From: Michael S. Lorrey (mike@lorrey.com)
Date: Sat Apr 03 1999 - 11:46:16 MST
CurtAdams@aol.com wrote:
>
> 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'd expect that most of the benefits of health care are not being
measured here. For example, I don't see any mention of cosmetic effects
(i.e. that leg you broke as a kid left you with a huge lump where the
bone healed unevenly cause you set it yourself, etc) or of changes in
ambulative ability.
Additionally, it is not measuring how improved health care is offsetting
the much more unhealthy living practices of today's person vs. a century
or two ago. People living today in civilized countries are for the most
part in far worse condition in terms of physical fitness. People also
are far more likely to die of traumatic accidents or drug use. The
healthier people take more risks. The most dangerous time to die of a
car accident is at age 16, which puts a nice damper on the stats long
before one reaches old age. This blip is a recent phenomenon.
Moreover, I don't see how you can look at the differences in average
life expectancy from country to country without seeing some definite
benefit to modern health care. The effects on the infant mortality rates
alone are phenomenal.
> 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?
You are forgetting that the group "Medicare patients" already asserts a
filter to a specific set of demographics which could very well gain
little from improved health care, while the rest of the population may
see significant benefits.
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