Most people are quite skeptical when I tell them the standard estimate is near zero for the marginal effect of medicine on health. While they grant that much of medicine may be useless, they point to particular cases where medicine was helpful, and can’t imagine much of it being harmful. But as I posted in November:
"The studies of colonoscopies DO include the costs, in that they have looked at total cancer rates for people who do and do not get the procedures. They have observed that people who recieve colonoscopies have a lower overall risk of dying from colon cancer."
The only results from comparing screened versus unscreened patients show MARGINAL (or even ZERO) decreased risk of colorectal cancer. What's more, the SCREENED groups had a higher ALL-CAUSE mortality rate. Read that last part again.
To clarify: I don't mean to say the goal is maximizing bad cuts to spending and minimizing good cuts to spending; I mean maximizing cuts to bad spending and minimizing cuts to good spending. This should be obvious from context, but I apologize for the ambiguous grammar.
My uncle is a doctor; my father is a doctor; my mother was a doctor, now retired, who battled with major health issues; I have battled with major health issues myself.
Based on a (relatively speaking) very large body of anecdotal evidence based on personal experiences and conversations with my family, my conclusion is that the basic level of health education among the general populace is low enough that people don't actually know when they should seek professional medical care; this means that cultural traditions are the primary factor in overall medical spending. Medicine has no real incentive to turn away people who don't really have a problem - or at any rate, a problem that medicine is good at - so if more treatment is kind of a wash, well... the treatment-provider now has more money. It would take EXTREMELY STRONG evidence - not just PRETTY GOOD evidence - that treatment was a complete waste of time in order to overcome this monetary incentive to provide treatment. And while it seems to be getting better, historically over the last few decades there has been a very strong incentive to run lots and lots of tests or risk a malpractice lawsuit (in short: "malpractice is not about medicine"). On the other hand, the medicine applied to myself and my mother (in most fields) has been remarkably effective; I attribute this to the fact that we are familiar enough with basic medical principles to judge when a problem is worth investigating with the help a medical professional.
If you will entertain the above notion for a while, this explains why medicine can seem so darn marginally useless despite the massive amounts of money and research pumped into it: bad decisions are drowning out the good ones. This would indeed probably be improved by cutting medical spending nation-wide in half by forcing people to be more economical about medicine, but if you want an even bigger improvement in good-to-bad spending ratio - if you want to really maximize bad spending cuts while minimizing effective spending cuts - then a more productive approach may be to increase general education in medicine.
From someone who will have a medical degree in a few months, my best guess is that the "zero marginal benefit from increased medical care" is correct, or close to it.
I would even go one step further: after removing antibiotics, vaccines, prenatal care, and care for traumatic injuries from the calculus, I would expect that the net benefit from all other care is close to zero. Or, at least, that it pales in comparison.
The studies of colonoscopies DO include the costs, in that they have looked at total cancer rates for people who do and do not get the procedures. They have observed that people who recieve colonoscopies have a lower overall risk of dying from colon cancer. So even positing that the loss of GI flora has some contribution to increasing risk (of which I am very skeptical), the total cost/benefit ratio is still in favor of benefit - ie, lower cancer risk.
Whether or not these benefits are worth the FINANCIAL cost of colonoscopies on the medical system is another questions altogether...
Also, people have been getting cancer for much longer than Americans have been fat and lazy. Most are caused by genetic predisposition, viruses, alcohol, or smoking, or are idiopathic (ie, bad luck). Models that I have read that attempt to break down the various contributing factors for cancer predisposition have tended to find only small contributions (<10%) of diet and lifestyle (besides smoking and alcohol).
Doctors already need to have a very high amount of information packed into their brains. It is not plausible to require that we should have exact quantitative knowledge about the size of an effect. For medical practice, it is sufficient for to know that "Current clinical guidelines are to avoid CT scans unless necessary, because experts suspect it causes cancer". This is what I should have suggested that 100% of doctors "know". I don`t think this is an illusion of expertise, but a good heuristic for everyday practice.
I take the claim to be this: Most people think that it would be good if we had the resources to spend more on medicine while not spending less on anything else. Robin is saying, No, even ignoring opportunity costs, more resources spent on medicine would do us direct harm.
