. (Wonder why the authors didn't include any of THOSE doctors when writing their paper.)

How do you know they didn't?

Except if you look at the authors of the article, pretty much everyone I've looked at would be against ANY sort of private sector health care involvement.

I think you are ********ting. Earlier you stated you did a quick check on 4 of the authors. I doubt that in the meantime you have become intimately familiar with the opinions of all 16 authors about the degree of private sector involvement in health care.

Early on, you claimed you tried to 'avoid bias' (supposedly by treating ALL material skeptically). Considering you seem to support this article so much, did YOU make any effort to obtain the detailed protocol? After all, if I'm to believe that you do everything you can to avoid bias, you must have a copy of the protocol right when you first read the article.

I do, although for different reasons than you describe above. It's a beautiful example of how to go about the process. Plus it is relevant to some of the stuff I have been consulted on in the past.

If you didn't, you'd be a hipocrite.

I don't do a detailed scrutiny on every article I read. All I said was that I give the same amount of scrutiny to stuff that supports my opinions as I do to stuff that doesn't. This is actually a valuable exercise and is at the heart of evidence-based medicine.

(Of course, could also point out that since web space is pretty cheap now adays, they COULD have easily posted a copy of their protocols on line, without cluttinging up the remainder of their article.)

Yeah, that would be useful. I might make that suggestion.

No, you wouldn't. As I pointed out before, because your taking a small subset of data, you introduce chances of deviations caused by the effects of random samples.

There are two different issues to consider. The smaller the sample, the more variation you will see. This will be reflected in your confidence intervals, where your range of possibilities based on the sample will be very large. For example, with your coin toss, your confidence intervals have to include the possibility that it is just as likely that you will get 3 tails as you will get 3 heads. So you'd have to admit that you couldn't draw any conclusions about what sort of result you'd get with a different set of coin tosses. As the number of coin tosses increases, your confidence in the result increases. If you had 38 coin tosses that all came up heads, you'd feel more confident about guessing that you were playing with a loaded coin.

The second issue is that of whether or not your sample is representative of the underlying population. And this gets back to the post I wrote about random-effects. Because the problem is that the specific examples of medical care that will have been studied will not be a random sample of all examples of medical care. The specific examples of medical care that will have been studied will have been chosen for a variety of non-random reasons. But there isn't anything that can be done about that, other than use meta-regression to look for patterns. However, unless there is some reason to think that a specific example is more likely to be chosen for study and is more likely to show benefit for Canada, it will still be a representative sample. It's the difference between attempting to determine the average height of the adult population in a particular area by measuring the height of the next 50 people to walk through the door of the DMV and measuring the height of a random sample of 50 people drawn from a census listing.

Blind faith. That's good.

Interesting. I wrote about how this issue had been studied and about what results had been found and you chose to characterize that as "blind faith".

No 'education' is needed. I have been involved in research before. But thanks alot for the condesention.

I'm sorry. You've haven't indicated much in the way of knowledge in what you have written.

I posted my general dislike of Meta-analysis prior to that, in ALL areas of study. This particular study does nothing to change my opinion.

There are considerable concerns with meta-analysis - one should always be cautious in attempting to draw conclusions. That is why, even though this meta-analysis showed a statistically significant, narrow confidence interval advantage to Canada, the authors did not conclude that Canada had an advantage (except in the setting of renal disease). They showed the same caution you are advising. But if you dislike their conclusion that an advantage cannot conclusively be demonstrated, that suggests that you think that one should be able to conclude that an advantage is present. Surely that conclusion would be even more misguided than the one the authors reached (which I agree with).

Language would not likely be relevant. Neither would age, assuming you were dealing with the same age ranges on both sides of the border.

Ah. Yes they are relevant. There is a considerable effect of both on health outcomes, and one can't assume that the demographics are the same between the two countries. For example, there are more older adults and fewer children in Canada than there are in the US. (https://www.cia.gov/library/publications/the-world-factbook/region/region_noa.html)

However, income IS relevant. I have no problem admitting that there is a disparity between the health care available to people in the U.S. due to income. Including a study that looks at poor people only does introduce a bias, even if that particular article was selected blindly.

It would be like including studies based on the mortality due to polar bear attacks...

Why? Why would outcomes after polar bear attacks be different in the US vs. Canada in a way that was unrelated to medical care?

