Re: Is Medicine Healthy?

Robin Hanson (
Mon, 05 Apr 1999 12:24:15 -0700

At 05:19 PM 4/3/99 -0500, you wrote:

>>>It's implausible that the medicine we get (as opposed to additional
>>>treatment we don't normally get) doesn't help. People get things like
>>>appendicitis, pneumonia in the young, and gangrene which were major risks
>>>in the past but very rarely die of them.
>>Sure we are lots healthier now than in the past. The question is how much
>>credit medicine deserves for that. Lots of other things have changed
>>besides medicine.
>That's why I picked those. Gangrene and appendicitis still have nearly
>100% mortality if not treated. Pneumonia is generally survivable by the
>young but still often lethal if not treated.

The question here is about the marginal health consequences of medicine, *averaging* over all the things medicine does. Some things may help, but when averaged in with other things that hurt, the average could be zip.

>>>>A recent analysis of 5 million Medicare patients, using regional
>>>spending variations of a factor of two (controlling for lots of stuff),
>>>>found that any mortality benefit of spending in the last six months of
>>>>life is less than a one part in a thousand.
>>>That sounds like a biased sample. People who die within six months are
>>>people for whom treatment has failed. If medical treatment works, they
>>>won't show up in the sample. Am I missing something?
>>It is a random sample of all Medicare patients. It looks at 5000 hospital
>>regions in the country, and predicts total mortality in each region from
>>a long list of features, one of which is how much is spent there in the
>>last six months of life.
>I wouldn't expect survival from a specific cause to be related to
>last-six-months spending; treated survivors are excluded while patients with
>other disease are included. ... My concern with excluding survivors remains.

This study looks at total mortality in each region, and everyone in a region eventually dies. Everyone also has some spending level in their last six months. I don't see a selection bias here.

>Statistical significance is a real problem with medical studies;
>some require hundreds of thousands of patients.

The figure I gave you, of less than one part in a thousand mortality benefit, was a 95% confidence level figure. 5 million people is enough to see real effects. Consider also that people have seen effects of fat, excersize, social status, etc. with far less data.

Robin Hanson   
RWJF Health Policy Scholar             FAX: 510-643-8614 
140 Warren Hall, UC Berkeley, CA 94720-7360 510-643-1884 after 8/99: Assist. Prof. Economics, George Mason Univ.