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Sunday, November 22, 2015

The "Risk" of the Cure...

(Republished because Google says "www.tattoodonkey.com" is somehow using this blog (which only Google can write to) to potentially take over my computer...  Apparently some old linked image is a "problem")
I came across the statistic at MedPageToday that in 2006 binge drinking cost the USA $224 billion (yes billion with a 'B') USD. Surprisingly, at the same site (you may have to register to see these articles but I can assure you its well worth it) I came upon this statistic for skin cancer (melanoma) in the USA: $3.5 billion USD.

Now in terms of death rates, let's say (and I am rounding and fiddling a bit here) that about 8,500 people died of melanoma in 2006.  Melanoma statistics are tracked by the CDC.  The exact cause of melanoma is not known but UV exposure and moles are thought to be risk factors.  There is a steady increase in the diagnosis of melanoma of about some 150 cases or so each year (from 2000 to 2006).

On the alcohol side death rates for "binge drinking" per se are harder to pinpoint.  Its thought that about 40% of teenagers engage in some form of binge drinking and that about one quarter of all teenage alcohol deaths involve drinking of some kind.  It seems from this site and others that the death rate of teenagers using alcohol is similar to (maybe 12 per 100,000 for teenage drivers).  The exact effect of binge drinking versus simply "drinking" is hard to pinpoint.

So, to look at this another way, binge drinking impacts our society in a way very similar to melanoma in terms of the death rate.

But the cost of binge drinking to society as whole is much larger.

Both articles associate the cost of "lost work and productivity" with the lions portion of these costs.

Though interestingly almost $22 billion dollars are spent annually on the "justice system" costs of teenage drinking.  Almost seven (x 7) times the entire cost of melanoma.

Now melanoma in terms of public awareness gets a boost from all the sunscreen commercials.

One of my children is an absolute sunscreen Nazi with respect to her children.  Little Suzy and Jr. are not allowed so much as out of the house without a healthy dose of the stuff (UV 50 of course).

Why?

Because the medical establishment beats the "sun causes skin cancer" drum very hard and loud in my child's ear.

Now things like lightning kill some 750 people a year (about 10% of the melanoma or teenage car crash numbers).  In general, for 2009 death rates looked like this according to this site:

Cause of Death in US            Number

All causes                           2,436,652

Cardiovascular diseases        779,367
Malignant neoplasms            568,668
Drug induced                          37,485
Suicide                                    36,547
Motor vehicle accidents         36,284
Septicemia (infections)          35,587
by Firearms                            31,224
Accidental poisoning             30,504
Alcohol induced                     23,199
Homicide                                16,591
HIV                                          9,424
Viral Hepatitis                          7,652
Cannabis (Marijuana)                     0

So melanoma and "binge drinking" are somewhere above lightning strikes and below Viral Hepatitis.

But think about the "lost work" and "justice system" costs of this table and how they would scale up for various other causes of death.

Think that if teenage drunk driving costs $22 billion USD a year in "justice system" costs what does 31,224 firearms deaths cost?  Or 36,284 motor vehicle deaths?

The New York City police budget is $3.9 billion USD annually - about the same cost as melanoma in the entire US - there were about 500 or so murders in NYC in 2008.

Annual Homeland Security budget: about $56 billion USD.

Imagine the "lost work" aspects of all of this...

Now obviously everyone dies and older people are far more likely to die in a given year than a teenager.  So the top several causes of death are always going to be something related to older folks.

The top two causes of death are much larger by a factor of five or more than all the rest of the causes combined.

Is it even possible to tell what's going on here?

Well, for one thing, cardiovascular disease and cancer (malignant neoplasms), kill older people far, far more often than younger people.

Things like car accidents, which are proven to decrease as the maximum speed limit decreases, kill across the spectrum but are often associated with young, inexperienced drivers.

Some things, like preventable medical errors, which kill an estimated 195,000 per year are not even listed above. (Some estimates take this as high as a million deaths per year.)

Binge drinking and melanoma are not even blips on the overall death rate radar...

In 1900 Tuberculosis and Influenza where the number two and number three causes of death behind  cardiovascular disease.  Yet these diseases affected everyone and in all age groups.  Today tuberculosis is barely a blip on the death rate chart (see this) and influenza has dropped off to a rate near car accidents.  Cancer in 1900 was about four times today's cancer rate.

In 2000, cancer is number two.

I think the answer is no on a couple of levels...

For one, today people are sold emotional "bills of goods" in terms of their healthcare.  A good example of this is "sunscreen."

Most of these "death rates" at the top are old people.  So if you cured all cardiovascular disease tomorrow then they would die of cancer, or some other problem.  But in any case they would still die.

The question would be what would be the "cost" of this death?

Then there is the question of "cost" to society...

It seems that "lost productivity" only matters when your in the work force - it means nothing if you are retired.

"Cost of death" is all over the place in terms of how its measured in various literature and by various agencies.

To me is seems like the "lightning strike" rule (which I just made up) would be a good one:

If fewer deaths occur due to some cause than lightning strikes its probably not something for society to get all wound up about - period.  (Obviously if its increasing at some exponential rate, say SARS which only had a few deaths but if it increased exponentially would be a problem.)

If, like melanoma, the death rate is increasing at less than the lightning strike rate, particularly if its relatively steady and significantly less, then maybe its not such a big emergency...  I am quite certain that 150 deaths per year ether way is well under the error rate of reporting for all kinds of "rates."

Then there is the "convenience death rule" (which I also just made up).  If something like a 65 mph (higher) versus 55 mph death rate (lower) is something people gladly accept for the convenience of getting somewhere quicker than I think that needs to come out of the "death rate" picture.  (Personally I have never met anyone who would rather drive at 55 mph than 65 mph in order to reduce their chance of a death.)

What I don't like is the fact that makers of "sunscreen" are exploiting the "melanoma bandwagon" for profit.  Shielding young children from the sun reduces their natural vitamin D production which may have other, negative effects on their health.  Since we don't know the down side personally I'd risk one of the 150 melanoma deaths per year on my child against the benefits of not slavering them full of chemicals every time they went outside for ten or fifteen years.

There is always "risk."

The problem is we don't ever hear about the opposite "risk" of taking the supposed cure.

I have yet to see any sort of meaningful science on the cost of death after removing a primary cause, i.e., if no one dies of tuberculosis anymore what does it cause to die of something else.

I also see nothing on "risk" of the supposed cure (though if you watch TV and see drug ads you realize that "liver failure" becomes a significant option for treating, say, eczema or incontinence).

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