Overcoming Bias

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Beware Cancer Med

www.overcomingbias.com

Beware Cancer Med

Robin Hanson
May 23, 2011
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Beware Cancer Med

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Chapter 2 of Ken Lee’s thesis compares med spending and age-adjusted deaths across the 50 US states from 1980 to 2007. Lee’s baseline model finds that deaths increases with smoking use, alcohol use, population density, and med spending: a 10% increase in med spending increases deaths by 0.85%. Breaking down this med spending death effect by drug vs. non-drug spending, and by four causes of death (cancer, heart attack, injury, and other), Lee finds (in Tables 5,6) that med spending hurts mainly because increasing non-drug med spending by 10% increases cancer deaths by 2.1%:

Cause of Death, Drug vs Non-Drug Med Spending

The apparent lesson: avoid cancer docs, and especially their non-drug cancer treatments. It seems some places tend to spend more on med overall, and when they spend more on cancer patients, those patients die no less, and maybe more. That fits with cancer patients living longer when they go to hospice and get no cancer treatment and with randomized trials of cancer screening consistently showing no effect on total mortality. Other explanations, however, are that high med spending places tend to classify more deaths as due to cancer, or that med treatment of all sorts tends to cause cancer.

For you stat whizzes, Lee uses state and year fixed effects, and uses per capita physicians, beds, and dental spending as med spending instruments to disentangle the direction of causation.  He picked that instrument set because it had the smallest bootstrap variance, and passed many tests. Here is Lee’s baseline model (from Table 3):

KenLeebase
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Beware Cancer Med

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Beware Cancer Med

www.overcomingbias.com
Overcoming Bias Commenter
May 15

If you look at table 9 in this

http://198.246.98.21/nchs/data/nvsr/nvsr56/nvsr56_10.pdf

Deaths: Final Data for 2005

The death rate for diseases of the heart in 85 and older is ~3x higher than the death rate for neoplasms in the same age group. The total death rate for the entire population for heart disease and neoplasms is only different by ~10%. There are many more heart disease deaths in the above 85 group than there are cancer deaths in the above 85 group. In the below 75 age group, the death rate from cancer is higher than the death rate from heart disease in every age group.

If you look at table 10, they have the actual numbers of deaths. What this shows is that:

For diseases of the heart there were 217,894 below age 75 and 434,197 above 75

For neoplasms there 309,436 below 75 and 249,876 above 75.

So more young people die of cancer than young people die of heart disease and more old people die of heart disease than die of cancer.

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Overcoming Bias Commenter
May 15

Sorry for the typo in second to last sentence .

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