Re: Vaccine efficacy

From: Robert J. Bradbury (
Date: Tue Feb 08 2000 - 08:54:18 MST

On Tue, 8 Feb 2000, Robin Hanson wrote:

> > > On the effect of medicine overall in the US, I point you to:
> > > Joseph P. Newhouse And The Insurance Experiment Group,
> > > Free For All? Lessons from the RAND Health Insurance Experiment,
> > > Harvard University Press, 1993, ISBN 0-674-31914-1
> >
> The book I cited is a summary of a 50M$ controlled experiment of 5000
> people over 3-5 years where some where randomly given free health care
> and others were instead given a small subsidy.

Robin, was this a government funded "experiment"?

> Those given free care incured ~30% more expenses, and yet had almost
> identical health.

Hmmmm, by that argument then, England should have a higher health
care bill per capita than the U.S., yes?

>From the description you give, I would say this is a poor source to
use in debates regarding vaccines for the following reasons.
First, I would presume that the study involved primarily adults
who have already been vaccinated or built up a natural immunity
to many diseases. You aren't accounting for the "sunk" costs
and benefits. Second, vaccines aren't a particularly expensive form of
health care so they aren't going to impact the costs very much.
Third, most vaccines may have health & longevity benefits that greatly
exceed the period of a 3-5 year study.

If I get a dyptheria or polio vaccination that keeps me from catching
the disease in 20-30 years (after I've been educated and am a productive
member of society) the payback has to be pretty large. Now that doesn't
occur very often I'll admit. The primary motivation for vaccinations
is to prevent the loss of life in children that have received a
substantial investment (monetary and emotional) from the parents.
The studies Cairns cites seems to show population declines of 20-30%
in the first 5 years of life. So to properly look at the issue of
vaccines you have to look at the "costs" of those deaths and the
degree to which they are prevented by vaccinations (vis-a-vis some
of the other death preventing developments we have discussed).
Then you have to compare those benefits to the infrequent deaths that may
be caused by vaccines and the actual costs of the vaccinations themselves.

If you are going to look at Medical costs, I think you have to look
at treatments on a case-by-case basis to determine whether or not
those treatments should be used. I'm under the impression that this
is what has been done in Oregon in determining what treatments are
covered and what treatments are not covered.

Finally, regarding the issue of health care costs, its generally
known that the elderly are the ones that are sucking up the $$$.
Some huge fraction of our health care dollars (20-30%???) goes
to support people in the last year of the lives. I think I've
mentioned to some people that this entire area needs to be rethought
in light of things like Cryonics, because at some point its going
to be cheaper for the government or insurance companies to pay
to freeze someone rather than attempt to keep them alive.


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