Sunday, April 15, 2012

Reuters Reporter Sharon Begley Shows How Tomas Phillipson Health Care Study That Lauds U. S. Health Care is a Sick Study

Funded by Drug Companies with Researchers Affiliated with Conservatives

Thanks go to Aaron Carroll of the great health care economic Forum The Incidental Economist for pointing everyone to a Reuters report on a recent examination of spending and outcomes for health care.  Here is the conclusion

We found that US cancer patients experienced greater survival gains than their European counterparts; even after considering higher US costs, this investment generated $598 billion of additional value for US patients who were diagnosed with cancer between 1983 and 1999. The value of that additional survival gain was highest for prostate cancer patients ($627 billion) and breast cancer patients ($173 billion). These findings do not appear to have been driven solely by earlier diagnosis. Our study suggests that the higher-cost US system of cancer care delivery may be worth it, 

which is great, it means that all the extra spending on health care in the U. S. is worth it.  Except of course, it isn’t.

Sharon Begley in Reuters exams the study and does what good journalists do, which is to investigate claims of the research by going to experts in the field.  It turns out the methodology of the study is fatally flawed.

Experts shown an advance copy of the paper by Reuters argued that the tricky statistics of cancer outcomes tripped up the authors.

"This study is pure folly," said biostatistician Dr. Don Berry of MD Anderson Cancer Center in Houston. "It's completely misguided and it's dangerous. Not only are the authors' analyses flawed but their conclusions are also wrong."

Wow, let’s take a look at some of the problems with the study.  One of the problems is survival time after diagnosis of cancer.  But that depends in large part on how early the cancer is diagnosed.

While that may seem straightforward, survival data is among the most problematic cancer statistics, Philipson's team acknowledges. In particular, they are plagued by something called lead-time bias.

If a tumor is diagnosed very early in its existence - if it has a long "lead time" - the patient may survive, say, two years if the tumor is very aggressive. If an identical tumor is found in that patient's identical twin later, the twin will survive, say, six months. But the twins die at the same age. The first survived longer with cancer due to lead-time bias, but did not have a longer lifetime.

Crediting medical care with "improving survival" is therefore misleading, cancer experts have long argued. Lead-time bias makes it seem patients live longer, but the only thing that is longer is the number of years they know they have cancer, not their lifespan.

A related problem is that by increasing screening, tumors are found that are so slow growing that they do not affect mortality, yet the survival is included in the results

Even more problematic, said Berry, is a problem cancer experts have only recently recognized: overdiagnosis. Because cancer screening is much more widespread in the United States than in Europe, especially for breast and prostate cancer, "we find many more cancers than are found in Europe," he said. "These are cancers that tend to be slowly growing and many would never kill anyone."

Screening therefore turns thousands of healthy people into cancer patients, even though their tumor would never threaten their health or life. Counting these cases, of which there are more in the United States than Europe, artificially inflates survival time, experts said.
"As long as your calculation is based on survival gains, it is fundamentally misleading," said Dr. H. Gilbert Welch, a healthcare expert at the Dartmouth Institute for Health Policy & Clinical Practice.

Well, read the entire article.  It is a great discussion in easy to understand terms about medical research and how even educated researchers can go horribly wrong.  And why would this particular study have made what appear to be glaring errors?  Well there is this about the lead investigator.

Philipson is a fellow at the conservative American Enterprise Institute and at the Manhattan Institute, served in the administration of President George W. Bush and was a healthcare adviser to Sen. John McCain's 2008 presidential campaign.

And there is this about the funding for the study.

The Philipson paper was supported in part by Bristol-Myers Squibb Co, whose cancer drugs include Yervoy. A drug for advanced melanoma, it costs $120,000 for a full course of treatment. Clinical trials showed that Yervoy produces a near-miraculous cure for some patients, with a median increase in survival of 3.6 months. (emphasis added)

U.S. spending on cancer care has continued to increase, reaching $72 billion in 2004, the last year for which data is available.

The new study did not examine the cost-effectiveness of that care. "In the last decade, spending in the U.S. has increased more than in Europe," said Philipson. "I would be extremely surprised if the survival gains haven't continued. But it is a much more open question whether that additional spending has been accompanied by an increase in longevity."

Yep, if you want funded research to come out a certain way, so you can continue to charge $120,000 a year for treatment that extends life 3.6 months, you know where to go. 

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