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More Medical Misadventures

How to waste money on pointless treatments.

By Will Offensicht  |  October 27, 2011

The Chicago Sun-Times announced bad news for medical sorts who've been pushing flu shots on people for lo these many years:

Seasonal flu shots prevent only about 59 percent of infections in adults — not enough to protect people in a global outbreak, a study has found.

The article had the expected sop to the flu vaccine industry:

The disappointing figure on flu-shot effectiveness will probably come as a surprise to many. But it shouldn’t discourage people from getting vaccinated, Osterholm [the author of a study published in Lancet Infectious Diseases] says.

So even if it works only 2/3 of the time, it's still worth doing?  We'll remember that next time the left complains that tax cuts don't always lead to increased economic growth.

The situation could be worse than vaccine advocates admit - some researchers claim that flu vaccine isn't effective at all.  The 41% who catch the flu after getting the shot are disproportionately older and sicker - just the sort of person who'd be most likely to get flu anyway.  One theory is that most people who didn't get the flu wouldn't have gotten it regardless of whether they took the shot or not, because they were already healthy enough to shrug it off.  Vaccine deniers argue that the observed decline in annual flu deaths over the years is due to better hospital care instead of to the vaccine.

The only way to settle such questions is via a double-blind study where nobody knows who got the real shot or a fake shot until later.  Doing that with enough people and seeing how many of each group got sick would indisputably tell us whether the vaccine works or not.

According to the CDC, this has been done once and got about the same results:

Only one large randomized, controlled trial of influenza vaccine has been conducted among an elderly population. During the 1991-1992 influenza season, a group of Dutch people 60 years of age and older not living in long-term care facilities (e.g., nursing homes) was studied (Govaert et al., 1994). In this study, vaccine efficacy was 58% in preventing clinically-defined influenza with serologic confirmation of infection. There are no published studies of the efficacy or effectiveness of influenza vaccines in preventing laboratory-confirmed, serious outcomes of influenza such as hospitalization, primarily because the size of the study would be large, and therefore, such a study is very expensive to conduct.  [emphasis added]

Vaccine advocates scream that the vaccine is so effective that it would be immoral to conduct such a trial - you'd be sentencing people who got the fake shot to death.  Vaccine deniers counter that there are enough uncertainties about how well the vaccine works that recommending it to everyone is immoral - after all, some people have bad reactions to any vaccine so it's only right to make sure it's otherwise helpful.

One thing is certain - getting a better vaccine through the approval process would be so expensive that the current manufacturer has little to fear from competition, even though the manufacturing technology hasn't changed since the 1940's.  The flu shot is what it is, and you can take it by faith or not, as you prefer.

The "Death Panel" Plan

During the Obamacare debates, we were promised that an all-wise, all-knowing, utterly impartial bureaucracy would decide which medical treatments everyone should get - based solely on scientific data, of course.  Being denied treatment would unavoidably be a death sentence in certain cases, so Sarah Palin memorably christened these committees "death panels."

If the panel decides that it's not worth spending taxpayer dollars to treat your cancer, well, it's death for you.  Not only do the taxpayers save money by not treating you, they don't have to pay Social Security after you're dead.

Arguments about the effectiveness of flu vaccine are nothing compared to the raging mammogram debates during the Obamacare follies.  The New York Times updated the mammogram story and argued that mammograms have been oversold:

While most agree that mammograms have a place in women’s health care, many doctors say widespread “Pink Ribbon” campaigns and patient testimonials have imbued the mammogram with a kind of magic it doesn’t have.

The problem is that there are four kinds of breast cancer.  Slow-growing cancers can be treated successfully whether they're found early via screening or later by examining a breast for lumps.  Fast-growing cancers are deadly no matter how early they're found.  Women with either of these cancers aren't helped by screening.

There are also innocuous cancers that wouldn't grow enough to do any damage or be found during a breast exam.  It's safe to leave them alone, because the woman will almost certainly die of something else before a super-slow cancer got anywhere.

When such a cancer is found via a mammogram, however, no doctor would dare to suggest doing nothing; the women are treated needlessly.  Women with these cancers are harmed by mammogram screening because it leads to surgery they'd otherwise not receive and which, in the final analysis, benefits them not at all.

A final group of cancers grow fast enough to be dangerous but slowly enough to be cured if they're found in time.  Women with these cancers have their lives saved by receiving mammograms - but that is not the case with most women:

It’s important to remember that of the 138,000 women found to have breast cancer each year as a result of mammography screening, 120,000 to 134,000 are not helped by the test.

Out of 39 million women who get mammograms each year, between 4,000 and 18,000 women are helped.  At best, that's .04%.

Medical Politics Writ Large

There's been so much publicity about mammography that it's pretty much impossible to make rational decisions on the subject.  The panel which published the first report questioning the effectiveness of mammography had to back off - too many women went on the news and swore that mammography had saved their lives.

Mammography absolutely can and does save the lives of individual women, but that is not necessarily true for everyone, or even for all women with breast cancer:

Colin Begg, head of the department of epidemiology and biostatistics at Memorial Sloan-Kettering Cancer Center in New York, said that he supports mammography screening and believes that it does save lives. But he agrees that many women wrongly attribute their survival after cancer to early detection as a result of mammography.

“Of all the women who have a screening test who have breast cancer detected, and eventually survive the cancer, the vast majority would have survived anyway,” Dr. Begg said. “It only saved the lives of a very small fraction of them.”

The notion that screening mammograms aren’t helping large numbers of women can be hard for many women and breast cancer advocates to accept. It also raises questions about whether there are better uses for the hundreds of millions of dollars spent on awareness campaigns and the $5 billion spent annually on mammography screening.  [emphasis added]

Five billion dollars is enough money for a medical effectiveness panel to want to cut mammography if it doesn't help.  On the other hand, five billion dollars is a lot of income for mammography specialists, radiologists, hospitals, and equipment makers.  They'll fight just as hard to preserve their incomes as the medical panel will fight to cut them, perhaps harder.

The underlying problem is that "medical science" is a misnomer.  Medicine is a healing art, not a science in the way that, say, physics is.

If you drop two cannonballs of different sizes off the Leaning Tower of Pisa, they will always hit the ground at the same time; this worked for Galileo centuries ago and it would work for you today if you went there and tried it.  Patients and cancers are nothing like as consistent or predictable; they differ so much that there's often no way to know who'll be helped or hurt by any given procedure.

The bottom line is that modern American medicine is a very big business where sales either come from government or are closely regulated by government.  With all that money subject to political whim, is it any wonder that medical folk spend so much time lobbying and rallying sick people to their cause?

The clear fact that modern medicine on the whole does save lives is very nice, but somewhat beside the point of making money for practitioners.  If you're healed, give thanks.