Just to remind you, the issue was that one of the studies pointed out better outcomes for Canadian AIDS patients. I pointed out a possible cause, namely that current lower drug prices in Canada, that have nothing to do with the issue of private vs. public health care might be the cause of better survival in Canada, and as such it wouldn't be fair to count it as support for public health care.

What do you think is the reason that drug prices are lower in Canada?

Yes, I do realize that you need to avoid any sort of 'bias', but its also necessary to eliminate any sort of external factors when comparing outcomes, so you're not comparing apples with oranges.

jimbob

14th August 2009, 04:14 PM

I thought I was stating something as controversial as "rain falls from the sky"...

However:

http://www.google.com/search?client=opera&rls=en&q=correlation+obesity+poverty&sourceid=opera&ie=utf-8&oe=utf-8

http://goliath.ecnext.com/coms2/gi_0199-6227596/Correlation-between-high-risk-obesity.html

http://scholar.google.com/scholar?client=opera&rls=en&q=correlation%20teenage%20pregnancy%20poverty%20&sourceid=opera&oe=utf-8&um=1&ie=UTF-8&sa=N&hl=en&tab=ws

http://www.popline.org/docs/1036/093680.html

EDIT: I can't be bothered to spend any more time googling at the moment... Maybe later.

Research also demonstrates poor people have two eyes and one nose.

In this case there is a correlation between both lower socieoeconomic status, and both obesity and teenage pregnancies.

In other words (and we are dealing with populations here, so this is valid) poorer people are more likely to be obese, and are more likely to be involved in teenage pregnancies. Than richer people.

In your example, I would argue that, due to the higher incidence of industrial injuries among manual workers, who tend to be poorer, that these would actually be less likely to have two eyes and one nose.

At least BeAChooser is engaging with the arguments and not stating complete non-sequiters.

BeAChooser

14th August 2009, 04:55 PM

In other words (and we are dealing with populations here, so this is valid) poorer people are more likely to be obese, and are more likely to be involved in teenage pregnancies.

Or the data could be telling you obesity tends to keep people poor.

And likewise teenage and out of wedlock pregnancy.

http://www.washingtonpost.com/wp-dyn/articles/A51337-2005Apr13.html

A decade of declining teenage birth rates has led to a notable reduction in the number of U.S. children living in poverty, according to a new analysis.

... snip ...

Not every teenage mother is poor, "but bearing a child as a teenager increases the chances of a mother and child living in poverty," she said.

Yes, teenagers in poor families are more likely to have teenage pregnancies. But as I pointed out, just because you socialize medicine doesn't mean you reduce the poverty rate. And just because you socialize medicine doesn't mean you reduce the teenage pregnancy rate. Just look at the UK.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1123322

2002

Altogether, 52 out of every 1000 girls aged between 15 and 19 in the United States gave birth, while the United Kingdom topped the list in Europe—and came second overall—with just over 30 births in 1000 teenagers.

http://www.dailymail.co.uk/news/article-1198228/6m-drive-cut-teen-pregnancies-sees-DOUBLE.html

2009

A multi-million pound initiative to reduce teenage pregnancies more than doubled the number of girls conceiving.

The Government-backed scheme tried to persuade teenage girls not to get pregnant by handing out condoms and teaching them about sex.

But research funded by the Department of Health shows that young women who attended the programme, at a cost of £2,500 each, were 'significantly' more likely to become pregnant than those on other youth programmes who were not given contraception and sex advice.

:D

Matthew Best

15th August 2009, 12:34 AM

Maybe the US life expectancy statistics are skewed by the leading cause of accidental death in America - mistakes in medical care. (http://www.chron.com/disp/story.mpl/deadbymistake/6555095.html)

Experts estimate that a staggering 98,000 people die from preventable medical errors each year. More Americans die each month of preventable medical injuries than died in the terrorist attacks of Sept. 11, 2001.

In addition, a federal Centers for Disease Control and Prevention study concluded that 99,000 patients a year succumb to hospital-acquired infections.

Motor vehicle deaths are the No. 1 cause of accidental death in the Unites States, with more than 43,600 deaths in 2006, according to the CDC. The next three causes — poisoning, firearms and falls — account for 90,000 deaths, combined.

