Free Republic
Browse · Search
Bloggers & Personal
Topics · Post Article

Skip to comments.

Wesley J. Smith: Using Computer Models to Ration Health Care?
First Things/Secondhand Smoke ^ | 1/13/12 | Wesley J. Smith

Posted on 01/14/2012 2:53:29 PM PST by wagglebee

We discussed the new computer model that supposedly can predict how much longer one has to live in the context of whether a patient should be told they have less than ten years.  But the NYT’s take on the same story raises another issue we only tangentially touched before; whether a computer program predicting how long a patient has to live could be put to pernicious heatlhcare rationing effect, similar to the “quality adjusted life year” (QALY) that was used by NICE to ration medicine in the UK.  From “Using Interactive Tools to Assess the Likelihood of Death:”

Now, researchers at the University of California, San Francisco, have identified 16 assessment scales with “moderate” to “very good” abilities to determine the likelihood of death within six months to five years in various older populations. Moreover, the authors have fashioned interactive tools of the most accurate and useful assessments. On Tuesday, the researchers published a review of these assessments in The Journal of the American Medical Association and posted the interactive versions at a new Web site called ePrognosis.org, the first time such tools have been assembled for physicians in a single online location.       

“We think a more frank discussion of prognosis in the elderly is sorely needed,” said Dr. Sei Lee, a geriatrician at U.C.S.F. and a co-author of the review. “Without it, decisions are made that are more likely to hurt patients than help them.” Dr. Lee and his colleagues cautioned that while the best assessments are reasonably accurate, there is insufficient data on whether using them improves patient care in clinical settings. The researchers stopped short of urging widespread use.

For now, perhaps. But wait until Obamacare bureaucrats grab ahold.

One doesn’t have to be paranoid to see where this can lead. Under QALY systems, roughly stated, a cost benefit analysis is done to justify providing or withholding an intervention based on the time it is expected to give a patient, adjusted for the quality of life during that time.  Thus, the same intervention that would give me, say, five years of life, might be only worth two years of QALYs if the time would likely include my being disabled.  And something worth five QALYs might be paid for but not something worth two.  The same type of thing could easily be fashioned with this computer model–and don’t think some people aren’t thinking about doing just that.

Do we want people to have information to properly give informed consent and refusal to potential interventions?  Absolutely. Do we want doctors to not offer particular efficacious interventions–or the government/private insurance company refusing to pay for them–because the computer model opined that the patient has a 78% chance of, say, living less than three years?  I think not. Could this kind of information to be used to justify medical discrimination?  You betcha! Indeed, I fear some want to do just that–particularly given the bureaucratic cost saving impetus behind Obamacare’s many cost/benefit panels.

Could this become a hope killer?  You betcha again!  We should tread with very great care here.


TOPICS: Health/Medicine
KEYWORDS: deathpanels; moralabsolutes; prolife; rationing
Zero's death panels will love this.
1 posted on 01/14/2012 2:53:36 PM PST by wagglebee
[ Post Reply | Private Reply | View Replies]

To: cgk; Coleus; cpforlife.org; narses; Salvation; 8mmMauser
Pro-Life Ping
2 posted on 01/14/2012 2:54:44 PM PST by wagglebee ("A political party cannot be all things to all people." -- Ronald Reagan, 3/1/75)
[ Post Reply | Private Reply | To 1 | View Replies]

To: 185JHP; 230FMJ; AKA Elena; APatientMan; Albion Wilde; Aleighanne; Alexander Rubin; ...
Moral Absolutes Ping!

Freepmail wagglebee to subscribe or unsubscribe from the moral absolutes ping list.

FreeRepublic moral absolutes keyword search
[ Add keyword moral absolutes to flag FR articles to this ping list ]


3 posted on 01/14/2012 2:55:45 PM PST by wagglebee ("A political party cannot be all things to all people." -- Ronald Reagan, 3/1/75)
[ Post Reply | Private Reply | To 1 | View Replies]

To: wagglebee
have identified 16 assessment scales with “moderate” to “very good” abilities to determine the likelihood of death within six months to five years in various older populations

I don't believe a word of it. To the extent that it's true, I'll wager they fall closer to "moderate" than "very good." And "moderate" isn't good enough.

