From: david gobel (davegobel@erols.com)
Date: Sat Apr 03 1999 - 22:22:55 MST
Hi
Robin Hanson said...
>Amazingly enough, researchers have yet to measure a significant aggregate
effect of medicine (doctors, etc.) on health.
This does not surprise me. Most medicine is practiced after homeostasis is
breached...this places medicine in the position of trying to catch horses
who've already run out the barn door. From a system analysis standpoint,
it's a SILLY point on the event curve to try to fix things.
>Sure there are lots of clinical studies purporting to show the benefits of
various treatments. But clinical trials tend to study best practice on
patients mostly likely to benefit. Negative results tend not to be
published, and the vast majority of medical practice has yet to be studied
with clinical trials.
There are currently two styles of medicine, preventive, and
reactive/allopathic. The preventive approaches are a net negative economic
factor to the medical industry. Sickness is what creates money events for
medicine. Health makes them no money. Dentists have LOST money due to
fluoride...and I've talked to a few who literally lament the days when they
could go "drilling for dollars". Business is business. For my own health, I
spent practically nothing on sickness treatment, and personally spend appx
$50 a month for nutrition, weight training etc. My wife and son on the other
hand are both cash cows in that they take weekly allergy shots. This costs
me about $5,000 a year. What incentive is there for medical science to
eliminate this "cure" with a final real cure? NONE. They LIKE my money.
Insurance spreads the COSTS but does not affect behavioural CONSEQUENCES.
Insurance makes healthy people feel and be less responsible for their own
health...thus reducing incentives to prevent problems...thus leading
statistically to a less healthy population. Has anyone done a study of
health/mortality rates on those who self insure via MSAs (medical savings
accounts) versus general health insurance? I would bet a ton of money that
general health insurance would be shown to HARM health when compared with
MSAs.
So, just as oil conservation seemed a stupid idea until oil SOURCES were
significantly (albeit artificially) reduced in the '70s, until AVAILABILITY
of medical care is constrained, there is NO instantaneous nor sustained
social/economic pressure to conserve health. If significant medical costs
were borne by individuals as was the case in the past, economic pressure
would be brought to bear within families to stay healthier.
Medical science is often based on great big arm waving general statistical
vagueries...so much so that it can take 40 YEARS to establish that - oh
yeah - cigarettes are bad for you after all. By the way...has anyone ever
done a study to see if the placebo effect occurs because people are drinking
more WATER to take the fake pill?
:
:
J Am Diet Assoc 1999 Feb;99(2):200-6
Water: an essential but overlooked nutrient.
Kleiner SM
Nutritional Sciences Program, University of Washington, Seattle, USA.
Water is an essential nutrient required for life. To be well hydrated, the
average sedentary adult man must consume at least 2,900 mL (12 c) fluid per
day, and the average sedentary adult woman at least 2,200 mL (9 c) fluid per
day, in the form of noncaffeinated, nonalcoholic beverages, soups, and
foods. Solid foods contribute approximately 1,000 mL (4 c) water, with an
additional 250 mL (1 c) coming from the water of oxidation. The Nationwide
Food Consumption Surveys indicate that a portion of the population may be
chronically mildly dehydrated. Several factors may increase the likelihood
of chronic, mild dehydration, including a poor thirst mechanism,
dissatisfaction with the taste of water, common consumption of the natural
diuretics caffeine and alcohol, participation in exercise, and environmental
conditions. Dehydration of as little as 2% loss of body weight results in
impaired physiological and performance responses. New research indicates
that fluid consumption in general and water consumption in particular can
have an effect on the risk of urinary stone disease; cancers of the breast,
colon, and urinary tract; childhood and adolescent obesity; mitral valve
prolapse; salivary gland function; and overall health in the elderly.
Dietitians should be encouraged to promote and monitor fluid and water
intake among all of their clients and patients through education and to help
them design a fluid intake plan. The influence of chronic mild dehydration
on health and disease merits further research.
:
:
Additional factors against preventive approaches. Personal noncompliance
over time (I used to take vit e...c...b..coQ10 etc. but I got bored with
it...I used to do caloric restriction, but it was too hard....
>The apparent low health value of medical care is all the more striking
given that we spend 14% of GDP on it in the U.S.
a couple of studies on where much of the 14% of gdp does to...