But it is clear that if medical errors and infections were better tracked, they would easily top the list.

fls

15th August 2009, 04:53 AM

Maybe the US life expectancy statistics are skewed by the leading cause of accidental death in America - mistakes in medical care. (http://www.chron.com/disp/story.mpl/deadbymistake/6555095.html)

Are you saying that the United States has more mistakes in medical care? And how would that not be a reflection of the health care system?

Linda

Matthew Best

15th August 2009, 05:17 AM

Are you saying that the United States has more mistakes in medical care?

No, I'm saying I don't know. That's why there was a "maybe" at the start of my post.

And how would that not be a reflection of the health care system?

Obviously, if it is true, it would be a reflection of the health care system. How could it not be?

BeAChooser

15th August 2009, 11:03 PM

Maybe the US life expectancy statistics are skewed by the leading cause of accidental death in America - mistakes in medical care.

Quote:
Experts estimate that a staggering 98,000 people die from preventable medical errors each year.

ROTFLOL!

Let's see ... in a country with 300 million people that's 327 deaths per million people. Shocking, yes.

But according to http://www.surgeryencyclopedia.com/La-Pa/Medical-Errors.html that 98,000 number came from a 1999 study by the Institute of Medicine which actually said that between 45,000 and 98,000 Americans die each year as the result of medical errors. So you've cited what appears to be the upper bound for the US mortality due to medical errors (at least in 1999). In fact,

http://www.encyclopedia.com/doc/1P2-8659868.html

The Boston Globe

July 25, 2001

An influential 1999 report that blamed hospital errors for up to 98,000 deaths may have overestimated the problem, according to a study published in today's Journal of the American Medical Association.

So perhaps the real rate of death due to medical errors is less than you claimed. But just for the sake of argument, let's say it is 98,000 deaths a year (i.e., 327 per million population).

Now let's look at Rolfe's universal health care paradise, the United Kingdom. According to http://www.surgeryencyclopedia.com/La-Pa/Medical-Errors.html :

British experts estimate that 40,000 patients die each year in the United Kingdom as the result of medical errors.

With a population of 61 million, that 40,000 works out to a rate of 656 deaths per million ... more than twice the US rate.

But wait ... it might be worse than that:

http://www.independent.co.uk/life-style/health-and-families/health-news/nhs-mistakes-may-lead-to-70000-deaths-a-year-694152.html

March 2001

The president of the Royal College of Physicians today calls for a national system for recording adverse medical events after a study suggested that mistakes by medical staff in NHS hospitals may be contributing to the deaths of almost 70,000 patients a year.

http://www.timesonline.co.uk/tol/news/uk/article468980.ece

August 13, 2004

... snip ...

Medical accidents and errors contribute to the deaths of 72,000 people a year, and they are directly blamed for 40,000.

... snip ...

The NPSA estimates that medical errors contribute to around 72,000 deaths each year, making them the fourth leading cause of death after cardiovascular disease, cancer and respiratory conditions.

Let's see ... 70,000 deaths a year would be a rate of 1148 deaths per million ... or more than 3 times the rate you say they are dying in the US from medical errors.

And get this:

http://www.southwaleslibdems.org.uk/news/000642/patient_deaths_due_to_nhs_errors_up_50__peter_blac k.html

January 2009

Figures obtained by the Welsh Liberal Democrats have revealed that the number of NHS patients dying from medical errors has increased by 50% in the last 3 years.

But maybe the UK is just a fluke. Let's look at another UHC paradise ... Canada.

http://www.cbc.ca/health/story/2004/06/09/med_errors040609.html

June 10, 2004

... snip ...

In May, a comprehensive study in the Canadian Medical Association Journal found preventable medical errors contribute to between 9,000 and 24,000 deaths in Canada a year.

With a population of 33 million, that works out (at the upper bound because fair is fair) to 727 deaths per million. Again, more than twice the US rate.

And what were you trying to prove, Matthew? :D

Leif Roar

16th August 2009, 12:09 AM

With a population of 61 million, that 40,000 works out to a rate of 656 deaths per million ... more than twice the US rate.

Are you sure you're comparing like to like? The US numbers "refer only to hospitalized patients; they do not include people treated in outpatient clinics, ambulatory surgery centers , doctors' or dentists' offices, college or military health services, or nursing homes . "

Matthew Best

16th August 2009, 03:28 AM

So you've cited what appears to be the upper bound for the US mortality due to medical errors (at least in 1999).

