Arnold Kling  

Breast Cancer: a Hansonian Tale

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Biases in Evaluation Scales... I Coulda Been a Contender...

According to the New England Journal of Medicine:


the age-adjusted incidence rate of breast cancer in women in the United States fell sharply (by 6.7%) in 2003, as compared with the rate in 2002. Data from 2004 showed a leveling off relative to the 2003 rate, with little additional decrease. Regression analysis showed that the decrease began in mid-2002 and had begun to level off by mid-2003. A comparison of incidence rates in 2001 with those in 2004 (omitting the years in which the incidence was changing) showed that the decrease in annual age-adjusted incidence was 8.6% (95% confidence interval [CI], 6.8 to 10.4)...The decrease in breast-cancer incidence seems to be temporally related to the first report of the Women's Health Initiative and the ensuing drop in the use of hormone-replacement therapy among postmenopausal women in the United States. The contributions of other causes to the change in incidence seem less likely to have played a major role but have not been excluded.

A standard puzzle in health care economics is that groups of people who receive more medical services do not show better health outcomes than comparable groups receiving fewer services. Robin Hanson argues that this suggests that medical services are as likely to make you worse as make you better. The women who used to receive hormone therapy and subsequently got breast cancer might agree.


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COMMENTS (9 to date)
shamus writes:

Health care is set up to serve insurance companies rather than patients. There is no incentive to make patients healthy. The incentive is to perform procedures that will be reimbursed by third party payers. Health care providers receive no economic benefit from determining whether their procedures benefit patients, so it should come as no surprise that medical services don't correlate to health outcomes.

Robin Hanson writes:

Shamus, it should surprise you that people choose to pay for something that gives them little or no value.

Ronnie Horesh writes:

Robin, I think they 'choose' to pay for it in the same sense as they choose to pay for farm subsidies or other corporate welfare schemes (scams). Asymmetric information, and asymmetric ability to influence the politicians.

Rafal Smigrodzki writes:

Arnold, do you have any evidence that "groups of people who receive more medical services do not show better health outcomes than comparable groups receiving fewer services"? I know that this is what Robin claims, yet he has never been able to point me to a single study that would strongly confirm this claim. The only experimental study he uses, the Rand study from the 70's, is severely flawed, and essentially useless in this context, although it does provide arguments against subsidized health insurance. Robin also mentions some correlational studies but in our discussions he never linked to them. Is there a single correlational study that has satisfactorily removed confounding variables?

And why are there studies claiming a 3 to 5 year gain in life-expectancy from access to medical care?

There is no doubt that some medical interventions, mainly traditional ones, make patients worse off in terms of survival or comfort but claiming that *all* medicine is on average useless or harmful goes very strongly against what I know about it.

Arnold Kling writes:

Actually, Robin has a whole paper that lists studies that support his position. Look up "Robin Hanson show care"

another bob writes:

fascinating.

there's a ph.d. for someone who can find all the effects of hormone replacement therapy; e.g. higher incidence of estrogen-positive breast cancer, lower incidence of leukemia, lower incidence of osteoporosis, higher incidence of stroke, etc.

then come up with a way to explain all the changes in probabilities to a woman with IQ=100 with little-to-no medical training so that she can make an informed choice.

what would dr. kling's decision matrix look like for this decision?

or, there's nationalized medicine.

shamus writes:

Health insurance coverage may provide a hedonic value unrelated to actual outcomes. Knowing that you are covered and will be cared for in the event of a medical emergency may provide value.

Dr. T writes:
Robin Hanson argues that this suggests that medical services are as likely to make you worse as make you better. The women who used to receive hormone therapy and subsequently got breast cancer might agree.
But the much greater number of women who received hormone replacement therapy and avoided atherosclerotic heart disease and hip fractures might disagree.
Floccina writes:

‘A standard puzzle in health care economics is that groups of people who receive more medical services do not show better health outcomes than comparable groups receiving fewer services.’


Would this be because the people who receive less medical services are healthier? Healthier people are less likely to seek health insurance.

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