From: CurtAdams@aol.com
Date: Sat Apr 03 1999 - 10:40:19 MST
In a message dated 99-04-02 15:04:21 EST, hanson@econ.berkeley.edu (Robin
Hanson) write:
> Two decades ago ~$50 million was spent on a
> randomized trial among 5000 people over 2-3 years, some of which got 1/3
> more medical care than the rest. The only differences found were corrected
> vision via glasses, more filled teeth cavities, and lowered blood pressure
> among the poor (which may be a placebo effect).
Or may not. Poorer people tend to get cheaper and less effective bp
medication
(diurectics rather than ACE inhibitors). Cheaper doesn't always mean worse
in the era of drug salespeople but in this case it does.
I do recall a study (sorry, can't find the reference) of Christian Scientist,
who
refuse most medical treatment. The study found that the loss of medical
treatment reduced their lifespan about 7 years.
I would suspect that medical care that really makes a difference probably gets
to almost anybody. Added money would mostly go to optional or speculative
treatment; that might well not improve mortality.
It's implausible that the medicine we get (as opposed to additional treatment
we
don't normally get) doesn't help. People get things like appendicitis,
pneumonia
in the young, and gangrene which were major risks in the past but very rarely
die of them. There's no question that trauma treatment reduces risk of death
as well. At the same time a lot of medical treatment doesn't help mortality.
Randomized studies have shown a mortality benefit for coronary bypass for
the left main and LAD arteries but no benefit for angioplasty (it helps
symptoms
only).
> A recent analysis of 5
> million Medicare patients, using regional spending variations of a factor
> of two (controlling for lots of stuff), found that any mortality benefit of
> spending in the last six months of life is less than a one part in a
> thousand.
That sounds like a biased sample. People who die within six months are
people for whom treatment has failed. If medical treatment works, they
won't show up in the sample. Am I missing something?
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