Higher US expenditures on cancer patients do not result in improved mortality.

But you’d never know that reading AEI’s highly dubious contribution to the literature in this week’s Health Affairs (lay Reuters article here). Consistent with their free-market solves everything and can do no wrong (cover ears and yell “nananananananana”) attitude towards the broken US healthcare system, they have managed to contaminate the literature with a paper that suggests our higher expenditures on cancer are generating significant returns in patient survival. Except that it doesn’t show this, and to her great credit, Reuter’s Sharon Begley nails it:

Cancer patients in the United States who were diagnosed from 1995 to 1999 lived an average 11.1 years after that, compared with 9.3 years for those in 10 countries in Europe, researchers led by health economist Tomas Philipson of the University of Chicago reported in an analysis published Monday in the journal Health Affairs.
Those extra years came at a price. By 1999 (the last year the researchers analyzed), the United States was spending an average of $70,000 per cancer case (up 49 percent since 1983), compared with $44,000 in Europe (up 16 percent). Using standard figures for an extra year of life, the researchers concluded that the value of the U.S. survival gains outweighed the cost by an average $61,000 per case. The greater spending on cancer care in the United States, they conclude, is therefore “worth it.”
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.”

I am amazed, this is real science reporting here, because rather than just doing a press-release rehashing of the AEI-authors’ dubious assertions, she found some real cancer experts and shredded it.
The mistake they made, or possibly ignored, is lead-time bias. By using survival from diagnosis, rather than the patient’s actual mortality, they create the appearance of improved outcomes. But the reality is, earlier diagnosis is creating a false survival signal. The US isn’t actually extending lives in comparison to treatment in other countries, the overall mortality rates are the same.
Further the paper only showed the benefit in prostate cancer and breast cancer, and, if anything, worse survival for colon and uterine cancer given the amount of expenditure. The reason is pretty straightforward, and consistent with the lead-time bias issue. In the US, we probably over-screen for breast and prostate cancer, which means more people live with these diagnoses than do in other countries. It’s been a topic of debate among medical professions and discussed extensively by other medical bloggers like Orac because it’s quite possible, especially for breast and prostate cancers, that screening protocols are too inclusive. The result is there are more patients in the US that are given a cancer diagnosis, but they have disease that may never progress to being a life-threatening illness. Excessive screening may even result in unnecessary procedures and treatments when it comes to these two diseases, and we are still trying to work out what protocols will include the most patients with serious disease, while excluding as many false-positive patients as possible. This is acknowledged by Begley’s expert reviewers:

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.
In the new analysis, the survival gains in the United States compared with Europe were greatest for prostate cancer, at more than triple the gains for breast cancer, the cancer with the second-greatest U.S. survival edge. “These are the two cancers where screening has raised the most serious issues about lead-time bias and overdiagnosis,” said Welch.
For melanoma and colorectal and uterine cancer, survival gains over the period analyzed were greater in Europe than the United States.

If anything the opposite is true based on the correct analysis which is based on mortality statistics, not survival.

Other calculations cast doubt on the superiority of U.S. cancer care. For instance, breast cancer mortality fell 36 percent in the United Kingdom from 1990 to 2006, calculates MD Anderson’s Berry, and fell 30 percent among whites in the United States. (The U.S. figure would be even lower, he said, if it included African-Americans, who generally have less access to health care.)
Cancer mortality in the United States is higher than in 11 countries reporting to the Organization for Economic Co-operation and Development, and lower than the rate in 14. Mortality is lower in Switzerland, Sweden, Japan and Finland, among others, but higher in Hungary, Slovenia, France and Britain, in the latest years for which OECD has data.
The reduction in cancer mortality in the United States since 2000 also puts it toward the middle of OECD countries. It is less than in Israel, Japan, Switzerland and some others, for instance, but better than in Britain, Estonia and Poland.

