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2205 andrew gelman stats-2014-02-10-More on US health care overkill


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Introduction: Paul Alper writes: You recently posted my moving and widening the goalposts contention. In it, I mentioned “how diagnoses increase markedly while deaths are flatlined” indicating that we are being overdiagnosed and overtreated. Above are 5 frightening graphs which illustrate the phenomenon. Defenders of the system might (ludicrously) contend that it is precisely the aggressive medical care that is responsible for keeping the cancers under control. The prostate cancer graph is particularly interesting because it shows the peaking of the PSA-driven cause of treatment in the 1990s which then falls off as the evidence accumulates that the PSA was far from a perfect indicator. In contrast is the thyroid cancer which zooms skyward even as the death rate is absolutely (dead) flat. And of course here’s the famous cross-country comparison that some find “ schlocky ” but which I (and many others) find compelling :


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3 Above are 5 frightening graphs which illustrate the phenomenon. [sent-3, score-0.391]

4 Defenders of the system might (ludicrously) contend that it is precisely the aggressive medical care that is responsible for keeping the cancers under control. [sent-4, score-1.193]

5 The prostate cancer graph is particularly interesting because it shows the peaking of the PSA-driven cause of treatment in the 1990s which then falls off as the evidence accumulates that the PSA was far from a perfect indicator. [sent-5, score-1.446]

6 In contrast is the thyroid cancer which zooms skyward even as the death rate is absolutely (dead) flat. [sent-6, score-0.871]


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Introduction: Paul Alper writes: You recently posted my moving and widening the goalposts contention. In it, I mentioned “how diagnoses increase markedly while deaths are flatlined” indicating that we are being overdiagnosed and overtreated. Above are 5 frightening graphs which illustrate the phenomenon. Defenders of the system might (ludicrously) contend that it is precisely the aggressive medical care that is responsible for keeping the cancers under control. The prostate cancer graph is particularly interesting because it shows the peaking of the PSA-driven cause of treatment in the 1990s which then falls off as the evidence accumulates that the PSA was far from a perfect indicator. In contrast is the thyroid cancer which zooms skyward even as the death rate is absolutely (dead) flat. And of course here’s the famous cross-country comparison that some find “ schlocky ” but which I (and many others) find compelling :

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Introduction: The (U.S.) “President’s Cancer Panel” has released its 2008-2009 annual report, which includes a cover letter that says “the true burden of environmentally induced cancer has been grossly underestimated.” The report itself discusses exposures to various types of industrial chemicals, some of which are known carcinogens, in some detail, but gives nearly no data or analysis to suggest that these exposures are contributing to significant numbers of cancers. In fact, there is pretty good evidence that they are not. The plot above shows age-adjusted cancer mortality for men, by cancer type, in the U.S. The plot below shows the same for women. In both cases, the cancers with the highest mortality rates are shown, but not all cancers (e.g. brain cancer is not shown). For what it’s worth, I’m not sure how trustworthy the rates are from the 1930s — it seems possible that reporting, autopsies, or both, were less careful during the Great Depression — so I suggest focusing on the r

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