A bit unrelated - but I always thought the American concept of "annual checkups" sounded a bit weird. Here where I come from, Norway, that is not a thing - unless you have / or have had some serious illness in the past. Obviously cancer patients, or those in remission, get checked up every x months.
But for regular people, it's pretty much not a thing. It also made me wonder: How much more would it cost our health-care system, if everyone took advantage of things like annual checkups, or going through those extensive screens/tests that a lot of American patients go through. I guess the fear of malpractice lawsuits, higher insurance rates, or whatever make the medical centers in US a bit more incentivized to catch anything at all.
But AFAIK, we don't have any higher mortality rate here than those living in the US. Earlier this year I went to the doctor, because I was feeling a bit lethargic - turned out I had severe vitamin D deficiency. But other than that, it must be 7-8 years since I talked with a doctor.
(But credit where credit is due - the US seems like an excellent option IF you really need to get treated for certain cancers. It's not like we have "death panels" or awful long wait time here, but I know patients that have gone to the US to get treatment - on their own bill - for cancers that were deemed too advanced for treatment, here in Norway.)
Just FYI, annual checkups are recommended, but certainly something that a lot of young people skip. A quick google shows that only around 60% of Americans see a doctor yearly.
The checkup also isn’t a battery of tests unless you are at an age or condition for that. For a healthy 20 something that goes it’s basically the doctor checking your blood pressure and asking if anything has changed.
Yeah, that annual check-up is a 15min consult with maybe a blood test or a mail in colon cancer test even if you're 55+. Many people will completely ignore extreme signals of unhealthiness (pain, shortness of breath, trouble sleeping), because it's "normal" while another group simply can't believe they don't have some treatable disease to explain all their aliments.
This research was about just cancer detection/treatment, but it's worrying that once they only mention correcting for smoking rates (umm duh, that's the least you need to do)... but then they don't mention weight... so weird?
If you are male, your life will probably be wrecked at some point by a heart attack/stroke or prostate/bowel cancer. The risk of cardiovascular disease can be reduced in various ways. You also might have rarer but more significant risk factors for premature death from cardiovascular disease (eg Lp(a)). There is still an unacceptably high rate of death or severe disability from the primary cardiovascular event ie. you don't get a second chance, as the first sign of the disease can be fatal or disable you permanently. The screening tests one has in an annual checkup are not 'extensive' really, it is asking questions about lifestyle and family history, checking lipids, routine bloods, blood pressure and doing cancer screening after certain ages. The chance of an incidental finding resulting in harm is very low with this kind of thing.
Has a proactive, annual checkup model been properly compared to doing nothing on a population level? No. But on an individual level, it makes a lot of sense.
I would say it is not useful to compare mortality rates between countries. Norway has the highest GDP per capita anywhere for example, and is quite culuturally, geographically and genetically homogeneous. How would you make a useful comparison to the USA?
> I know patients that have gone to the US to get treatment - on their own bill - for cancers that were deemed too advanced for treatment, here in Norway.
The US is outstanding at taking money from sick people, just not any better at getting them well.
Not to defend anything about the American model (I personally hate it and think it's broken) but the annual checkup is a very cheap way of dealing with a possibly expensive condition.
The checkup is non-intrusive and for presumably healthy people consists of a physical, basic blood tests (glucose and some metabolic indicators + infection markers) and a blood pressure check. As an example, it's way cheaper to find out you have pre-diabetes this way, than to go to the doctor with symptoms when you have full on diabetes. This is mainly the reason why insurances pay for these in full, as they're part of 'preventive care'.
> How much more would it cost our health-care system, if everyone took advantage of
Annual checkups are definitely not the reason healthcare costs are sky-high in the US.
Neither of those links provide any numbers or good reasons to think that Cuba and the US can be easily compared. So while I agree that the idea is attractive and plausible, it remains merely an idea. And it is an old one too, I remember reading somewhere that in ancient China doctors were paid while you were well but you stopped paying if you fell ill so it was in the doctor's interest to prevent you falling ill. I have no idea if the story is true but it does suggest that the idea is not new.
