Modern medicine doesn't really work?

[advancedatheist]

Apparently the empirical evidence doesn't support the claim that modern medicine works as advertised (requires Adobe):

Fear of Death and Muddled Thinking – It Is So Much Worse Than You Think
(http://hanson.gmu.edu/feardie.pdf)

Robin Hanson
Department of Economics
George Mason University
August 2005

Sorry to be the bearer of bad news, but, well, maybe you should sit down. Everything I am about to tell you has long been well known among the people who specialize in studying these things. None of this is particularly new or controversial to them. But most of it is probably news, perhaps even shocking news, to you. Here goes.

...snip...

Edited for breach of Rule 4.

Correlations-in-the-world studies see many apparently large influences on health, including age, gender, exercise, social status, urban location, smoking, sleep, and even church attendance. Gender, exercise and social status, for example, can change lifespans by ten to fifteen years or more. When one looks at medical spending, however, the usual finding in such studies is no effect. When comparing nations or counties or individuals, people who get more medicine have no significant difference in health when compared to people who get less medicine.

[Hydrogen Cyanide]

So we are supposed to take medical advice from an economist now?

So because the medical world does not operate like HE thinks it does perhaps I should take my teenager with the very severe heart condition off of Atenolol.

Oh, so bogus.

Anyone with two brain cells to rub together can look up the effacy of many procedures and the research that went into them. It has been made very simple with the use of www.pubmed.gov and the incredibly valuable www.medlineplus.gov (which I used extensively after my son was diagnosed with hypertrophic cardiomyopathy).

[advancedatheist]

How, then, do you explain the empirical evidence which shows zero marginal value for healthcare, at least at the levels Americans consume it? Many countries poorer than the U.S., and thus lacking many medical resources available here, have healthier and longer-lived populations, including ones where people smoke a lot of unfiltered cigarettes like Japan.

[Hydrogen Cyanide]

Originally posted by advancedatheist
How, then, do you explain the empirical evidence which shows zero marginal value for healthcare, at least at the levels Americans consume it? ....

WHAT empirical evidence? If you have it, please present it in its original form... not by going through an economist's opinion paper please. I cannot respond if I do not have sufficient data. You are speaking in great swaths of generalities, so it is hard to actually take note of any real evidence. Give me something to work with, like say this: http://www.disastercenter.com/cdc/ .

Here is a big for instance:

I am pretty sure that right now that the vaccination programs in the US have worked better than they do in Japan (where measles still exists):
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=DisplayFiltered&DB=pubmed

[Asolepius]

Originally posted by advancedatheist
How, then, do you explain the empirical evidence which shows zero marginal value for healthcare, at least at the levels Americans consume it? Many countries poorer than the U.S., and thus lacking many medical resources available here, have healthier and longer-lived populations, including ones where people smoke a lot of unfiltered cigarettes like Japan.
Any differences between populations are going to have all sorts of confounding factors. Let's take the example of the Japanese which you cite. True, they have less heart disease than Americans, although they smoke more. But they have a very different diet, with far more fish. They also have the highest per capita consumption of prescription drugs in the world. When they migrate to the USA, they adopt the local diet and guess what - they have the same incidence of heart disease as Americans. What's more, Japanese who have migrated to Hawaii occupy an intermediate state, in terms both of diet and heart disease incidence. It is folly to select one parameter, in this case prescription drug availability, and attribute a whole range of effects to that, when there is a host of other factors. And that's without even thinking about genetic differences.

Oh yes, and since when was Japan poorer than the USA? Forgive me for relative ignorance of the US welfare system, but do all US citizens have equal access to medical care?

[geni]

Originally posted by advancedatheist
How, then, do you explain the empirical evidence which shows zero marginal value for healthcare, at least at the levels Americans consume it? Many countries poorer than the U.S., and thus lacking many medical resources available here, have healthier and longer-lived populations, including ones where people smoke a lot of unfiltered cigarettes like Japan.

You assume zero effiency saveing in any system.