These numbers are not absolutes. There is no definitive study — which is part of the problem — but all of the available research indicates that the death toll from preventable medical injuries approaches 200,000 per year in the United States. (http://www.chron.com/disp/story.mpl/deadbymistake/6555095.html)

and "federal analysts believe the rate of medical error is actually increasing."

While your UK figures are all several years out of date after a period in which the NHS had record levels of investment, the US figures are apparently getting worse. :D

Gregoire

16th August 2009, 04:08 AM

Thanks for your reasoned reply, and you are absolutely right, biggest risk of infant mortality is lack of prenatal care, and then I would have to resort to an anecdotical evidence and something that just "sounds logical" i'm afraid, I strongly suspect that pregnant women countries with UHC are more prone to to their prenatal care, consultations and all that because they are used to regard all those things as free and a right they have as citizens. Even if there are programs to get free medical attention for pregnant women in the US, as you have already mentioned (and setting aside the issue about if they are indeed high quality programs and everyone has access) I think in some cases the pregnant teen may not be aware of it, and would be less likely to use those services as someone who has regarded receiving medical care for free as the norm. (well, not for free but paid in taxes. :) just in case someone gets picky). As I mentioned before this is only an intuition but i'm strongly positive about this statement, I have met many friends from Spain and France who are as used to visit the doctor whenever something strange happens to them, as if it was the most natural thing in the world.

I should make it clear that I am not arguing against UHC. I was only trying to say the relatively high infant mortality rate here has other causes than just the healthcare system. The last line was meant to be sarcastic and was meant as a response to those on this forum and in the media who blame the US healthcare system for the high obesity rate here. (I thought the words themselves sounded sarcastic, but was not sure if others would understand, so I had to use the :rolleyes: etc.)

Your point above is interesting. Is is possible to change the culture with UHC? I do know the government advertises in poor neighborhoods and on the radio to make people aware of government programs, so I can't imagine anyone not knowing about them. But can we change people's attitudes to actually see the value in prenatal care? I don't know.

What about the American hangups about sex in general? Does this have anything to do with avoiding prenatal care? Or Is it more the basic mistrust of authority? Again, I don't know.

Similarly, the vast majority of people here seem to know what healthy food is and that exercise is important, but the common joke I hear is that you can do everything right, but then get killed in a car wreck at an early age anyway.
Is there a way to change the culture relative to this?

Travis

16th August 2009, 04:52 AM

fls

16th August 2009, 05:11 AM

No, I'm saying I don't know. That's why there was a "maybe" at the start of my post.

I see. It may not matter. It doesn't look like medical error makes much of an impact on life expectancy, in that it tends to occur in people who are already at higher risk of dying. That is, the death rate in people who are exposed to medical error is the same as the death rate in people who aren't exposed to medical error, when you compare groups that are otherwise comparable. The number of people who lose many years of life due to medical error may be too small to have a noticeable effect on life expectancy. It looks like it would skew the cause of death more than the occurrence of death.

Obviously, if it is true, it would be a reflection of the health care system. How could it not be?

Sorry, I misunderstood. I thought you (like some of the others in this thread) were looking for ways in which the life expectancy statistics for the US do not reflect the quality of the health care delivery system.

Linda

Dymanic

16th August 2009, 06:23 AM

ROTFLOL!

Let's see ... in a country with 300 million people that's 327 deaths per million people. Shocking, yes.
Even using the lower bound (45,000), it's still more than the number of people killed in motor vehicle accidents.

BeAChooser

16th August 2009, 01:49 PM

Are you sure you're comparing like to like? The US numbers "refer only to hospitalized patients; they do not include people treated in outpatient clinics, ambulatory surgery centers , doctors' or dentists' offices, college or military health services, or nursing homes . "

Good question, but even assuming you are right and you double the number of deaths, the US rate would still be no more than that reported for the UK and Canada. Which destroys the argument that I think Matthew was trying to make.

But in any case, I think the statistics I cited are comparing apples to apples.

First, the source I supplied for Canadian medical mistakes specifically stated that those were "medical errors in Canadian hospitals".