> It's not like we have "death panels" or awful long wait time here, but I know patients that have gone to the US to get treatment - on their own bill - for cancers that were deemed too advanced for treatment, here in Norway.)
This sounds like the right way to go, but I want you to understand this is exactly what people mean when they say “death panels”.
The argument never made sense to me because that's surely not much different from how a private insurance company in the US already operates - you can bet they have a team of actuaries who has calculated the exact point it's probably not worth their money to try to save a patient.
Both approaches have pros and cons, because while an early diagnostic of some diseases can make a huge difference, there are also false-positives and needless invasive procedures
(And I guess the people that are the most oblivious about their health are the ones that are more prone to have lifestyle related conditions - some people have never measured their blood pressure or blood glucose)
Part of the reason why it’s a thing in the US is that a huge number of people do have/have had a serious illness in the past: heart disease, diabetes, obesity, etc. Part of the reason they have those illnesses is because they neglected their health due to the cost of prevention.
The annual check up is something that's been advocated a long time, 50s at least, and predates the obesity epidemic.
The annual checkup is a symptom of a therapeutic view of health care, a view which cannot be divorced from modernism. The body is a machine which must be oiled and greased, frequently submitted to tests and expert investigation, so it can be tuned perfectly, just like a car, like a machine.
This really was _the_ obsession in post war America: that all human activity (really, all of it), needed to be mediated by technology. This included personal transportation, education, cooking, ... and also maintaining our health.
And that is where we are now; a chronically medicated population and a bureaucracy optimized to propagate this state of affairs. The annual checkup fits perfectly in this mindset.
Implicit in that statement (taken together with the comment you're responding to) is the assumption that the kinds of plants cheaper than meats and dairy are healthier than a lacto-carnivorous diet. Locally, chicken and live anchovies are cheaper than lettuce, tomatoes, broccoli, and even beans and rice when denominated in pounds, sulfur, protein, calcium, B vitamins, .... I can understand the argument for having a high level of plants in your diet, but I'm skeptical that it's cheaper to live on just plants unless you only count calories and no other nutrients.
Plus I think they were probably talking about how all of those options are vastly more expensive than living on Raman and peanut butter sandwiches, especially once you count for prep time and power costs.
Wait a sec: mammograms, postate exams, colonoscopies? You don't have these regular screenings when you hit a certain age? AFAIK, the data is very good on the early detection power of these exams.
What is the right time? Here in Ontario, Canada a letter gets sent at around 50 (I think) asking you to do a FIT test. Call your Dr, get the kit, do the self-test and mail it in.
Also from Norway: no I don't, nor anyone else I know, certainly not any pets.
Women get regular mammograms after a certain age; prostate examinations are offered if you are concerned and if anything is found then more frequent checks will be offered but nothing like annual checks for people not known to have a problem.
Since we spend twice as much as anyone else on healthcare but rank somewhere around 50th in lifespan, it would be weird if we were getting better outcomes in any area due to greater spending.
The average lifespan numbers are rigged. Most countries don’t count an infant delivered alive but terminal in their infant mortality numbers. Like when a placenta ruptures and you have an emergency birth before 28 or 30 weeks. Those don’t count in most if not all of Europe.
In the US, every live birth counts, even if it only lasts minutes
I don’t know if that completely makes up the difference, but the real disparity is nowhere near the numbers that get thrown around. It’s apples vs oranges.
Covid positives were a similar situation.
Most countries would not report a positive Covid patient unless the test was positive and the patient was symptomatic.
Data collection differences are well-known to the people who produce cross-country numbers. Further, your specific observation about when births are counted in the US is flat wrong. We have 54 ways of doing things. Furthermore, not everything is a conspiracy. Reasonable people do things differently. To suggest these numbers are rigged is glib.
>I don’t know if that completely makes up the difference, but the real disparity is nowhere near the numbers that get thrown around. It’s apples vs oranges.
The CDC[2020] reports an infant mortality rate of <0.6%. Excluding all of it would only increase life expectancy from 78.8 to 79.2
As a researcher in the field and someone who has seen a few friends go due to cancer, the current standard of care is very frustrating.