[Eos of the Eons]

Are we to believe that Armstrong died of cancer, and this guy winning bike races is a figment of our imagination?

[advancedatheist]

Originally posted by Hydrogen Cyanide
WHAT empirical evidence? If you have it, please present it in its original form... not by going through an economist's opinion paper please.

You can start with the counterintuitive findings of the RAND Health Insurance Experiment from a few years back:

Effects of Cost-Sharing on Use of Medical Services and Health, by Emmet B. Keeler, Ph.D.:
http://www.rand.org/publications/RP/RP1114/RP1114.pdf

And the longer study,

How Much is Enough? Efficiency and Medicare Spending in the Last Six Months of Life, by Jonathan Skinner and John E. Wennberg:
http://www.dartmouthatlas.org/pdffiles/w6513.pdf

[Ziggurat]

Originally posted by advancedatheist
Apparently the empirical evidence doesn't support the claim that modern medicine works as advertised (requires Adobe):

What, EXACTLY, is the claim being made here? Is it merely that increased medical spending doesn't contribute much to life expectancy? Or is it that modern medicine doesn't provide much benefit? Because these aren't the same claims. For example, prescription drugs for allergies might improve your quality of life significantly, but not alter your lifespan at all. Likewise, medical technology might extend life expectancies and yet still have most of the money spent on it go to aspects which don't make you live any longer. So what, exactly, is your point? In the absence of some more clarification, I think you're going to end up with a lot of people thinking you're just trolling.

[Eos of the Eons]

Wellllll, going by the article first posted:

Fear of death makes us spend fifteen percent of our wealth on medicine, from which we get little or no health benefit, while we neglect things like exercise, which offer large health benefits.

We could point to sCAM, offering supplements and quack treatments that supposedly will improve our bodies and help us be healthier/younger/ for longer.

I would say THAT is a waste of money, but isn't legitimately "modern medicine"...so I read on...

The article is so full of lies and conspiracy theories that it made my stomach churn. It looks familiar, and I think I've seen rebuttals.

People don't get life-saving surgeries just to "extend lifespans". If you have appendicitus or a heart attack, then you are simply getting your life saved. The article makes this sound silly, why "extend your life" (be saved by surgery) if you are going to die sometime anyway? The author poo poos surgeons, and accuses doctors of using meds improperly!

He accuses the medical system of playing on our fears of death. Hmm, I guess my reasons for getting my appendix out was just my insane fear of death?? Well, duh, in some cases!! But if I get a broken bone, then my fear of pain will be more my motivation!!

That idiotic paper, and idiotic lying paranoid author are just plain trash. There is no evidence offered, just opinions. There are misquotes as well. Awful.

I've found where the quote came from for Bunker, J. P., Frazier, H. S., & Mosteller, F. (1994). Improving Health: Measuring Effects

http://www.milbank.org/720203.html

I feel they have been completely misquoted.

[SezMe]

Originally posted by advancedatheist
Many countries poorer than the U.S., and thus lacking many medical resources available here, have healthier and longer-lived populations, including ones where people smoke a lot of unfiltered cigarettes like Japan.
And what is one obvious, large difference between those countries and the USA? The USA is the only one without a universal health care system.

[ungoliant]

i, for one, would have died this year had i not lived in a first world country like the US. my surgery is one offered only in the most advanced nations.

and i am not old, but in my mid-30s. so, this is a life extension that is greatly appreciated.

thank you modern medicine and the government that spends on it!

[Hydrogen Cyanide]

Originally posted by advancedatheist
You can start with the counterintuitive findings of the RAND Health Insurance Experiment from a few years back:

Effects of Cost-Sharing on Use of Medical Services and Health, by Emmet B. Keeler, Ph.D.:
http://www.rand.org/publications/RP/RP1114/RP1114.pdf

And the longer study,

How Much is Enough? Efficiency and Medicare Spending in the Last Six Months of Life, by Jonathan Skinner and John E. Wennberg:
http://www.dartmouthatlas.org/pdffiles/w6513.pdf

