Robin Hanson said...
>Amazingly enough, researchers have yet to measure a significant aggregate
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.
effect of medicine (doctors, etc.) on health.
>Amazingly enough, researchers have yet to measure a significant aggregate
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 Negative results tend not to be published, and the vast majority of medical practice has yet to be studied with clinical trials.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.
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
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?