Most people are quite skeptical when I tell them the standard estimate is near zero for the marginal effect of medicine on health.
Stupid question: isn't that how it's _supposed_ to work for *anything*? IOW, it's optimal to spend resources on something *until* the marginal net benefit is zero, right? Where MC = MB?
If you don't know how much something increases cancer, you don't know whether it increases cancer. Seriously, you might as well not know anything as have a piece of nonquantitative knowledge like that; it is the pure illusion of expertise.
Consider eating some yogurt BEFORE!!!Seriously... why do you think people get cancer? Usually because of how they live and eat!I agree, meds are usually more harmful than useful and even though prophylactic treatments, tests and scans do actually really pose different kinds of risks, so do other things, like flying. you usually get a whole lot more radiation that way.But the real problem here is that people rely on test, scans, meds etc. to get their illness detected and to get well. Unfortunately that's not how it works. Even if there were no dangers connected with those it would still leave the patient in an effect position. To be causative, you just have to adapt a very healthy lifestyle and a very healthy diet. it's actually a lot of fun, too and I've never seen anyone who lived that way getting colon cancer etc.!
I am much more skeptical of your ability to off-handedly assess your classmates than of the study you link. Sure, call the medical school in the study "incompetent" but that is quite compatible with it being of average competence. Similarly, invoking the knowledge of the top surgeon does not distinguish between 9% and 90% (though it suggests your medical school is not typical). Also, studies show that typical doctors cannot turn statistical knowledge into false positive rates.
One indirect "harm" of medicine is that people would rather take a pill than take care of themselves.
So blood pressure meds, cholesterol meds, etc take the place of actually taking care of one self. Regardless of how effective the meds really are since people will routinely try one drug after another (and be on several meds for several conditions simultaneously).
Seems you are suggesting I stop posting on med media reports unless I've read and judged the original research myself? I accept that you have reasonable doubts about the conclusions, and don't like that they didn't give a citation. I surely didn't mean to claim that all radiologists know about radiation is only one media article; not sure where you get that from.
"The studies of colonoscopies DO include the costs, in that they have looked at total cancer rates for people who do and do not get the procedures. They have observed that people who recieve colonoscopies have a lower overall risk of dying from colon cancer."
The only results from comparing screened versus unscreened patients show MARGINAL (or even ZERO) decreased risk of colorectal cancer. What's more, the SCREENED groups had a higher ALL-CAUSE mortality rate. Read that last part again.
Colonoscopies are a sham. Period.
To clarify: I don't mean to say the goal is maximizing bad cuts to spending and minimizing good cuts to spending; I mean maximizing cuts to bad spending and minimizing cuts to good spending. This should be obvious from context, but I apologize for the ambiguous grammar.
My uncle is a doctor; my father is a doctor; my mother was a doctor, now retired, who battled with major health issues; I have battled with major health issues myself.
Based on a (relatively speaking) very large body of anecdotal evidence based on personal experiences and conversations with my family, my conclusion is that the basic level of health education among the general populace is low enough that people don't actually know when they should seek professional medical care; this means that cultural traditions are the primary factor in overall medical spending. Medicine has no real incentive to turn away people who don't really have a problem - or at any rate, a problem that medicine is good at - so if more treatment is kind of a wash, well... the treatment-provider now has more money. It would take EXTREMELY STRONG evidence - not just PRETTY GOOD evidence - that treatment was a complete waste of time in order to overcome this monetary incentive to provide treatment. And while it seems to be getting better, historically over the last few decades there has been a very strong incentive to run lots and lots of tests or risk a malpractice lawsuit (in short: "malpractice is not about medicine"). On the other hand, the medicine applied to myself and my mother (in most fields) has been remarkably effective; I attribute this to the fact that we are familiar enough with basic medical principles to judge when a problem is worth investigating with the help a medical professional.
If you will entertain the above notion for a while, this explains why medicine can seem so darn marginally useless despite the massive amounts of money and research pumped into it: bad decisions are drowning out the good ones. This would indeed probably be improved by cutting medical spending nation-wide in half by forcing people to be more economical about medicine, but if you want an even bigger improvement in good-to-bad spending ratio - if you want to really maximize bad spending cuts while minimizing effective spending cuts - then a more productive approach may be to increase general education in medicine.