Here you have an over ten year old article on health insurance cost-sharing and the financial decisions that need to be made at the "end of life". It makes some general medical statements about hypertension, but absolutely nothing specific. (I would have to argue against the paragraph that controlling high blood pressure gives about a 3 month increase in life... my step-mother is from a family with a genetic form of hypertension. She said they usually "dropped dead" in their early forties. Though more accurately as evidenced by the photos of one of her brothers near the end of his life, it was a painful agonizing death. About 50 years ago there came the earliest medications for hypertension, and now she and her other siblings lived way into their 70's and 90's... except for the one who was a Christian Scientist --- he died in his early 60's, but he also did not smoke or drink).

The latter one only deals with the last six months of life. Not even relevant, except if you have decided that the only time you will avail yourself to medical attention is when you are dying. Then it is a bit late.

This hardly qualifies as something that shows "modern medicine does not work".

Insurance companies are always evaluating what they will cover and by how much. Especially if they are part of a national health service, like Canada. Here is an example of a report from British Columbia showing that Health Canada should not pay for cranialsacral therapy: http://www.chspr.ubc.ca/bcohta/pdf/bco99-01J_cranio.pdf

(It is only when stupid politicians decide to override insurance policies and force them to pay for idiot procedures, like chiropracty. It happened in my county, and the main county council member who advocated did die earlier than would be expected... more than likely since he was using alternatives instead of conventional treatments earlier, his family refused to disclose what he died of at age 60. http://archives.seattletimes.nwsource.com/cgi-bin/texis.cgi/web/vortex/display?slug=pullen16m&date=20030416& )

Even the health insurance provided by hubby's employment has a sliding scale for the "worth" of prescription medication. With insurance I pay $30 for a bottle of 30 Allegra antihistamines, BUT for my son's Atenolol the cost is $5 for a bottle of 90 pills (a three months supply).

Also, the health insurance has paid for my son's 3 to 4 times a year appointments with the cardiologist. Those visits and the twice a year $1000 echocardiograms show that the medication has decreased the pressure across the already damaged mitral valve.

They also paid for the echocardiograms for the other two children. Which fortunately showed they did not inherit the same condition.

(By the way, the most common first symptom of this condition is "sudden death" in adolescents... we are very lucky that a heart murmur was heard during a regular "well child" doctor appointment, which is how he got his first echocardiogram. The other kids were checked because 50% of the time they will find another family member with it)

The insurance also pays for the vaccines they all receive. Possibly because it is cheaper to pay $10 for a vaccine than thousands of dollars for hospitalizations should they get something like measles, HepB, Hib or even tetanus. (I expect in the next year they will be getting the new adolescent version of the pertussis vaccine, and later the college age meningococcal disease should they go live in a dorm, or earlier depending on high school band trips).

So given these specific examples of modern medicine that DOES work, please give us specific example of where it does NOT work.

To help you out: if you check www.pubmed.gov for specific conditions or treatments you will find several studies that show risk/cost benefits for several procedures and medications. A quick check with the search words "cost risk" brought up over 30 thousand hits (or you may wish to skip to the almost 7000 reviews). Have fun.

[Ducky]

Originally posted by ungoliant
i, for one, would have died this year had i not lived in a first world country like the US. my surgery is one offered only in the most advanced nations.

and i am not old, but in my mid-30s. so, this is a life extension that is greatly appreciated.

thank you modern medicine and the government that spends on it!

I also would be at the very least paralyzed and most likely dead without my surgery and cancer treatments. The surgery was done by one of, if not the foremost neurosurgeon in spinal tumors in the country.

I am not 30 yet. I also appreciate the extension of life.

I echo this thanks.

[bruto]

I'd quite possibly have been dead in 1952 if it hadn't been for penicillin (a real rip-roaring case of scarlet fever on top of a lingering debilitation from what was later suspected as dysentery).

Eventually I'll die anyway, but I've been having some fun in the meantime.

I say whoopee for modern medicine.

[c4ts]

Oh I'm sure that cancer went away all by itself and the radiation treatment was just a big fat placebo. If you need me I'll be beating my head against the wall again.



