To Hell With “Government Experts” 2: Keep Covering Your Ass
Almost exactly two years ago, I wrote a post titled “To Hell With ‘Government Experts’, Keep Feeling Your Boobies” in which I explained my disagreement–admittedly in a gut-level sense–with new guidelines pushing breast cancer screenings for women out a decade further (from 40 years old to 50). I ended by warning, “And men, don’t take this sitting down. Your ass (colonoscopy guidelines) could be next.”
I was right: now the same agency, the U.S. Preventive Services Task Force, has issued guidelines stating we may be over-doing the PSA screening test.
The truth is, after reading the reasoning behind the decision, I can see the cost/benefit analysis that has gone into the decision (here is a decent point/counterpoint on it). Basically, many of those who have screened positive are either “false” positives or their cancer was so slow growing it wouldn’t be (to put it bluntly) their ultimate cause of death. So many men go through the treatment to “cure” them of something that just may not actually kill them. Similar arguments were made regarding the breast cancer screenings. Of course, this is all based on averages, not actual lives. Sucks to be an outlier!
Guidelines serve a purpose, but it still boils down to a personal decision. However, as Glenn Reynolds noted, “when [you] politicize health care, the suspicion is that all health care decisions are political.” Especially when it seems decisions are being made based on a cost/benefit analysis model that defines cost in dollars, not lives.
There’s so much flawed with this one, it’s hard to know where to start. Let’s try this one… “it seems decisions are being made based on a cost/benefit analysis model that defines cost in dollars, not lives.”
Wrong. What you neglect here is that there is a physical cost to many treatments and that cost can outweigh the benefits, which is in fact what the USPSTF attempts to measure.
http://www.uspreventiveservicestaskforce.org
One more before moving along… what you call “government experts?” The rest of us call private sector providers.
http://www.uspreventiveservicestaskforce.org/members.htm
Those dang physicians! Always meddling in our health decisions.
I didn’t intend to gloss over the physical costs of undergoing a PSA or cancer treatment (the links I referenced make mention of them), though by not explicitly including the point may have implied as such.
As for the panel of experts, well, there sure seem to be plenty of other medical professionals who disagree with these findings. (Just Google PSA testing). Here is one such argument against the findings –
covertrationingblog.com/healthcare-policy/some-implications-of-the-new-psa-recommendation
As I said, I get the C/B argument, but I don’t think it’ll be of much solace to those (future) victims of cancer. It’s hard applying–and convincing people–that lives should undergo a C/B analysis in the manner this has been put out there. Perhaps instead of conveying the message that the PSA isn’t worth it, the panel should instead focus on–and emphasize–that we need a better test.
“I get the C/B argument, but I don’t think it’ll be of much solace to those (future) victims of cancer.” “It’s hard convincing people that lives should undergo a C/B analysis” That’s exactly the kind of thing you’ll see over at kmareka.com. I say it there and I’ll say it here: You can’t have even halfway-decent public policy without making these kinds of decisions. Lives DO have monetary values, not because we say so, but because we have limited resources (money) to save lives with, and some spending is MUCH more effective than others. Any politician who says “We can’t put a value on a human life” is really saying “I can’t do my job because my emotions cloud my judgement.” Here are a few examples that hit closer to home: RI spends 2.5x the national per-capita average on fire departments. We also have the second-lowest rate of death in fires. There DOES appear to be a correlation between money spent and lives saved; but we spend something like $38M for each additional life saved from fire over the national average, a number WELL ABOVE the accepted norms used for other programs. Basically, we have more people dying of other things because the money is going to firefighting instead of other life-saving programs. Same for the mandatory bus-aides. That’s a program that saves one kid every 2.5 years, but it costs $12M a year. We’re spending $30M for each kid not crushed under a bus, which is nice and all, but if every other life-saving program only costs $1M per life saves, aren’t we at a net-loss (given steady spending levels)? You want to screen for cancer above-and-beyond the point where costs and risks exceed benefits? Go for it, but I don’t want it manifesting as higher premiums for me… Read more »
Hey, you’re generally free to pay for whatever procedures you’d like. I at least hope that my physician is making recommendations on an evidentiary basis.
It’s fine to say we should have perfect tests, but that’s to ignore that for many these important decisions need to be made right now with the tools we have on hand.
First, anyone familiar with government contracts knows that when costs come in too high, they “reduce the scope of the work”. They do not send it out for new bids. Why this will not carry over into medical care, I don’t know.
Russ sets forth various “guidelines”. While I do not doubt they exist, the question is how well are they observed. If the “experts” do not agree with you, one of the best strategies is to get another set of experts. It is all well and good that the experts are “independent”, but I think that is an idealization. What part of their income do those doctors receive from the government and insurance companies. And when the government becomes the “insurance company”, what then? “Don’t bite the hand that feeds you”.
“the suspicion is that all health care decisions are political.” Without my expressing an opinion, consider this. The number of men dying, annually, from the cancer which a PSA test will reveal, is almost 3 times the number of women that die from breast cancer. Which form of cancer does the research money go to?
“The number of men dying, annually, from the cancer which a PSA test will reveal, is almost 3 times the number of women that die from breast cancer. Which form of cancer does the research money go to?”
I wonder if that has anything to do with the age at which the lives are claimed. If breast cancer is largely taking-out people in their prime, but colon cancer is mostly taking-out folks who are past retirement age, the current policy makes perfect sense.
Consider the following:
Now think about your answer. Then consider that only 15% of physicians get this answer right. Next read the explanation (of Bayes Theorem) and then tell me whether evidence-based guidelines make sense.
yudkowsky.net/rational/bayes
Posted by mangeek
“I wonder if that has anything to do with the age at which the lives are claimed. If breast cancer is largely taking-out people in their prime, but colon cancer is mostly taking-out folks who are past retirement age, the current policy makes perfect sense.”
I suppose one’s reaction to the “perfect sense” of that depends on whether, or not, you are retired. Fotunately, I understand there is a “radioactive” pill which eliminates the need for much of the prior slice and dice. That seems to be the result of only a little research money finding a solution. That could be taken as an argument for reducing research money.
Here’s a thought. Back when it was impossible to accurately gauge longitude, the Bristish government offered a significant “prize” to anyone who could discover a method. That succeeded. In stead of “picking winners” by deciding what research to fund, why don’t we offer financial prizes?