and therefore your comment is incorrect: "If docs are especially bad at treating cancer, then we would expect those who use docs more to do worse at cancer. And in fact women, the rich, and the well educated do worse at cancer". These groups have improved survival with regard to cancer mortality. Even if you meant to say that the cancer mortality RRR was higher relative to the other RRR's with regards to the above populations, it does not negate the fact that it is still a risk reduction. Therefore, if your willing to make the speculation that these statistics are explainable by physician use, then you have to conclude that physicians are effective at treating cancer, just not as effective as they are at treating heart disease. You have a very narrow interpretation of your very broad population statistics and fail to recognize the simplest of rules for interpreting statistics. Correlation is not causation. If you really want to study the efficacy of cancer treatment, you first need to study each cancer individually, and second, only an RCT will provide you with direct evidence.

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I first glossed this as "Death causes correlations."

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The facile analysis that Robin is presenting is fatally flawed by the Ecological Fallacy the assumption that the average individual in the group has the characteristics that are the average of the group.


If you have heart disease, treatment for cancer isn't going to help your heart disease and treating you for cancer when you have heart disease is (very likely) going to kill you faster. But that is not how medical care is delivered. Making that assumption is completely nonsensical.

An even bigger problem is that the expenditures are per capita. Money an insured rich person spends on expensive boner pills doesn't keep an uninsured black person with hypertension from getting heart disease from poor blood pressure control due to lack of cheap meds for blood pressure control.

With a large disparity in health expenditures, increasing health spending by increasing the expenditures of individuals with health care that are already at the margin won't improve their health. To improve health money needs to be spent on individuals below the margin. Lee does cite Canadian data that shows improved health with increased expenditure.


It is really strange to me that a PhD thesis does all this analysis and doesn't mention (or consider?) the ecological fallacy and that Robin comes up with truly strange ideas that more health care kills more people. It is almost like he is trying to find an excuse to limit what other people spend on health care for their own good.

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I don't understand why you find this disturbing. Suppose that doctors had no effect at all on cancer, but some effect on cardiovascular troubles. Then when you put more money into doctors, you would prevent some deaths from heart attacks, and cancer would eventually get those people - they are still going to die of something! So you would get an increased rate of cancer and a higher lifespan.

So what you're seeing is that cancer is the most intractable of medical problems, and presumably also the place where we get the least return to our research and medical efforts; but why is this disturbing? One field or another has to be the worst! If the effect were reversed, and cancer was now relatively easily treatable but we couldn't do much about heart attacks, would that be a problem?

Now, if you can show that the situation from my hypothetical holds, and that the effect of doctors on cancer is literally zero, then yes, we have a problem: We're wasting a lot of money. But if you are merely saying that the return on our investment has been less in this field, oh well.

Actually, I guess my threshold for saying "We have a problem" is not that the effect be literally zero; if you can show that the return from investing X dollars in cancer research or treatment has been, say, one-tenth what we got from the same money elsewhere, then that's a problem too. But merely showing that cancer is the most stubborn medical problem does not demonstrate this.

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does married life prevent contagion compared with single life?

1. Married couples may stay home more, reducing exposure.

2. A spouse will push someone to go see a doctor earlier than a single person will go in on his/her own.

(Or at least that's how it works in my life . . .)

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"does married life prevent contagion compared with single life?"Another opportunity to link to Paul Ewald on infection! If lots of diseases are spread amorously, monogamy can be safer.

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Females do better than males on cancer, but not as well as they do on non-cancer, relative to males. Same for rich, educated.

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Are all odds ratios greater than 1 indicating an increased risk of that type of death? Your statements on rural and poor areas suggest this, but by that measure females, the educated and the rich all do better on cancer.

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