You hear that? It's the sound of a quack being published.

[SezMe]

While recognizing that multiple anecdotes do not constitute data, I would add my "salvation" to the others. I have two artifical hips and, without those, would be wheelchair-bound. As it is, I live a relatively normal life.

And, at the height of passion, when I am shouting, "I am a steel driving man" I am only telling a white lie. I am actually a titanium driving man but it sounds so...well, intellectual at the very moment when intellecutualism is not called for.

Never mind.......

[Rolfe]

One of my senior technicians (type I diabetes diagnosed when he was about 25 years old, nicely stabilised on insulin within a week, only lost about a day's work over it all) would also like to add his scorn and derision to the general clamour in this thread.

Rolfe.

[stamenflicker]

People don't get life-saving surgeries just to "extend lifespans". If you have appendicitus or a heart attack, then you are simply getting your life saved. The article makes this sound silly, why "extend your life" (be saved by surgery) if you are going to die sometime anyway? The author poo poos surgeons, and accuses doctors of using meds improperly!

Well I belive the article in question is referring to the last six months of life, if I read the abstract correctly. If that is so, then yes, I belive the numbers.

My grandfather, diagnosised with lung cancer was given no more than 2 years to live without various surgeries and treatments. He opted to go the surgery and treatment route and was dead in six months anyway.

I know of many other stories like this, so if that is what the article is referring to, it wouldn't surprise me if it were true.

Flick

[bruto]

Originally posted by stamenflicker
Well I belive the article in question is referring to the last six months of life, if I read the abstract correctly. If that is so, then yes, I belive the numbers.

My grandfather, diagnosised with lung cancer was given no more than 2 years to live without various surgeries and treatments. He opted to go the surgery and treatment route and was dead in six months anyway.

I know of many other stories like this, so if that is what the article is referring to, it wouldn't surprise me if it were true.

Flick

If you read the whole article, it goes much further than this, though one of the studies cited deals with results for the last 6 months of life. The problem is that it is a statistical study, so while it may have value in predicting what will happen to a population as a whole, it is irrelevant to individual choices. The author's point, which seems fairly reasonable on the surface, is that for the whole population, medical care is not the most cost-effective way to keep us alive. We'd do better to put our time and money into better diet and exercise, etc. But while this may be true on average, it does not bear even a little bit on the question of whether, as individuals, when we get sick with cancer or diabetes or whatever, we should seek treatment.

Of course, we also have to trust the statistics, and in some cases, I wonder about those. For example, Hanson brings up improved water suppies and sanitation in cities, and concludes that the advent of these did not affect the death rate. This may well be true, but cities are complicated, and without factoring in other causes of death and other trends which might have raised the death rate, you cannot conclude from this that improved sanitation was a wasted effort - only that it wasn't enough. It also ignores the fact that even if a treatment does not prolong our life it can improve it. Some people are healthy until they die, and some are sick. It makes a difference even if it doesn't show in the statistics.

In addition, the author implies that expenditure on medicine and on other ways of improving one's life are mutually exclusive. You can take your medicine and go for a bike ride.

[Rolfe]

Originally posted by bruto
For example, Hanson brings up improved water suppies and sanitation in cities, and concludes that the advent of these did not affect the death rate. This may well be true, but cities are complicated, and without factoring in other causes of death and other trends which might have raised the death rate....I'd also like to know a bit more about that statistic. I mean, taken crudely, nothing can lower the "death rate". Everybody dies, exactly once.

I had this query about the Shipman statistics. Dame Janet Smith went through each suspected case one at a time, and came to the conclusion that the statistician's estimate of the excess deaths in Shipman's patient list was about the same as the number of suspicous cases she fingered. But some of that didn't make sense. A significant proportion of Shipman's killings were of people who were terminally ill, and many of the rest were of elderly people who, however healthy, would probably have died in the relatively near future (say, within 5 years). So how could the fact that he hastened these deaths actually show up in the comparative statistics? The evidence was certainly there when the individual circumstances of the cases were looked at with a cold and fishy eye, but I still can't see how the statistician could have got it right. Making me wonder if there were actually more cases than ever made it into the Enquiry.