J Clin Epidemiol 1997 Dec;50(12):1319-26
Proportion of hospital deaths associated with adverse events.
Garcia-Martin M, Lardelli-Claret P, Bueno-Cavanillas A, Luna-del-Castillo
JD, Espigares-Garcia M, Galvez-Vargas R
Department of Preventive Medicine and Public Health, School of Medicine,
University of Granada, Spain.
OBJECTIVES: To determine the fraction of hospital deaths potentially
associated with the occurrence of adverse events (AE). DESIGN: A paired
(1:1) case-control study. SETTING: An 800-bed, teaching tertiary care
hospital. PATIENTS: All patients older than 14 years admitted to the
hospital between January 1, 1990, and January 1, 1991, were eligible. All
524 consecutive deaths (death rate of 3.74%) that occurred in the hospital
comprised the case group. For each case, a control patient was matched for
both primary diagnosis on admission and admission date. MEASUREMENTS: The
proportion of hospital deaths associated with adverse events (defined as
problems of any nature and seriousness faced by the patient during
hospitalization, and potentially traceable to clinical or administrative
management) was estimated from attributable risks adjusted for age, sex,
service, severity of illness, length of stay, and quality of the medical
record. RESULTS: For stays longer than 48 hours, the adjusted attributable
risk for all adverse events was estimated to be 0.51 (0.40-0.61). When the
data were stratified according to the category of adverse event, the
attributable risks remained significant except for administrative problems.
The greatest proportion of deaths associated with adverse events was
observed for surgical adverse events [0.56 (0.38-0.71)] and nosocomial
infection [0.22 (0.14-0.28)]. CONCLUSIONS: A significant proportion of
intrahospital deaths were associated with AE. These results suggest the need
to consider programs focused on the prevention of mortality from AE
-------------------
Adverse drug events in hospitalized patients. Excess length of stay, extra
costs, and attributable mortality.
Classen DC, Pestotnik SL, Evans RS, Lloyd JF, Burke JP
Department of Clinical Epidemiology, LDS Hospital, Salt Lake City, UT 84143,
USA.
OBJECTIVE: To determine the excess length of stay, extra costs, and
mortality attributable to adverse drug events (ADEs) in hospitalized
patients. DESIGN: Matched case-control study. SETTING: The LDS Hospital, a
tertiary care health care institution. PATIENTS: All patients admitted to
LDS Hospital from January 1, 1990, to December 31, 1993, were eligible.
Cases were defined as patients with ADEs that occurred during
hospitalization; controls were selected according to matching variables in a
stepwise fashion. METHODS: Controls were matched to cases on primary
discharge diagnosis related group (DRG), age, sex, acuity, and year of
admission; varying numbers of controls were matched to each case. Matching
was successful for 71% of the cases, leading to 1580 cases and 20,197
controls. MAIN OUTCOME MEASURES: Crude and attributable mortality, crude and
attributable length of stay, and cost of hospitalization. RESULTS: ADEs
complicated 2.43 per 100 admissions to the LDS Hospital during the study
period. The crude mortality rates for the cases and matched controls were
3.5% and 1.05%, respectively (P<.001). The mean length of hospital stay
significantly differed between the cases and matched controls (7.69 vs 4.46
days; P<.001) as did the mean cost of hospitalization ($10,010 vs $5355;
P<.001). The extra length of hospital stay attributable to an ADE was 1.74
days (P<.001). The excess cost of hospitalization attributable to an ADE was
$2013 (P<.001). A linear regression analysis for length of stay and cost
controlling for all matching variables revealed that the occurrence of an
ADE was associated with increased length of stay of 1.91 days and an
increased cost of $2262 (P<.001). In a similar logistic regression analysis
for mortality, the increased risk of death among patients experiencing an
ADE was 1.88 (95% confidence interval, 1.54-2.22; P<.001). CONCLUSION: The
attributable lengths of stay and costs of hospitalization for ADEs are
substantial. An ADE is associated with a significantly prolonged length of
stay, increased economic burden, and an almost 2-fold increased risk of
death.
If you really want to get convinced to stay out of hospitals, look up
nosocomial infection, adverse, hospital, mortality as key words in medline.
You may find as it seems to me that appx 1% die in hospitals due to BEING at
the hospital. Imagine if you were to ask the FDA if you could sell a drug
that KILLED one in a hundred?
dave gobel
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