Bogus article in _Science_ writes off young, old

Extremely Right 99 at
Fri Nov 22 08:55:07 EST 1996

The Bean Counters in the New World Health System need some way of
determining who gets the left over health care. Isn't it fair to have an
algorithm to tell your mama she's goin' to die. ###8up

Deathcare the new name in Hillary's Villagecare... ask your witch doctor today!
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In article <573ipu$5ro at>, Tommy the Terrorist
<mayday at> wrote:

> "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..."

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