And as far as the 40,000 deaths per year cited for the UK,

http://tai-botanicals.com/news-health.html

Charles Vincent, head of the clinical risk unit at University College London, who is leading the study, has pioneered efforts to examine the extent of clinical errors in Britain. His team has so far concentrated on two London hospitals. The first data from one hospital showed that 32 out of 480 patients in four different departments were victims of hospital mistakes. Vincent's estimate of 40,000 deaths comes from studies showing that 3-4% of patients in the developed world suffers some kind of harm in hospital.

http://www.second-opinions.co.uk/why-i-wrote-trick-and-treat.html

according to the 13 August 2004 edition of the British Medical Journal, with: ‘About 850 000 medical errors [occurring] in NHS hospitals every year, resulting in 40,000 deaths’, has put hospital doctors in the unenviable position of being now the fourth leading cause of death in Britain.

http://www.bmj.com/cgi/pdf_extract/329/7462/369

About 850,000 medical errors occur in NHS hospitals every year, resultig in 40,000 deaths.

http://www.odemagazine.com/doc/5/sick_practices/

A similar gloomy picture is painted in the United Kingdom. Here, medical errors, which include drug reactions, kill 40,000 people every year, according to a study by the University College London. Again, the study is based on deaths in hospitals

Architect

16th August 2009, 01:57 PM

Vincent's estimate of 40,000 deaths comes from studies showing that 3-4% of patients in the developed world suffers some kind of harm in hospital.

Are you assuming that the US isn't included in this category?

BeAChooser

16th August 2009, 02:49 PM

While your UK figures are all several years out of date

You were the one that first cited 1999 data to claim that the US is worse than other countries when it comes to medical errors. I simply showed using data from around that time period that the US rate was actually much lower than several UHC countries held up by Obamacare supporters as models for the US to follow. :D

These numbers are not absolutes. There is no definitive study — which is part of the problem — but all of the available research indicates that the death toll from preventable medical injuries approaches 200,000 per year in the United States.

And if you look at total deaths due to medical injuries and hospital-acquired infections (which is where the 200,000 figure comes from) in the UK and Canada I'm sure you will get much higher numbers than the ones I cited too. For example, http://www.publications.parliament.uk/pa/cm200405/cmselect/cmpubacc/554/55405.htm cites 1995 data suggesting

Around 5,000 deaths in the UK per year may be directly attributable to the presence of a hospital acquired infection, and in a further 15,000 deaths, hospital acquired infection may be a substantial contributor.

And extra 100,000 deaths per 300 million is a rate of 333 per million.

And extra 20,000 deaths per 61 million is a rate of 327 per million.

Which demolishes any point you were trying to make.

And more recent articles suggest the problem in the UK has gotten MUCH worse since 1995. For example:

http://www.dailymail.co.uk/news/article-505798/How-doctors-lie-death-certificates-hide-true-scale-toll-hospital-infections.html

In 2006 almost 56,000 elderly hospital patients caught C. diff, which is spread by poor hygiene, dirty hands and soiled bedding. Amazingly, we still don't know how many of these people died because the figures have not yet been released by the NHS.

In 2005, the latest year that death statistics for C. diff were available, 3,807 hospital patients died, a rise of almost 70 per cent over the previous 12 months.

But the truth is that this figure may be utterly meaningless because many people, including Joan, believe there is a cover-up over the figures.

As this investigation has discovered, when a person dies from a hospital superbug the details are often left off the death certificate. The practice has become so widespread that last autumn the Government's chief medical officer, Sir Liam Donaldson, wrote to hospitals and doctors warning them that any dishonesty has to stop.

He said: "There is still a widespread belief that the figures underestimate the mortality associated with both MRSA and C. difficile. This is compounded by the idea that doctors are reluctant to put information about hospital-acquired infections on certificates, or indeed that they are discouraged from doing so."

... snip ...

The Government says that there were 6,381 cases of MRSA in England last year, although some experts believe it could be nearer to 100,000. The latest figures from the Health Protection Agency and the British Paediatric Surveillance Unit show that 74 cases involved children, three-quarters of them babies of less than a year old. It is not known how many of them died.

Data from the National Office of Statistics shows that deaths from MRSA rose from 51 in 1993 to 1,629 in 2005. But the startling totals are likely to be the tip of the iceberg.

The truth is that UHC hasn't solved the problem or made conditions any better in UK hospitals than they are in the US. Maybe UHC has even made them worse.