I believe cancer is orders of magnitude easier to treat when it is still asymptomatic but detectable using metrics such as circulating tumor DNA (ctDNA). However, it is taking ages to deploy this technology because healthcare struggles with any data-oriented solution.
Healthcare is notoriously slow with adoption of new technology. IMO this is because healthcare is fee-for-service, which is basically incompatible with prevention. A movement to value-based care would vastly improve adoption of preventive and personalized healthcare.
The HMO model was basically designed to bring in an element of value-based reimbursement. For example, the CMS capitation payments to Medicare Advantage plans are weighted by (inter alia) health outcomes.
OK that explains a few countries which have a fee-for-service model, what about those countries incentivized to prevent problems? Do they take new technology on faster?
Austria has a single payer system but each part of that system still charges via fee for service.
Innovation does not get injected top down by the omniscient insurance system but bottom up from research clinics and forward thinking doctors.
People engaging the insurance directly with an efficiency play almost always fail here. There are even some vaccines against transmissible diseases that you have to pay for as an adult. I always wonder how that can make any sense. Either the value of delivering the vaccine is less than the 10 euros they are charging me (which probably means it is not very important for me to get it) or the insurance makes a colossal mistake. Especially since most vaccines are only individually unimportant since everyone else has them.
As naive as it may sound, start your own little health care facility, with physicians and individuals who see the problems that plague mainstream. The facility can be either be a secret or out in the sea, outside the jurisdiction of most governments. The rot in mainstream medicine (as with some other aspects of life) is so deep and entrenched that no amount of attempting to fix it by individuals (or even groups) will work.
I guess creating startups that offer polished ctDNA solutions or pressing local governments to make healthcare more streamlined, perhaps even with healthcare IT startups too.
The problem is that most healthcare systems are too fragmented and not geared towards prevention. Hence, one faces a huge uphill battle.
Yes, and it's not very expensive. Many EU & US labs would do a test for you for ~$300--$500.
I guess it'd be really cheap if it was deployed nationwide. Furthermore, predictions would be a lot more sensitive / specific as they would be tuned with millions of datapoints.
It's the same for other technologies such as TCR-seq. They could theoretically bring immense prevention benefits, but it's really hard to bootstrap them without collaboration from big healthcare systems as you need thousands of datapoints to get it going. Very frustrating.
Would there be an opportunity to advertise this online and provide an end-to-end service of testing on an interval basis to customers? Subsidized by VC money on the promise of valuable data sets for this sensitivity/specificity in the long term?
I truly think so. The real hurdle is to get into a collaboration with a reasonably organized healthcare provider that lets you access a sufficiently large pool of donors, with electronic health records and the capability to follow them up.
Bonus points if you can genotype them, i.e. measure common genetic variants using a chip similar to e.g. the one used by 23andme. Most tumors have an association with variants in the HLA region, and pre-screening susceptible individuals will reduce sample sizes and therefore initial costs to bootstrap.
The same applies to TCR-seq and other biomarkers which are incredibly useful to detect autoimmune disorders really early in the process.
In case you are interested in discussing this further, just get in touch via email (on my profile).
Very true. The headline is misleading though. The actual article is framed as the inverse: "does spending more on cancer care give the US better outcomes?" and the answer is no. We're on par with other wealthy countries that spend half as much per person on cancer care.
So yeah, the exorbitant costs of US healthcare do not correlate with better health outcomes. Just worse financial outcomes.
We shouldn't expect outcomes to be much different, because when someone gets cancer in the rich world, they get treated with whatever medical science thinks is best. Contrast that with an ordinary purchase like a washing machine.
What's left when you're definitely going to buy the Cadillac is that the price depends on how much money you have, and Americans tend to be wealthy.
It also depends on factors relating to restriction of competition. If there's only so many doctors, which is the case because they restrict how many can be trained, doctors can extract more. Add to that the fear of litigation (friend dated a girl whose father made a living suing US doctors) and they end up spending money on tests that they wouldn't in the rest of the west. Possibly collective purchasing in national systems means something too, not sure.
