Health care - administrative incompetence

[Architect]

Who cares anyway if we have "well trained docs, state of the art tech" if an increasing amount of Americans can't even access them?

It's a bit like claiming that the Italians make the best cars in the world just because of Ferrari etc. Alas, the fact that most people can't afford it.......

...and of course, the rest of them are stuck with Fiats. Ouch.

 

[xjx388]

With respect, that's demonstrably inaccurate.

You specifically citied the failure of the UK to test for Strep Throat routinely as cost-specific. You hand-waved away evidence that a number of other western countries including France, Germany, Canada, and Australia all said the same.

No, I pointed out that they are all UHC and that maybe that's why their guidelines are different. I also said I could be wrong.

You were provided with links to the UK guidance that stated when testing would be appropriate, including (for example) in the case of persistent infections and those with imuno-defficiency problems.

Links to guidelines don't prove anything other than "this is the guideline."

You have now stepped back from this position, and - instead of admitting you were wrong - have described it as "clarification".

I was wrong in saying we test every sore throat. We test most sore throats we see, as per the AAFP guidance. It's still an open, if rather minor, question as to why there is such a difference in guidelines.

You have been challenged no fewer than five times (I checked) to show that our failure to regularly prescribe antibiotics resulted in an increased infection or complication rate. You failed to do so. I think we know why - by you own admission, the US does not appear to collate clinical data in the same way as the UK.

Both countries have about the same incidence of post-strep complications.

As for Prostate Cancer, whichever one of the two of you was online earlier will be aware of several pages of discussion regarding over-diagnosis in the US. Stop trying to steer the conversation onto old territory (where you lost, by the way). And remember to compare your notes a bit more often.

I haven't "lost" anything; I'm not trying to "win." I know the arguments you have raised, but you can't argue with actual outcomes. You will remember that I posted the latest GLOBOCAN numbers showing that the US has a much lower mortality rate in Prostate cancer. So we catch and treat more with our screening which translates to less lives lost.

 

[Garrison0fMars]

You will remember that I posted the latest GLOBOCAN numbers showing that the US has a much lower mortality rate in Prostate cancer. So we catch and treat more with our screening which translates to less lives lost.

What if I were to develop cancer today though? Those outcomes wouldn't mean crap to me honestly, since I wouldn't be included in the group receiving any oncology care.

 

[Ivor the Engineer]

<snip>

You will remember that I posted the latest GLOBOCAN numbers showing that the US has a much lower mortality rate in Prostate cancer. So we catch and treat more with our screening which translates to less lives lost.

What do men in the US die of then?

 

[Architect]

No, I pointed out that they are all UHC and that maybe that's why their guidelines are different. I also said I could be wrong.

With the very deepest of respect, this is a sceptic site. One is not expected to merely turn up, make a sweeping - and very specific assertion - merely to then admit that one has absolutely no data to support the case.

I was wrong in saying we test every sore throat. We test most sore throats we see, as per the AAFP guidance. It's still an open, if rather minor, question as to why there is such a difference in guidelines.

Both countries have about the same incidence of post-strep complications.

I'd be genuinely interested to see your source (It's not that I doubt you, I'm really just interested), if you could post a link.

In the meantime, however, compare and contrast the two quotes: you treat with antibiotics more regularly than we do, but have the same complication rates. I've no medical training, but I would suggest that this is evidence that widespread use of antibiotics is not necessarily beneficial. It is, however, costly I would imagine.

I haven't "lost" anything; I'm not trying to "win." I know the arguments you have raised, but you can't argue with actual outcomes. You will remember that I posted the latest GLOBOCAN numbers showing that the US has a much lower mortality rate in Prostate cancer. So we catch and treat more with our screening which translates to less lives lost.

There was a long discussion on this; would it be helpful if I provided you with a link to the posts and you could identify the specific points you believe support your position or which you wish to discuss further?

 

[xjx388]

I'd be genuinely interested to see your source (It's not that I doubt you, I'm really just interested), if you could post a link.

In the meantime, however, compare and contrast the two quotes: you treat with antibiotics more regularly than we do, but have the same complication rates. I've no medical training, but I would suggest that this is evidence that widespread use of antibiotics is not necessarily beneficial. It is, however, costly I would imagine.

There are non-guideline reasons for the prescription of antibiotics. I've told you what they are. Change patient attitudes, then we can change practice. We work to do this every day.

There was a long discussion on this; would it be helpful if I provided you with a link to the posts and you could identify the specific points you believe support your position or which you wish to discuss further?

Not really. It would be more helpful if you could just review the reasons why you think a lower mortality rate in Prostate Cancer in the US does not mean better care in that domain.