Rolfe.

[Beth]

Originally posted by bruto
In addition, the author implies that expenditure on medicine and on other ways of improving one's life are mutually exclusive. You can take your medicine and go for a bike ride.

I haven't read the article, so I'm not sure how applicable this is, but from an economic point of view, resources spent on medicine cannot be spent on going for a bike ride. If you spend $500 over the course of a year on a prescription, you cannot spend that same $500 to purchase a bike. Now, it's not mutually exclusive that you can't do both, but to do both would cost $1000 . I'm assuming that the author is promoting the idea that if you only have $500 to spend on your health, you might be better off buying a bike and using it regularly buying than a prescription.

Or maybe not. But you don't have to presume that doing both is mutually exclusive, only that resources to spend on health care are limited and it's reasonable to look for the best value for the money. Clearly, he has different ideas about what that best value might be for society as a whole than others do.

Beth

[drkitten]

Originally posted by Rolfe
I'd also like to know a bit more about that statistic. I mean, taken crudely, nothing can lower the "death rate". Everybody dies, exactly once.

I had this query about the Shipman statistics. Dame Janet Smith went through each suspected case one at a time, and came to the conclusion that the statistician's estimate of the excess deaths in Shipman's patient list was about the same as the number of suspicous cases she fingered. But some of that didn't make sense. A significant proportion of Shipman's killings were of people who were terminally ill, and many of the rest were of elderly people who, however healthy, would probably have died in the relatively near future (say, within 5 years).

The death rate is usually calculated in deaths per population norm per year, not simply in deaths per population norm. (That's, ahem, what makes it a "rate," if you see what I mean.)

People dying "too soon" will therefore inflate the number of deaths per year. As a naive example, a stable population of 1000 people with a 50-year life expectancy would see a death rate of 20 people per year (and over fifty years, would therefore see 1000 deaths, exactly as predicted). The same population, but with a 25 year life expectancy, would see a rate of 40 deaths per year.

Equivalently, in the first case, we have a death rate of 20/1000 and in the second, of 40/1000.

In Shipman's case, if we assume that his all patients should die within five years, the death rate among his patients should be (handwave, handwave) about 200/1000. If his death rate is significantly above this, then it means that people aren't living out their full five-year "expectation," and it's legitimate to wonder why....

[Rolfe]

Originally posted by new drkitten
The death rate is usually calculated in deaths per population norm per year, not simply in deaths per population norm. (That's, ahem, what makes it a "rate," if you see what I mean.) ....I think I'm missing something, but I'm reasonably content to accept that I'm missing something....

With Shipman the deaths occurred over a long period of time. So I suppose I was wondering, if the people who should have died this year had already been killed two years ago, then there's room in there for him to kill the ones who would have died in two years time now, and not muss the figures.

I think maybe I'm missing your "population norm".

But still, how could the people he killed who were obviously dying at the time possibly figure in the statistics of "excess deaths"?

Back on topic, looking at it simplistically, I'd expect better public hygiene to improve life expectancy, not "reduce the death rate", though I could see that under certain conditions of measurement these two things could be the same.

Even more back on topic, I could well imagine that a lot of money spent on healthcare could be seen as a waste - for example, the aggressive interventions in a cancer patient who only has a few months to live in any case. Nevertheless, in certain circumstances medical interventions are spectacularly successful, as we have seen detailed above. If you happen to be in a category of patient for which a highly successful treatment exists, you'd be mad to say, oh, medicine isn't worth it, I'll just go eat an apple.

So is the author of the economic study really suggesting that we stop treating type I diabetes, or hypertrophic cardiomyopathy, or appendicitis, or asthma, or doing cardiac bypasses, or kidney transplants, or treating cancers with a good prognosis on treatment?

I wonder if he even thought about it in those terms?

Rolfe.

[Ducky]

Originally posted by Rolfe
I think I'm missing something, but I'm reasonably content to accept that I'm missing something....

