In my health care reform plan, I noted that back in 2008 or so, we spent more than 10 times as much as Mexicans on health care, yet Mexicans live nearly as long. How can the Mexicans, who suffer from all of the same junk food and obesity problems as Americans, live nearly as long without paying for the latest and greatest drugs and procedures? One possibility that I hadn’t considered is that the latest and greatest drugs and procedures are mostly worthless. That’s basically the message of an interesting article from The Atlantic, “Lies, Damned Lies, and Medical Science”. The author covers the work of John Ioannidis, a Greek doctor who found that most innovative medical procedures and drugs have not, in fact, been proven to be effective. “Why Most Published Research Findings Are False” is an example of Ioannidis’s work.
[Separately, the same issue of the magazine has a good article on the experience of our troops in Afghanistan. Maybe worthwhile to read before voting for politicians who continue to fund this war.]
See also “The Longevity Myth”, by Steve Salerno, Skeptic Magazine, Volume 15 Number 4 2010. Can’t find it online (somebody emailed me a PDF), but here’s an article about it. Bottom line, Salerno suggests that increases in US life expectancy at birth over the last century look impressive, but only because of a massive decline in infant mortality.
A point that it does not address is meaningful improvements in quality of life irrespective of mortality: Hip replacement can make that last decade of life a heck of a lot more pleasant.
Thanks, Matthew. I have had a long-standing debate with an old neighbor. My contention is that someone with access to a pharmacist, antibiotics, and vaccines plus the advice of a good physician from Roman times would live just about as long as a present-day American who followed the best practices as outlined in the New York Times, e.g., vitamin E, fish oil pills, flax seed supplements, yoga, etc.
That said, it won’t be long before I’m 70 and will be delighted to let hard-working young Americans buy me some new hips!
If you haven’t yet read it, I highly recommend Druin Burch’s “Taking The Medicine”. It’s a history of medicine, and makes a good case that it’s only very recently that you’ve been better off with the care of a doctor than without.
And my major takeaway from the book was that three things have contributed to human longevity in the last century and decade or three: Vaccines (late 1800s, early 1900s), antibiotics (middle 1900s), and stopping smoking (late 1900s). Pretty much everything else is noise in the signal.
One eye opener: At one point he claims that in the second half of the 20th century the simple act of quitting smoking will prolong a life as long as all of the other medical advances of those 50 years. If you do a little statistical cherry picking on how much life expectancy quitting smoking gives you versus how much additional work we have to do to fund the cost of modern medicine, you could almost come up with negative numbers.
Modern Medicine is a myth Americans like to believe in. It replaces tough lifestyle choices with a magical potion. Who wouldn’t want, that especially if someone else is paying for it?
It’d be nice if Dr. Ioannidis’s skepticism and scientific discipline could be applied to climate change, legal policies, parental advice, and so many other areas where the truth is elusive and the long term ramifications are huge.
Note: Dr. John [Ioannis] Ioannidis of Ioannina would be roughly translated in English as Dr. John Johnathan from the city of Johnathans.
Modern antibiotics (Clyndamycin in particular) possibly saved my life this February when my throat got taken over by bacteria of unknown nature. Modern emergency room medicine proved pretty effective, too.
So I have to echo the voices of Phil and Dan regarding the effectiveness of things like vaccines and antibiotics. I think it may make sense to divide “modern medicine” into 2 parts — the part that deals with responding to immediate injury or infection, and the part that deals with “chronic” problems like diabetes, arthritis, ADHD, depression, etc. To me it looks like part #1 is generally very effective (if expensive — my infection episode cost me $7000, would have cost ~5x that or about $35,000 if I had no insurance), while part #2 is the part that could be a fraud. (I can’t really express an opinion this point — will have to examine the links to John Ioannidis).
Another possibility is that, for every person modern medicine saves, there’s an equal and opposite person that it kills. I worked at a long-term acute care hospital – we would see things like people who had a hernia repair or a knee surgery, from which they contracted a nasty nosocomial infection, and soon they’re in renal failure, on a ventilator (from which they get VAP – ventilator associated pneumonia), etc. And then you have wonder drugs that turn out to do more harm then good – this happens all the time. Most recently, it turned out that the Bush-era blockbuster Avandia was causing heart attacks.