 

[Ivor the Engineer]

<snip>

Not really. It would be more helpful if you could just review the reasons why you think a lower mortality rate in Prostate Cancer in the US does not mean better care in that domain.

I've just been looking at the 2006 period life expectancy data for white males in the USA and males of all races in the UK. Both tables appear to be very similar.

Is it better to be treated for a condition that isn't going to kill you and that if you hadn't had a PSA test may never even have known you had?

 

[Darat]

I'm still curious how USA stats are collated since there doesn't seem to be any compulsory universal reporting criteria, are the USA figures estimated from a sample, are there some diseases that have to be recorded and so on?

 

[Architect]

Not really. It would be more helpful if you could just review the reasons why you think a lower mortality rate in Prostate Cancer in the US does not mean better care in that domain.

It took me a wee bit of hunting to find the posts as they were actually in threads, and I think that a quick look at these is probably more sensible than my attempting to summarise them. Also some of the material against UHC came from BaC, a man who's long on statistics but short on accuracy.

Turning firstly to the thread you posted most actively in, much of the discussion centred upon your insistance that PSA testing be carried out as a way of saving lives:

http://www.internationalskeptics.com/forums/showpost.php?p=6692561&postcount=43

Now for BaC. He posted a series of links which showed that our breast cancer treatment rates were less successful than the US (true). In response the following material on the difficulties in comparing rates was shown:

http://www.internationalskeptics.com/forums/showthread.php?t=195122&page=5

Don't be fooled by BAC's endless links, remember: quite often the quotes are cherry picked and sometimes the full material downright contradicts what he says.

Incidentally, some of our problems aren't treatment but getting people to their (free) doctors early enough:

http://www.internationalskeptics.com/forums/showpost.php?p=6690156&postcount=202

 

[Architect]

There are non-guideline reasons for the prescription of antibiotics. I've told you what they are. Change patient attitudes, then we can change practice. We work to do this every day.

Just copy our example and don't give them the antibiotics!

 

[xjx388]

I've just been looking at the 2006 period life expectancy data for white males in the USA and males of all races in the UK. Both tables appear to be very similar.

Is it better to be treated for a condition that isn't going to kill you and that if you hadn't had a PSA test may never even have known you had?

Are you suggesting that we don't treat prostate cancer?

You have completely dodged the issue. We all die of something sooner or later. However, we catch and treat more Prostate Cancer than the UK. This translates to lower mortality from Prostate Cancer. Lower mortality = Better Medical Care. Discuss.

 

[Architect]

Are you suggesting that we don't treat prostate cancer?

I think he's suggesting something quite different, and I suggest that you read the links I gave you above. In the meantime it seems to me that there are two issues with Prostrate Cancer:

Diagnosis Rates. Some caution is required here as there is material which suggests identification of cancers which are unlikely to present themselves as a problem, hence a high figure can be misleading.

Survival Rates. If you are over-diagnosing, then the median life exectancy may well be higher (because you have a larger number of inherrently healthy people).

We might also find, I suspect, that you have two very different survival rates depending upon whether the patient has adequate insurance or not, plus the usual socio-economic factors.

In short, there's a problem with comparing apples to oranges. This is why we come back to terribly broad-brush indicators such as infant mortality and life expectancy.

 

[Leif Roar]

Not really. It would be more helpful if you could just review the reasons why you think a lower mortality rate in Prostate Cancer in the US does not mean better care in that domain.

Age-adjusted mortality rate for prostate cancer in USA 2003-2007: 24.7 deaths per 100,000 males.[1]

Age-adjusted mortality rate for prostate cancer in the UK 2008: 23.9 deaths per 100,000 males.[2]


[1] Table 1.4

[2] The table just says "per 100,000 population", but if you crunch the numbers you'll see they must mean "per 100,000 males"

 

[Architect]

Age-adjusted mortality rate for prostate cancer in USA 2003-2007: 24.7 deaths per 100,000 males.[1]

Age-adjusted mortality rate for prostate cancer in the UK 2008: 23.9 deaths per 100,000 males.[2]


[1] Table 1.4

[2] The table just says "per 100,000 population", but if you crunch the numbers you'll see they must mean "per 100,000 males"

Bear in mind that all deaths in the UK normally result in a post-mortem, saving where the patient is already under treatment and expected to shuffle their mortal coil, hence we can have some considerable confidence in our statistics. I am given to understand that PMs are not the norm in the US but suspect that this is a gross over-simplification as there are bound to be state-by-state variations and the like.

 

[Ivor the Engineer]

Are you suggesting that we don't treat prostate cancer?