These analyses are very crude. How do they work out spending on cancer care? They take total spending and get the % spent on cancer care. % spent on cancer care is a published figure, it is not calculated directly. In single payer systems, like Australia, the true costs of cancer care are probably submerged in broader healthcare spending. The comparison is also unfair because of drug costs. Essentially, drug companies know they can make a lot on cancer drugs in the USA [1]. This means that they are more willing to negotiate lower prices in other smaller countries. There is also the fact that the crazy legislation in the USA prevents price negotiations. The USA is in a way subsidising cancer drugs for the rest of the world.
I also think it is impossible to really compare cancer mortality between countries. My take on these figures is that given how big and dirty the USA is, they are doing remarkably well to have mortality that is significantly lower compared to smaller wealthy countries.
Healthcare spending is almost as unequal as wealth, with a tiny minority consuming most of the resources [0]. Don't have data for this, but I see no reason not to assume a similar distribution applies to groups like cancer sufferers. That is - those most likely to die account for most of the cancer spending, while those with good outcomes account for relatively little. If you set a per person spending cap, you could expect a great reduction in per capita spending without much impact on aggregate outcomes (perhaps even an improvement). Which is exactly what public healthcare systems effectively do by strict rationing and discouraging private spending.
^ looks into more granular data, surveys sources that show +/0/- correlation between spending + outcomes, compares end-of-life vs non-end-of-life, cites a few studies about specific cancer types, wasteful spending. Does a better job of investigating international change in spending vs outcomes over time.
the OP globocan paper is using a country average; averages don't tell you that much, esp in the US.
cancer data is very granular these days (NY mandates per-case reporting, for example https://www.health.ny.gov/statistics/cancer/registry/about.h...). would be interesting to have a live model somewhere of outcomes by cancer, stage, comorbidity + hospital
Cancer Care costs are insane..my mom is being treated for breast cancer..each chemo infusion cost $65k to her insurance company. Her surgery to remove her left breast cost $165k. 5k going to the surgeon fee while the rest was a facility fee. It's been less than a year now and the insurance has paid out almost a million dollars.
>each chemo infusion cost $65k to her insurance company. Her surgery to remove her left breast cost $165k. 5k going to the surgeon fee while the rest was a facility fee. It's been less than a year now and the insurance has paid out almost a million dollars.
Do you know that your insurance paid that, or is it what you have been quoted?
US hospitals are notorious for overcharging by factors of ~10x when looking at their charge master, but the insurance companies will get a much better price after negotiating with the hospital, which is one of the reasons why the hospitals will blow-up charges in the first place, to get paid despite the insurance companies not paying everything.
It's a broken system because you need an insurance agent as a "lawyer" to get the real rates.
Instead what is necessary is price competition and transparency. You should be able to look up online the cost of chemotherapy for a certain type of cancer in the whole US, then you can filter by distance, reviews and price. The price on the sticker has to include everything. Whether you have insurance or not should not factor into the price at all.
The free market is maybe not a solution to the social problem here, but it could at least drive down costs.
My Mum was diagnosed with stage 4 lung cancer - had 2.5 years of radiation, chemo and monthly doctor visits. Saw many specialists, etc. etc.
Never saw a single bill, and in fact was paid actual money for the inconvenience of having to drive 3.5 hours to a bigger facility that had equipment the local small-town hospital did not. Also got a free apartment to stay in for those out of town appointments, meal allowance, etc.
Mum had never paid a cent in insurance premiums in her life, etc.
This mirrors my personal experience. To make a treatment decision, against the advice of my local doctors, that was key to survival I relied on US research.
To compare costs: For an extremely rare cancer, total cost of treatment was 100k EUR in Germany, whereas US patients report case costs of >2m USD.
Part of these savings stem from the public healthcare system not providing adequate treatment, while strictly necessary for a reasonable chance of survival in this case. What happens in Germany then is the amazing doctors do stuff anyway (if you can convince them), bill whatever they can, and write off the remainder. Profits from privately insured patients make up for this shortfall here.