If people with access to health care are living as long as people without access to health care, despite all that, they have to be saving somebody.
This implies that you can benefit from medicine if you use it intelligently. For starters, don’t get elective surgery.
My then five year old daughter had a brain tumor. She almost certainly owes her life to modern medicine (craniotomy/resection/radiation). Prior to surgery she couldn’t keep any food down for a month, and had just gone crosseyed. She’s now 11 and we couldn’t be happier.
I’m biased, but I don’t quite buy ‘fraud’.
The key differentiation between modern and Roman medicine is the germ theory of disease vs. the Roman (Galen) theory that diseases were the result of humours (hot/cold, wet/dry). Sounds like you ascribe to this much.
Sure much medical spending is frivolous, and will be until it becomes totally impossible to support.
The recent legislation had many attempts to control costs (http://voices.washingtonpost.com/ezra-klein/2010/03/the_five_most_promising_cost_c.html). My understanding is that many of these were rendered toothless in the final mix (not being an unemployed lawyer, I am not clear on all the particulars). Assume a day of reckoning will arrive sometime.
These estimates on Roman life expectancy seem appropriate:
http://www.utexas.edu/depts/classics/documents/Life.html
Folks appeared to do quite well assuming they survived childhood.
C’mon Phil — you know enough statistics; you shouldn’t fall into this trap. (Maybe you need a refresher course; maybe http://aduni.org/courses/probability/ ) You should know that the Ioannidis paper is about statistics, only peripherally about science, and not at all about medicine. What Ioannides says is that if you’re in a domain where you expect only 1% of experiments to yield a positive result, and if you use a statistical technique that allows a 5% chance of random error, then you should expect that about 5/6 of your positive results are actually negative. Ioannides complains that such results get published anyway (which doesn’t actually do much damage) and that the press then picks them up (which does do damage in terms of public perception). [Also note that this is all theoretical–Ioannidis makes no attempt to decide which, if any, papers include incorrect conclusions.] But does this affect the practice of medicine? Not at all. In order to get approved, a treatment needs more than one positive study. What’s the chance, under these assumptions, that a treatment would get positive results 5 out of 5 times, given that it is actually ineffective? Well, it depends on how correlated the studies are, but if they are reasonable uncorrelated, then less than 1 in a million. Even to get 3 out of 5 positive results is around 1 in a thousand. So what Ionnides is saying is that lots of individual studies are wrong, but presents no evidence at all to claim that the process of medical decision-making is less than 99.9% effective.
Peter: Since the health care industry has access to an unlimited supply of federal tax dollars, it is mostly a matter of intellectual curiosity as to whether or not Ioannidis is correct. I didn’t link to the articles because I was sure that he has found the entire explanation for why the U.S. spends so much and achieves so little, but because I thought that the articles were worth reading.
Anecdotally, my doctor friends have changed their clinical practices based on research results and then changed them back when those results were discredited. I know docs who believed that everyone with marginally high cholesterol should be on a statin, then changed their minds when new risks from the drug were identified (see http://www.nytimes.com/2010/03/31/business/31statins.html for some coverage of the back-and-forth).
The Ioannidis article is pretty good; one of the first mainstream things which has stated the obvious in a long time. Contra Peter: I mean, it was only an article in the Atlantic. I’m sure one can find abundant baloney in medical practice. Dr. Dean Edell has more or less made a career of casting a critical eye on the primary literature and telling people what to pay attention to, and what to ignore.
I mean, statins, SSRI’s -is there really good, unambiguous evidence these are any good for people who don’t own stock in the companies who make them? And … nutrition advice: I’ve never read any which wasn’t the sheerest rubbish -stuff come up with by political committee, rather than, like, using regression and normal distributions and such. Whatever people believe now: they sure are fat and sickly, so something isn’t right.
I read a great, old history book about Medicine called “Devils, Drugs and Doctors.” It was written pre-antibiotics. Pretty much, you could reduce the entire corpus of Western Medicine to “washing your hands,” “vaccines,” “anesthetic,” (making possible proper trauma care), “vitamins,” and, these days, antibiotics. Everything else is probably better cured using my grandfather’s remedy of hard liquor and a dinner of cabbage soup. Antibiotics were a real revolution and changed how people live forever: nothing since then has led to an increase in human lifespan like the invention of antibiotics.