Friday, 30 May 2008

"Only" two percent?

I notice so called "cancer experts" are in the news this morning -- something that happens regularly when something as important as health care is politicised.  I'm not going to comment on that case this morning, or on what happens when health care is politicised, at least not directly; I'm going to tell you a brief story about some of the "cancer experts" in our government hospitals.

As some of you know, our friend and fellow blogger Annie Fox had a cancer last year that everyone thought would kill her.  It didn't.  After treatment, about which there can be no complaint, she underwent a year of full-body scans and tests and post-treatment observation to make sure the treatment had been successful.

Early last week she got the all-clear.  She was told the treatment programme had been successful, and apart from regular visits to keep an eye on the cancer, she was fine. 

She didn't even have time to celebrate.  She collapsed that same afternoon with a seizure, and was rushed into hospital. 

Turns out that despite the assurances of her "experts" she had a tumour the size of a large marble lodged in her brain.  Turns out that those 'full-body scans' to check against the development of other cancers in the body didn't include the head.  Why?  Because, her family were told when they met with the quacks to find out, "only two percent" of cases like these result in metastases in the brain ... so they don't bother.

Two percent.  So they don't bother.  Too bad if you or one of your loved ones is one of those two-percent, eh?

People buy lottery tickets and make significant long-term investments based on lesser odds than those, but in "our" government hospitals having a two-percent chance (it's only two-percent, eh) means you get tossed in the medical wastebasket.

You can say that such aggregating of averages is justified (it's only two percent of cancer patients, after all -- fuck 'em).  You can say that the health system can't afford such profligacy (if we ration the amount of scanning done, we'll fit under our 'budget cap.' And what about those unfortunate two percent? Oh, fuck 'em).  You can even say that the scanning of heads should be minimised due to the risk of scanning the brain -- but, even then, why in hell wouldn't you set up 'proxies' that give you and the patient some idea about what's going on:  Proxies paying special attention to symptoms that commonly develop when a person contracts a brain tumour, however minor -- headaches, loss of balance, loss of control of some motor functions, problems with vision, insomnia.  Why wouldn't you advise a patient that if any of these did occur they should get their arses back into the quack's office for further investigation?

Why wouldn't you do that?  Frankly, I have no idea.  After all, I ain't the "expert" here.

Like I said, I'm not going to comment this morning on what happens when health care is politicised, at least not directly.  But I have shown you just one story showing what happens when the delivery of health care is decided by rationing.


  1. A close relative who died last year had the "all clear" with cancer, died a few months later from an unrelated condition, and the autopsy showed it was far from clear. The chemo had been stopped because she was sick one week, and the hospital delayed renewing it for many weeks.

    A friend died of cancer that hadn't been checked for after a heart attack, he was given the all clear until his doctor noticed a lump adjacent to the heart - by then it was too late.

    Don't forget ACC protects the entire NZ medical profession from being sued for negligence. No other country that I know of has this absurdity - and all parties in Parliament support the status quo, doctors can only be sued for exemplary damages, and that is quite a case to build.

    I'm sick of people worshipping the glorious public health system - it gets many things wrong and people die, and it is about incentives not money.

  2. Elijah Lineberry30 May 2008, 11:00:00

    I am shocked by this post, Peter, gosh this is awful.

    Is Anna out of hospital as yet?

  3. This is what happens when the Socialists take control. Education produces stupidity, welfare produces poverty, and health produces death.

  4. This post shows what happens when an instrument called the statistical life value is ignored. Statistical life value is inferred from the rate of compensation for life risk in labour markets. It is not a value for any one person's life. It is a threshold below which safety and health is worth investing in, otherwise not.

    The politically correct do not like valuing life like this, saying that putting a dollar value on anyone's life is immoral.

    But who cares if it saves lives, and undoubtedly it does when when applied.

    Using statistical life value means adopting the following rule: adopt all health and safety measures which save lives at or below the statistical cost of a life. Do not do the things that do not.

    The upshot of placing a dollar value on life is that for any given investment in health and/or safety, more lives will be saved, because the most life-saving measures will be done first, less effective measures later or not at all.

    Here is what is outrageous about the performance of the health system as described in this post: it put a very low value on Annie's life. Work it out: if 2% of patients have a brain metastases, and, say, 20% of those are fatal, and the extra cost of checking the head is, say, $2000, you get an implied value of 2000/.02/.2 = $500,000. Much less with less conservative assumptions.

    US statistical life value is in the order of US$7,000,000.

    The government would save many lives by explicitly adopting policies based on statistical life value, and abandoning policies that do not meet this test. I imagine the rate at which smoking ads and most recent air emission rules save lives implies billions of dollars per life saved, while people like Annie have treatment they need quite unjustifiably withheld.

  5. My late two cents: NZ has one of the worst survival rates for cancer. Maybe that isn't well known. I think we're number 49 on the WHO list.

    If I or someone on my family gets cancer, it's the first plane out.


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