Public healthcare being adequate is somewhat of a myth, for Germany at least.
on the research side, this would tend to reduce prices, right? clinical trials usually aren't charging (per [1]).
this 2017 article[2] claims that the US pharma $ premium is more than R&D spending for 13 of 15 top pharma cos. (Note: this isn't even talking about profit, it's talking about the excess profit from higher US prices). Maybe you can make an argument that R&D is lockstep to margins, and would shrink if margins went down?
Do you have any data to backup your claim? For example Cuban healthcare/treatment/outcome is excellent based on its own research. Roche(Swiss) nor Merck ( German, not related to US Merck) don't benefit much (if at all) from US subsidies.
Cuba has developed a few drugs and exports doctors as chattel for foreign income but their actual healthcare is abysmal. They larger operate without antibiotics, pain killers, and at times clean water. They can’t provide 24h power to hospitals so most modern tech is pointless there. The notion that anything else is true is just Cuban propaganda. There are tons of accounts from NGOs and doctors who have defected.
Cuba's data is pretty suspect. Too lazy to find it at the moment, but I recall reading that their cancer rates or deaths were some absurd fraction of what would be expected given smoking rates even compared with better developed countries. They also had some eye raising way of counting perinatal infant death that makes their infant mortality rates look a lot lower.
> “The pattern of spending more and getting less is well-documented in the U.S. healthcare system; now we see it in cancer care, too,” said co-author Elizabeth Bradley
It's a cynical viewpoint, but I can forgive those who think that modern health care is mostly a way to extract as much wealth as possible from sick people before they die.
Having dealt with end of life Healthcare for a family member who dies of cancer, I'm curious how you can see it any other way. It is purely wealth extraction at end of life.
When you lose you job and insurance due to health, you can not qualify for state aid if you have any assets at all. you you must spend until you are broke before you get any help. Then there is the issue of nursing homes. If you end up in one, they have the ability to unwind any asset transfers in the previous 5 years, so if you thought you can transfer your house to your children before you die, you can not. The nursing home and the hospitals will suck every penny out of an estate and the only way to prevent it is to die quickly.
But this is adjusting for the baseline illness, remember. This isn't just age-standardised mortality rates. It's disease-standardised mortality. Hopefully they've adjusted for confounders...
The relatively poor average quality of healthcare was made apparent in covid pandemic where US had among the highest mortality rates and deaths per capita in the developed world [1]
And I do not need data to tell me this, just overal experience comparing it to my previous experience getting healthcare in Europe leaves a lot to be desired.
Getting medical care in US is hard with a lot of bureaucratic/insurance overhead and when you finally get to the doctor they are more prone to follow strict procedures/checklists to reduce liability instead of being genuinly curious about your condition.
And all this while most have to pay astronomical price for healthcare out of their pocket. Not sure that the case for privatised healthcare can hold up with these results.
While your premise may not be wrong, I'm not so sure that COVID statistics can tell us much between countries. There are a great deal of countries that are either wholly inadequate, or purposefully misleading when it comes to their true COVID numbers.
For example, India has an official COVID death count of around 500k. The WHO has made their own estimates and believe their death count to be closer to 5 million, ten times the official number.
Which does not seemed to changed. Of course the they did put a spin on it by saying that the flu and other diseases disappeared because of all the measures taken. Heads I win, tails you loose.
Are you implying that the excess death rate was zero? Or do you have a different definition than I do? The excess death rate is the difference between the current death rate and the rate expected by extrapolation from historical data.
If I recollect the excess death rate was actually negative in 2020 and slightly positive after that in 2021. In both years in my opinion, the numbers are statistically insignificant. But then I have a different opinion on what exactly is statistically 'significant' compared to most people.
We are talking approximately 1% of the population dying each year and excess death rate being in the region of -+20% of this 1 percent. All above figures are approximate ball park figures from memory - so don't hold me accountable to the exact numbers.
Did you get the total deaths (not excess) from the links you posted?
Edit - your numbers are seem correct but the question is, do consider them statistically significant? For me a jump from 2.6 million to 3.2 million is still tiny.
