Bogus article in _Science_ writes off young, old

Tommy the Terrorist mayday at super.zippo.com
Fri Nov 22 01:55:58 EST 1996


"Evidence-Based Health Policy - Lessons from the Global Burden of Disease
Study"
Christopher J. L. Murray and Alan D. Lopez, Science, vol. 274, 1 Nov 1996

To quote the introduction:  "Public health policy formulation desperately
needs independent, objective information on the magnitude of health
problems and their likely trends, based on standard units of measurement
and comparable methods."

Now we'll see whether they offer this.

The study concludes that lower respiratory infections and diarrheal
diseases are far more important than ischemic heart disease, malaria, or
HIV.  

How do they do this?  "Disability-Adjusted Life Years" - "... the sum of
years of life lost because of premature mortality and years of life lived
with disability, adjusted for the severity of disability.  Time lived
with various short-, medium-, and long-term disabilities is weighted by a
severity weight that is based on the measurement of social preferences
for time lived in various health states (7)."

If I hadn't noticed the peculiar disclaimer, "the authors alone are
responsible for the views expressed here" [not Harvard School of Public
Health or the World Health Organization], I may never have progressed to
reference 7.  And if someone else had dared to commit to print the
vicious scheme they are about to perpetrate in that reference, then they
might have hidden it in a reference there, instead of putting in this
fine print...

"Time lived at different ages has been valued with an exponential
function of the form Cx exp (-beta x), (where C is a constant, x is age,
and beta is 0.04) to reflect the greater social role played by adults in
caring and providing for the young and the old.  Time lost to premature
mortality has been discounted at 3%, so that a year of life lost in the
future is less valuable than a year of life lost today."

In case that equation doesn't speak to your heart, here are the relative
values they place on time lived at various ages (I'm not going to try to
duplicate their normalization, but the *ratios* between the importance of
these times are what matters.)

newborn:  *zero*.
5 years:  4.1
10 years:  6.7
15 years:  8.2
20 years:  9.0
25 years:  9.2
30 years:  9.0
35 years:  8.6
40 years:  8.1
45 years:  7.4
50 years:  6.8
55 years:  6.1
60 years:  5.4
65 years:  4.8
70 years:  4.3
75 years:  3.7
80 years:  3.3
85 years:  2.8
90 years:  2.5
95 years:  2.1
100 years:  1.8

Now, in addition, don't forget that 3% a year deduction.  That means that
if a newborn dies, the time he "would have lived" is worth 3% less per
year in the future [27% less for a decade in the future; 54% less for two
decades in the future, and so on]  So the "real" lifespan he'd have when
he was an adult is counted for half or less.

Now, they refer also to a system of deciding how bad a disability is
based on surveys in which they ask a person whether they'd rather live 10
years healthy or 15 years with chronic diarrhea (or whatever).  There
there is at least a pretense of an unbiased 'democracy'-like decision
making process.

They could have done the same thing for age, and asked people whether a
year of a 5-year-old's life or a 65-year-old's life is really worth only
half of the value of a year of a 25-year-old's life.  They don't.  They
impose an arbitrary formula with a convenient differentiatable form and a
nice round number, which happens to match the value of life as they
perceive it.  And then, having encased this in this "evidence-based"
report, they move on to their concluding section of the report, "Policy
Implications".

"... Although a number of infectious and parasitic diseases, such as
tuberculosis and malaria, are likely to remain major health challenges,
many developing regions are already faced with the problems of responding
to a large burden of noncommunicable conditions and injuries.  These
combined demographic and epidemiological trends will increasingly shift
the focus of policy debate and research to the adult health agenda..."

NO WONDER.



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