You have completely dodged the issue. We all die of something sooner or later. However, we catch and treat more Prostate Cancer than the UK. This translates to lower mortality from Prostate Cancer. Lower mortality = Better Medical Care. Discuss.

And the US also puts far more men through invasive medical investigations and treatments who have non-cancerous prostates, or cancers that will not kill them before something else does.

Is that better care?

 

[Architect]

XJX

One of the debates going on in the UK which your wife you may find of interest, and which has been discussed already in the forum, is the approach to breast screening.

As you are aware, all females in the UK above a certain age are automatically screened. There is, however, a debate as to whether this is necessarily the most effective way of managing the problem and the extent to which it might result in false positives. I'm not sure if it's reached its conclusion yet, but it batters over the press quite regularly. In comparison, the US does not - as I understand - have a wholesale screening process although patients can seek private screeing and some insurers provide coverage.

Linky (English NHS)

The Scottish NHS has started providing Bowel Cancer screening to at risk (usually age-related groups). Kits are sent to patients' houses and are returned (postage paid) to the labs for a test. All FoC and done purely on the basis of very high Bowel Cancer death rates in our country.

I put it to you that UHC systems are best placed to address these kind of issues because of their very universality. Well-off groups may well have good survival rates in the private system, but Heaven-help the poor and those on the margins.

 

[Agatha]

Run the cost between another measure of success, how much freedom do you have?

As much as anybody in the developed world. I can see my GP usually the same day I call, if I want to change my GP it's an easy process, if I'm away from home I can see any other GP. I can get free telephone advice 24 hours a day from trained staff on NHS Direct, I can go to any A&E department in an emergency, I can call an ambulance if I need one, I have low waiting times for operations, I can get a carrier bag full of drugs which I need with no hassle every month and all free other than the minimal amount of tax I pay.

How much freedom have you lost to take care of your own body?

None. Do you contend that I have lost any? Or that I do not have such freedom?

How much is your NHS financed by theft? (Taxation by gunpoint).

Approximately half as much as in the US, for a system that every UK resident can use; the US taxpayer pays about twice as much for a system that can only be utilised by some.

How many die by government fiat?

None.

 

[Architect]

Are you suggesting that we don't treat prostate cancer?

XJX:

In all seriousness, and it's not a trick or leading question, I'd welcome your clinical views on this advice from the (English) NHS:

http://www.cancerscreening.nhs.uk/prostate/index.html

I note in passing that the Scottish NHS (www.NHS24.co.uk) direct readers to this site and hence assume that they take a similar view to our southern cousins.


ETA: If you're really interested in the kind of research which the NHS carries out then there's a link to this paper on the site:

http://www.hta.ac.uk/execsumm/summ102.shtml

It's quite old, by the looks of it, but I think it demonstrates the kind of very public reviews that a UHC system like ours conducts.

 

[xjx388]

Age-adjusted mortality rate for prostate cancer in USA 2003-2007: 24.7 deaths per 100,000 males.[1]

Age-adjusted mortality rate for prostate cancer in the UK 2008: 23.9 deaths per 100,000 males.[2]


[1] Table 1.4

[2] The table just says "per 100,000 population", but if you crunch the numbers you'll see they must mean "per 100,000 males"

You are comparing two different sources using two different kinds of age adjustments. Notice that the UK source says "Age-standardised rate (European)" Not the same thing as the "Age Adjusted" rate in the US source. GLOBOCAN uses the same age adjustments for all countries so that we can compare better. As this little fact sheet shows, in 2008, the USA had a 9.7 mortality rate compared to 13.8 in the UK.

 

[Architect]

You are comparing two different sources using two different kinds of age adjustments. Notice that the UK source says "Age-standardised rate (European)" Not the same thing as the "Age Adjusted" rate in the US source. GLOBOCAN uses the same age adjustments for all countries so that we can compare better. As this little fact sheet shows, in 2008, the USA had a 9.7 mortality rate compared to 13.8 in the UK.

That's an interesting site, but I'm not sure how much it helps everyone.

So, for example, US prostate cancer diagnosis is high but death rates are low. This may be due to the effective early treatment of the disease or it could be due to a high false positive diagnosis combined with a limited PM regime.

On the other hand, breast cancer rates for the UK are higher than the US and so are mortality rates. This squares with what we expected, as other data has confirmed that UK treatment is less successful than both the US and Canada. Spain beats us all on both counts, using a largely UHC system.

They also seem to use national recording programmes and hence we start to hit the problems already identified.

To be honest, I'd love a view from someone with more knowledge of statistics than me.