> The relatively poor average quality of healthcare was made apparent in covid pandemic where US had among the highest mortality rates and deaths per capita in the developed world
This discounts the fact that the vast amount of money spent on Medical practices is in the US which causes the advances here. Once the advances happen though they're global, so the US does not get the benefits from that money.
This "tragedy of the commons" with regards to medical science causes everyone to misattribute things. Europe for example can pay little money for their medical practices because of the US bankrolling the research and drug development that allows them to do so.
One route to fixing things in the US, if we really wish to do so, is to create by law a "most favored" status for the US such that if a US drug company sells outside the country, they must sell the drug in the US for the same price as the lowest price they sell it to any other country. This would largely fix our expensive healthcare, but would also harm the world heavily in advancement.
I work in the drug development industry, its a shame this has been downvoted, it's largely true - at least for new drug innovation. The fact that routine procedures are expensive in the US is unrelated.
The US is ~35% of the global pharmaceutical industry, which is the topline driver of new drug development.
When the US pays top dollar for new drugs, it does effectively subsidize European access to the new research.
> One route to fixing things in the US, if we really wish to do so, is to create by law a "most favored" status for the US such that if a US drug company sells outside the country, they must sell the drug in the US for the same price as the lowest price they sell it to any other country. This would largely fix our expensive healthcare, but would also harm the world heavily in advancement.
Then you'd end up bankrupting most healthcare and pharmaceutical companies, that is if most of them don't leave the country. If the current scenario is a "tragedy of the commons" a la Guns or Butter, then the US's domestic medical policy is the biggest contributor. A "most favored nation" policy as such just allows the government to pick winners and losers by creating a de facto price control. It's not a solution and would do more harm than good.
The ultimate reason why it's expensive to sell a drug in the United States is because the FDA makes it illegal to import competing drugs. The solution is to let the market determine the "real" prices.
> they must sell the drug in the US for the same price as the lowest price they sell it to any other country. This would largely fix our expensive healthcare, but would also harm the world heavily in advancement
Drug prices are far from the leading cause of the high cost of US healthcare.
The whole system is deeply dysfunctional with massive perverse incentives.
Do you have the numbers to back these claims? Is the extravagant money spend on healthcare in US actually drives everything ahead? Do countries like UK, Germany, Switzerland and Japan lag behind due to the smaller amounts spent?
No they don't lag behind, because as I mentioned, once they're developed the drugs are available globally, and often reverse engineered and re-sold by less scrupulous countries that don't care about intellectual property.
As to your first question, I don't have an answer for you off hand.
Okay, what are the sources of this claim? I'm kind of surprised that Germans and the British steal American technology developed though bankruptcy inducing childbirths.
edit: Hmm, if that's true then US must be actually behind because every now and then the UK or some Europeans might invent something but the Americans won't have it because they respect intellectual property. Which means Americans will have only American stuff but the Brits and the EU will have Europeans stuff too.
Okay, can you provide some literature on that claim? Do you, by any chance refer to the European governments buying directly from the pharma companies, thus getting solid discount? Or is it the case that European companies simply copy the drugs and move on? If that's the case, is the US healthcare expensive because pharma companies need to make money from the US sales only?
But for regular people, it's pretty much not a thing. It also made me wonder: How much more would it cost our health-care system, if everyone took advantage of things like annual checkups, or going through those extensive screens/tests that a lot of American patients go through. I guess the fear of malpractice lawsuits, higher insurance rates, or whatever make the medical centers in US a bit more incentivized to catch anything at all.
But AFAIK, we don't have any higher mortality rate here than those living in the US. Earlier this year I went to the doctor, because I was feeling a bit lethargic - turned out I had severe vitamin D deficiency. But other than that, it must be 7-8 years since I talked with a doctor.
(But credit where credit is due - the US seems like an excellent option IF you really need to get treated for certain cancers. It's not like we have "death panels" or awful long wait time here, but I know patients that have gone to the US to get treatment - on their own bill - for cancers that were deemed too advanced for treatment, here in Norway.)