To sum up, the authors successfully identified lead-time bias in two cancers which the US is known to screen more for than other nations with universal healthcare systems that have health expenditures of roughly 50% less than ours, per capita. They then falsely attributed this lead time bias to our excessive health expenditures, then generalized this biased finding to suggest our excessive expenditures overall provide benefit to our population. This is despite a large body of literature, using appropriate measures of health outcomes, that suggest many other countries do better than us in cancer and medically-preventible disease mortality in general.
It is amazing that this paper passed peer-review, and that such a substandard analysis by authors with clear ideological biases was not detected and rejected. And one could have predicted this considering the author’s affiliation with AEI and Manhattan Institutes, think tanks which routinely engage in denial of science like global warming. This is a comparable mistake to accepting a paper from the Discovery Institute, or Peter Duesberg without approaching it with a hefty dose of skepticism. Anti-science ideologues tend to write shoddy, unscientific papers, and some basic peer review should have prevented this analysis from contaminating the literature.
Shame on Health Affairs for publishing this garbage, but let’s a salute Reuter’s for doing an excellent job in appropriate post hoc review of this flawed paper.

Jennifer Lawrence channels Katniss, says "Screw PETA"

In it’s increasingly bizarre need to inflict it’s animal rights morality on everybody, PETA’s Ingrid Newkirk has criticized Jennifer Lawrence for scenes in Winter’s Bone and the Hunger Games, which show her hunting and eating animals.

The actress was dubbed “the coolest chick in Hollywood” by Rolling Stone, and in the magazine’s latest issue she recounts her on-screen squirrel-skinning scene in the 2010 movie “Winter’s Bone.”
“I should say it wasn’t real, for PETA. But screw PETA,” she told the magazine.
In response to the actress’s comment, PETA president Ingrid Newkirk told Gothamist, “[Lawrence] is young and the plight of animals somehow hasn’t yet touched her heart. As Henry David Thoreau said, ‘The squirrel you kill in jest, dies in earnest.’ We are told that this squirrel was hit by a car, but when people kill animals, it is the animals who are ‘screwed,’ not PETA, and one day I hope she will try to make up for any pain she might have caused any animal who did nothing but try to eke out a humble existence in nature.”

Gag me with a spoon. Lawrence’s initial instincts were correct. Screw PETA. In these scenes and movies characters are grappling with survival in the face of starvation and poverty. PETA seems to think the appropriate ending for Katniss would have been a moral vegan death from starvation in district 12 rather than being a life-affirming, kickass hunter. And I guess Ree should have morally died from exposure in the Ozarks. The producers bought her a squirrel from a local hunter, and she realistically portrayed the skinning of an animal by hunters for food. I think what really upsets PETA about these portrayals is that they realistically show what humans will do to survive, that hunting and eating animals comes naturally to us, and there’s nothing wrong with hunting for food.
Let’s hope Lawrence doesn’t back down, for some reason I think she won’t:

The actress, who spent a month in Missouri with a rural family learning to shoot rifles and chop wood in preparation for “Winter’s Bone,” and was trained by four-time Olympic archer Khatuna Lorig for her role as Katniss in “The Hunger Games,” also told Rolling Stone, that when she is done with her next movie she is “thinking about buying a house. And a big dog. And a shotgun.”

I’m liking her more and more.

Good News, Max snubs PETA, will give to a local shelter

Maybe my email worked? I got a one sentence reply from Max last night saying he agreed, and today Tucker Max says hellz no to PETA and instead wants to give to a local shelter:

I do not agree AT ALL with the mission of PETA.

If we’re talking about what an awful organization PETA is, that’s really just the beginning. They’re so ridiculous, they compared the holocaust to killing chickens. Not only that, but they have a history of shitting on celebrities they’ve worked with in the past. And perhaps worst of all, they are the ones that think violence against women is OK. Their stated ultimate goal is complete animal liberation. They’re serious about that. F*** [sorry to be a prude, ed.] that-I not only disagree, I vehemently oppose that goal.

To that effect, I am proposing another solution, one that helps dogs but doesn’t force me to give money to an organization that works at odds with most of my personal beliefs:
In the past, I have supported a cause in Austin called Austin Pets Alive that is trying to open a no kill shelter (another thing I disagree with PETA on, they operate kill shelters). Their new building has numerous naming opportunities. I would love to make a sizable donation to them, and PETA should agree to match whatever I put in. If that happens, I will open it up to any of my fans to contribute as well.
If PETA doesn’t like Austin Pets Alive for some reason, that’s OK, they are welcome to suggest any other dog-related charity in the Austin (or surrounding Texas) area, and I am down for contributing a lot of money to help them do positive things for dogs. Together, I am sure we can raise several hundred thousand dollars for needy and worthy dogs in the central Texas area.