From someone who will have a medical degree in a few months, my best guess is that the "zero marginal benefit from increased medical care" is correct, or close to it.
I would even go one step further: after removing antibiotics, vaccines, prenatal care, and care for traumatic injuries from the calculus, I would expect that the net benefit from all other care is close to zero. Or, at least, that it pales in comparison.
The studies of colonoscopies DO include the costs, in that they have looked at total cancer rates for people who do and do not get the procedures. They have observed that people who recieve colonoscopies have a lower overall risk of dying from colon cancer. So even positing that the loss of GI flora has some contribution to increasing risk (of which I am very skeptical), the total cost/benefit ratio is still in favor of benefit - ie, lower cancer risk.
Whether or not these benefits are worth the FINANCIAL cost of colonoscopies on the medical system is another questions altogether...
Also, people have been getting cancer for much longer than Americans have been fat and lazy. Most are caused by genetic predisposition, viruses, alcohol, or smoking, or are idiopathic (ie, bad luck). Models that I have read that attempt to break down the various contributing factors for cancer predisposition have tended to find only small contributions (<10%) of diet and lifestyle (besides smoking and alcohol).
The statement below is false.
If you don’t know how much something increases, then you don’t know whether it increases.
I agree that I misused the word "know".
Doctors already need to have a very high amount of information packed into their brains. It is not plausible to require that we should have exact quantitative knowledge about the size of an effect. For medical practice, it is sufficient for to know that "Current clinical guidelines are to avoid CT scans unless necessary, because experts suspect it causes cancer". This is what I should have suggested that 100% of doctors "know". I don`t think this is an illusion of expertise, but a good heuristic for everyday practice.
I take the claim to be this: Most people think that it would be good if we had the resources to spend more on medicine while not spending less on anything else. Robin is saying, No, even ignoring opportunity costs, more resources spent on medicine would do us direct harm.
Most people are quite skeptical when I tell them the standard estimate is near zero for the marginal effect of medicine on health.
Stupid question: isn't that how it's _supposed_ to work for *anything*? IOW, it's optimal to spend resources on something *until* the marginal net benefit is zero, right? Where MC = MB?
Seriously, you might as well not know anything as have a piece of nonquantitative knowledge like that;
Epidemiologist claimed quantitative knowledge—in particular, that the effect was very likely not as large as indicated in the post.
If you don't know how much something increases cancer, you don't know whether it increases cancer. Seriously, you might as well not know anything as have a piece of nonquantitative knowledge like that; it is the pure illusion of expertise.
Consider eating some yogurt BEFORE!!!Seriously... why do you think people get cancer? Usually because of how they live and eat!I agree, meds are usually more harmful than useful and even though prophylactic treatments, tests and scans do actually really pose different kinds of risks, so do other things, like flying. you usually get a whole lot more radiation that way.But the real problem here is that people rely on test, scans, meds etc. to get their illness detected and to get well. Unfortunately that's not how it works. Even if there were no dangers connected with those it would still leave the patient in an effect position. To be causative, you just have to adapt a very healthy lifestyle and a very healthy diet. it's actually a lot of fun, too and I've never seen anyone who lived that way getting colon cancer etc.!
Those percentages sounded pretty low to me.
I am much more skeptical of your ability to off-handedly assess your classmates than of the study you link. Sure, call the medical school in the study "incompetent" but that is quite compatible with it being of average competence. Similarly, invoking the knowledge of the top surgeon does not distinguish between 9% and 90% (though it suggests your medical school is not typical). Also, studies show that typical doctors cannot turn statistical knowledge into false positive rates.
One indirect "harm" of medicine is that people would rather take a pill than take care of themselves.
So blood pressure meds, cholesterol meds, etc take the place of actually taking care of one self. Regardless of how effective the meds really are since people will routinely try one drug after another (and be on several meds for several conditions simultaneously).
Seems you are suggesting I stop posting on med media reports unless I've read and judged the original research myself? I accept that you have reasonable doubts about the conclusions, and don't like that they didn't give a citation. I surely didn't mean to claim that all radiologists know about radiation is only one media article; not sure where you get that from.