[extropy-chat] Are vaccinations useless?

[Rafal Smigrodzki]

On 3/18/06, Robin Hanson <rhanson at gmu.edu> wrote:

that the marginal health value of medicine seems
> near zero today, both in rich and poor countries.   This is also
> the consensus among health economists.

### No, it isn't. Even the references on your own site say the opposite.

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> At 03:12 AM 3/14/2006, BillK wrote:
> >... if you include the huge scale of medical fraud, worthless
> >treatments, unnecessary surgery, 'snake-oil' concoctions, useless
> >supplements, etc. etc., then Robin may have a point that 'overall'
> >there isn't much benefit. But I feel that including all this fraud is
> >a mistake. There are many medical treatments and operations with
> >obvious life-saving benefits. You just have to stay away from the
> >hucksters and conmen
>
> Most of those worthless treatments and unnecessary surgeries are
> recommended and performed by respected and credentialed doctors.   How
> are ordinary people supposed to distinguish them from the valuable
> treatments?

### There is no "huge scale" of medical fraud. Most treatments offered
by allopathic physicians today actually are not worthless, since the
majority of them are supported by RCTs.

The problem is that most of them, including the most expensive ones,
make a small difference on survival, if any, so not surprisingly you
get low correlation between global spending patterns and lifespans. In
fact, by excluding interventions that either are intended to improve
quality of life (e.g. eyeglasses, dental services, pain medications,
most orthopedic surgery) and interventions with high cost but low
impact on survival (e.g. treatment of strokes in anybody above, say,
75 years old, most of whom will die in a few years anyway, even if you
reduce their risk of stroke by 70%), you could cut half of medical
spending in the US and notice hardly a blip on the aggregate mortality
rates.

Of course, this would leave a lot of people in pain, or disabled, or
toothless, or dead a few months sooner than otherwise, which leads me
to conclude that one way or another, medicine is overall valuable.

One place where you could save a lot without sacrificing almost
anything is if you could reduce care driven by fear of legal
liability. There are literally millions of MRI scans ordered every
year in young people with vague neurological complaints solely to make
sure they don't have some extremely rare conditions that frequently
cannot be treated anyway, such as vertebral dissection, and this means
billions of dollars down the drain for essentially no benefit
whatsoever. If you allow limited-liability medical care, the savings
would be immense.

Another reason for unnecessary medical spending is the use of medical
insurance, rather than out of pocket payments. This leads to
profligacy and lack of accountability, and could be countered by
widespread adoption of catastrophic insurance plans.

So, medicine is valuable but could be made much more efficient.

Rafal