Twaddle

The lives of more than 5,000 cancer sufferers will be saved each year under an £800 million government drive to make England’s survival rates among the best in Europe, the Health Secretary will announce today.

What is meant is that more money will be spent in an attempt to get the UK\’s dreadful cancer survivial rates up to hte European average, in which case 5,000 lives will be saved.

The problem with the realisation of this ambition is that in many ways the NHS is deliberately set up in order to introduce waiting times: this keeps costs down, we have rationing by queue. Which is fine, as long as you know you\’re doing that. Except that cancer is possibly the main disease that you don\’t want to ration treatment by queue, given that it can and does progress from treatable to not so while people are waiting.

4 thoughts on “Twaddle”

  1. Thats how rationing by queue works. If customers are served faster than they join the queue, there is no queue. If they join faster than they are served, the queue rises to infinity.

    So people have to drop out of the queue, in a manner which increases with the length of the queue, or it grows to infinity.

    They drop out in four ways:

    1. They get better by themselves.
    2. They die of something else.
    3. They get treatment somewhere else.
    4. They die of the disease they are queuing for.

    Now 1 and 2 are relatively harmless, those people didn’t really need treatment that much did they? 3 is effectively a boost to the NHS budget as people are paying twice for a treatment they have supposedly already paid tax for.

    4 is the real problem.

  2. Twaddle 2:

    It isn’t actually clear how much difference early detection/intervention makes.

    Certainly it makes sense that it should make a difference. And the figures definitely look better.

    But the figures for “survival” are defined as “survived 5 years after diagnosis”. So if you catch it 2 years earlier you automatically have a better chance of surviving 5 years – not because the treatment necessarily works but because you started the clock earlier.

    This would be true even if the treatment was entirely ineffective. So that makes the figures look better, but without necessarily having helped anyone.

    Secondly, many “cancers” are extremely slow growing. At the point of detection, it is hard to tell whether this is a slow-growing cancer you will die with, not from, or whether it is what will finish you off. If you don’t do early screening, you only catch the agressive cancers. If you do early screening, you catch both.

    That makes the figures look better, because all the survivors of the non-aggressive cancers are counted, where without screening they would not have been. Again, without having helped anyone – this works even if you don’t give any treatment at all.

    And finally, drugs to treat and surgery to remove a cancer is not without risks. The drugs are deeply unpleasant, and the surgery carries at least a 1 in 200 chance of complications and around 1 in 1000 to 1 in 100 chance of death dependent on the type. Breast lumpectomy is about 1 in 600 mortality, mastectomy is much higher.

    So what with the unnecessary surgery on lumps which would never have posed a problem, it is entirely possible that early detection and screening actually makes things worse, but that the effect is masked by the two statistical artifacts mentioned above.

    The evidence we have simply doesn’t allow us to answer the question.

    Anecdote: Shortly after the invention of the X-Ray, surgeons diagnosed a condition of dropping of the internal organs, and carried out operations to lift them up again. Much later, they realized that the organs were dropping because the X-Ray was taken in a standing position, while the cadavers they were using as a baseline were lying down.

  3. Cancer has been given a strange, special status among diseases. It’s not the only to cause a dreadfully painful death, but it does seem to be the only one having a “war” waged against it. This oddness may have started in the US but it seems to have infected us too. Myself, I’d be inclined to examine the incentives in the medical trades.

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