With Shipman the deaths occurred over a long period of time. So I suppose I was wondering, if the people who should have died this year had already been killed two years ago, then there's room in there for him to kill the ones who would have died in two years time now, and not muss the figures.

I think maybe I'm missing your "population norm".

But still, how could the people he killed who were obviously dying at the time possibly figure in the statistics of "excess deaths"?

Back on topic, looking at it simplistically, I'd expect better public hygiene to improve life expectancy, not "reduce the death rate", though I could see that under certain conditions of measurement these two things could be the same.

Even more back on topic, I could well imagine that a lot of money spent on healthcare could be seen as a waste - for example, the aggressive interventions in a cancer patient who only has a few months to live in any case. Nevertheless, in certain circumstances medical interventions are spectacularly successful, as we have seen detailed above. If you happen to be in a category of patient for which a highly successful treatment exists, you'd be mad to say, oh, medicine isn't worth it, I'll just go eat an apple.

So is the author of the economic study really suggesting that we stop treating type I diabetes, or hypertrophic cardiomyopathy, or appendicitis, or asthma, or doing cardiac bypasses, or kidney transplants, or treating cancers with a good prognosis on treatment?

I wonder if he even thought about it in those terms?

Rolfe.


I had to be on public assistance to pay for my surgery and treatment of solitary plasmacytoma of bone. It was life threatening (if left alone) and I recovered (so far.) While I wholeheartedly agree someone with 5 months left to live with a brain tumor isn't showing a good chance of improvement, I would say there should be nothing less than every treatment possible to extend their life. That's not economically viable, but then if I were that patient I wouldn't care. what is the price on extending life?

At the same time, when proven methods are tried and fail, then, yes make them comfortable and let them live the rest of their short life. The hail mary pass should only be instituted (in terms of cost) when there is a good chance of improvement.

So, by this paper's logic, the 500K spent sawing me in half, removing a tumor, building a new vertibrae out of my rib, surrounding it in a titanium cage, and using titamium bolts and rods to fuse the surrounding vertibrae and subsequent radiation treatment were a waste economically? I can walk now, I have returned to work, and can function toward my own and society's improvement.

Are we saying that the numbers can't take into account the addition of funds from taxes from those recovered? Or that their life is worth a bottom line?

I am a bit confused by all of this, really. Yes there is a need to economic feasibility on health care, and yes the US system is beginning to fail, but how exactly are we quantifying life in economic terms?

[Hydrogen Cyanide]

Originally posted by Rolfe
..
But still, how could the people he killed who were obviously dying at the time possibly figure in the statistics of "excess deaths"?

Back on topic, looking at it simplistically, I'd expect better public hygiene to improve life expectancy, not "reduce the death rate", though I could see that under certain conditions of measurement these two things could be the same.

...snip..

So is the author of the economic study really suggesting that we stop treating type I diabetes, or hypertrophic cardiomyopathy, or appendicitis, or asthma, or doing cardiac bypasses, or kidney transplants, or treating cancers with a good prognosis on treatment?

I wonder if he even thought about it in those terms?

Rolfe.

This was my problem with the whole topic title and the "emperical evidence" presented: too general. The OP made a broad statement, gave a couple of oblique references to insurance cost without any understanding of the complexity of medicine in the first place.

If one were to try to actually cut deaths, they need to look at the statistics, like http://www.disastercenter.com/cdc/. Using the stats in that and if we used the same broad brush of generality without looking at the full complex reality the best way to prevent death would be to keep EVERYONE under the age of 45 away from motor vehicles. (note: accidents account for the largest number of deaths in the 44 and under group, with motor vehicles accidents being the most for those between 5 and 44).

[Rolfe]

Well, the OP wasn't quite hit and run, but I see no attempt by the poster to defend the position he seemed to be supporting.

Rolfe.

[Hydrogen Cyanide]

Actually I think he/she did not quite understand the level of evidence used in Sci/Math/Med/Tech.

We really are not that mean... we just want the details.