And Canada is no better.

http://www.ochu.on.ca/section-03/documents/HAI_Fact_Sheet.pdf

Hospital acquired infections are the fourth largest killer in Canada. Each year, 220,000-
250,000 hospital acquired infections result in 8,000-12,000 deaths.

12,000 deaths in a population of 33 million is a rate of 364 per million.

Again, you haven't proven anything. Universal health care is not the solution to problem of hospital acquired infections. The problem is just as great, if not worse, in UHC countries than it is in the US.

While your UK figures are all several years out of date after a period in which the NHS had record levels of investment, the US figures are apparently getting worse.

Yes, but so what? As one of my sources noted, the rate of medical error deaths has increased 50% in the last three years in the UK. Despite record levels of investment, things are getting much worse there, too. :D

BeAChooser

16th August 2009, 02:57 PM

Even using the lower bound (45,000), it's still more than the number of people killed in motor vehicle accidents.

So what? The number of medical error related deaths in the UK is also much greater (in fact, many times more even using the lower bounds) than the number of people killed in motor vehicle accidents in the UK.

Dymanic

16th August 2009, 06:38 PM

So what?
I took the "Shocking, yes" part of your post to be a sarcastic dismissal of the significance of those numbers, and thought it worth noting that we've already more or less agreed that that would be enough to influence the statistics on average lifespan.

BeAChooser

16th August 2009, 06:51 PM

I took the "Shocking, yes" part of your post to be a sarcastic dismissal of the significance of those number

It wasn't, but then shock about the number of people killed in medical errors isn't the topic of this thread. The issue (in the context of the health care debate) is whether UHC countries really have better life expectancy than the US, once you factor out all the things that effect life expectancy but which aren't part of the health care system.

Leif Roar

17th August 2009, 05:18 AM

But in any case, I think the statistics I cited are comparing apples to apples.

I am not convinced. The difference is so great that I think it has to be down to differences in methodology -- UK and US medical staff has roughly comparable training and roughly comparable working conditions, so they should be making roughly as many mistakes.

While trying to track down the paper by Vincent, I came across an article (http://www.medicalnewstoday.com/articles/11856.php) which suggests an undercounting in the US studies. If we use that study's number of 195,000 deaths due to medical error, we get a rate of 61.1 deaths per 100,000 in the US, versus 65.7 per 100,000 in the UK. This seems more reasonable.

jimbob

17th August 2009, 09:27 AM

Okay, I just arrived here and, for whatever reason, the statistics being discussed don't seem to have made the trip in the thread split. So I've got a couple questions:

1) When did the US drop to the bottom in life expectancy? It seems not that long ago I checked and the US was near the top of the world (with Japan at the top and Nigeria at the bottom) so this would be a rather dramatic drop, if true. Was there a famine when I wasn't looking?

2) Is what's being alleged here that the US is suffering from a lack of health care or that the health care that is performed is done so very poorly? If it is about substandard quality of care then what is causing that? Incompetent doctors? Malfunctioning equipment? Gypsy curses?

This link has a discussion of some of the factors:

http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2007/May/Mirror--Mirror-on-the-Wall--An-International-Update-on-the-Comparative-Performance-of-American-Healt.aspx

Access: Not surprising—given the absence of universal coverage—people in the U.S. go without needed health care because of cost more often than people do in the other countries. Americans were the most likely to say they had access problems related to cost, but if insured, patients in the U.S. have rapid access to specialized health care services. In other countries, like the U.K and Canada, patients have little to no financial burden, but experience long wait times for such specialized services. The U.S. and Canada rank lowest on the prompt accessibility of appointments with physicians, with patients more likely to report waiting six or more days for an appointment when needing care. Germany scores well on patients' perceptions of access to care on nights and weekends and on the ability of primary care practices to make arrangements for patients to receive care when the office is closed. Overall, Germany ranks first on access.

Equity: The U.S. ranks a clear last on all measures of equity. Americans with below-average incomes were much more likely than their counterparts in other countries to report not visiting a physician when sick, not getting a recommended test, treatment or follow-up care, not filling a prescription, or not seeing a dentist when needed because of costs. On each of these indicators, more than two-fifths of lower-income adults in the U.S. said they went without needed care because of costs in the past year.