Good for him. Whatever flaws he has, he’s no animal liberationist.
Finally, a note about the HSUS and PETA. They are not for animal welfare. They are for animal liberation. That means they don’t believe in animal agriculture, they don’t believe in animal research, and they don’t believe in pet ownership.
HSUS runs deceptive and sleazy ads showing suffering puppies and kittens to make you think your money is going to rescue and adoption, yet only 1% of their budget goes to shelters. They are not a rescue organization!
Their animal experts include ALF morons like JP Goodwin, a high-school dropout who has dedicated his life to animal liberation. People think that since “Humane Society” is in its name, it is affiliated with local humane societies or that it shares the same mission. It does not. If you want to donate money to spaying and neutering of animals, animal rescue, or adoption, give to your local humane society or SPCA, not HSUS. HSUS is a animal liberation advocacy organization, not a shelter! Likewise PETAs shelters euthanize 95% of the animals they receive, they are not interested in promoting pet adoption. They are interested in animal liberation. If you’re for animal liberation fine, but don’t represent yourself as a humane society or animal welfare organization. They’re not the same thing.

The Bigger Pink Slime Problem for Business

In a matter of weeks, activists have been able to assassinate a popular product through a confluence of events: an official labeled it derogatorily as “pink slime,” social media buzz (or anti-buzz), and media attention against the background of Americans’ greater concern about processed foods. Could this happen to other products? Does it relate to a broader shift in power from PR firms and industry to the consumer mob?
John Bussey has a good article in today’s Wall Street Journal featuring some of the wound-licking of the lean finely textured beef industry. Note the tactics:
1) Make it about consumer choice:

This week beef producers belatedly said they’re considering labeling the beef that contains LFTB. The idea is simple. Tell consumers what they’re buying. Give them an option. Let them make the choice.

Of course, how much choice do I have as a student at some public school that has decided to save five cents on my burger by packing it with LFTB?
2) Change the language:
Notice the use of LFTB acronym…Notice the reporter used it, and it is the same acronym used by the industry.
3) Make an entirely unverifiable and vague claim, one that reporters seem to always quote faithfully:

“We have recently seen an increased interest in purchasing ground beef containing LFTB as customers and consumers gain access to more accurate information,” adds Gary Mickelson, a spokesman for Tyson Foods…”

I am so totally sure that if consumers just knew that their food had to be treated with ammonia because of underlying problems with the safety of its rendering, they would clamor for it.
4) Rely upon toady regulators–here the USDA. Note the unidentified spokesperson. Does the fact that the USDA expert won’t identify him/herself a signal?

“It’s beef,” says a USDA official. “There are various parts of the animal that come together in ground beef. This is just one part.”

5) Say it’s really no different from the rest of the sorry state of processed foods, because that is a very cogent argument:

As for the ick factor, well, wake up and smell the Spam. “There are plenty of examples in the food system where you could come up with a derogatory term for the process,” says Edward Mills of Penn State’s animal science department. “Luncheon meat, sausage, hot dogs. All of these are batter products. They’re made in a slurry. It isn’t pretty.”

6) And don’t forget to malign the critics:

“a troubling mix of industry intransigence, uninformed consumers and a megaphone-toting media–social and otherwise. The only innocent bystander was the cow.”

Of course, consumers are always uninformed. No one can be fully informed…
In order to win the larger battle with big business and their PR tactics, the consumer movement (and ordinary consumer themselves) has to recognize these tactics. In large part, this article has illustrated the pattern of argumentation that is so effective at manipulating the media and regulators. We need to get wise to this.

No Tucker Max, not PETA!

You may have heard about Planned Parenthood turning down Tucker Max’s 500k charitable donation on the grounds his misogynistic past marred the gift.
Now PETA is asking for the donation.
Let’s beg him not to do this. Instead of giving money to the dog-killing animal rightsists, how about a donation to pro-test and put a thumb in the eye of the anti-research pet killers? Send him a message, donate the money to a pro-science group.
Here’s my email to Tucker:
Continue reading “No Tucker Max, not PETA!”