4 posted on 01/14/2012 3:03:12 PM PST by BfloGuy (The final outcome of the credit expansion is general impoverishment.)
[ Post Reply | Private Reply | To 1 | View Replies]

To: BfloGuy; no-to-illegals; All

I cared for my mother with congestive heart failure and my husband with Alzheimers, both of who wanted to die at home. I also spent a fair amount of time helping my father who died shortly after a stroke in the years before he died. Having watched 3 people die up close and personal, I think I could be pretty good at predicting if someone was going to die within 2 or 3 years with adequate data from family.

For longer term predictions one has to consider if there is the possibility of significant life style changes by the person identified. I am reminded of a joke my husband told.

A man goes to the Dr. and says, “Doc, I feel tired all the time, can’t sleep, no appetite, stomach hurts, feel like hexx.”
The doctor examines him and says, “Well sir, you are in bad shape and you need to give up smoking, drinking, and running with wild, wild women.”
“But Doc,” the man says, “I don’t do any of those things.”
“Well,” says the doctor, “There you have it, you’re a sinking ship and you have no ballast to throw overboard.”

Whenever predictions are made that we don’t like, we always need to look at our lives to see if we have any ballast that we can throw overboard. In the case of my mother and husband, not much could be done. In my father’s case, however, he did not stop smoking until he was 87, and he had a bad temper and high blood pressure. He blew his stroke while standing in a grocery line on a Friday afternoon buying groceries for a 90 mile drive to a rental property with bad tenants who owed rent where he was going to spend the night. I’ll bet he was in a seething temper. Failure to learn anger management and also to cut back his activities appropriately killed him at age 90.


5 posted on 01/14/2012 3:23:29 PM PST by gleeaikin
[ Post Reply | Private Reply | To 4 | View Replies]

To: wagglebee

Let us use our Liberty and our Constitution to RATION GOVERNMENT!


6 posted on 01/14/2012 3:38:55 PM PST by G Larry ("I dream of a day when a man is judged by the content of his Character.")
[ Post Reply | Private Reply | To 1 | View Replies]

To: wagglebee
The Master Computer deems you to be useless, please report to Carousel. B-P


7 posted on 01/14/2012 4:33:10 PM PST by Nowhere Man (Holodeck Computer: End Obama Administration simulation program, NOW!!!!)
[ Post Reply | Private Reply | To 1 | View Replies]

To: wagglebee

The general public might like it, too. If people will let their iThingies and AmazonBeebers auto-correct their web posts and emails, no matter how many times it produces hysterical howlers or total gargle, why wouldn’t they trust medical decision-making to an “app”?


8 posted on 01/14/2012 4:38:31 PM PST by Tax-chick (Be the one who gets it done (instead of a useless drone)!)
[ Post Reply | Private Reply | To 1 | View Replies]

To: gleeaikin
Whenever predictions are made that we don’t like, we always need to look at our lives to see if we have any ballast that we can throw overboard.

I disagree. I look at my doctor as I do my auto mechanic. If I have harmed my body or my car and there is a fix, then I shall pay for it to be fixed. My poor maintenance has nothing to do with the decision. And nobody else need concern himself with it.

9 posted on 01/14/2012 5:33:29 PM PST by BfloGuy (The final outcome of the credit expansion is general impoverishment.)
[ Post Reply | Private Reply | To 5 | View Replies]

To: wagglebee

Why there’s no need of death panels now. It’s so...so...old fashioned to have humans in charge of making life and death decisions.

All we need is a good program that can send an email. I mean, after all, a computer can’t be moved by a human appeal for unnecessary treatment.


10 posted on 01/14/2012 5:50:15 PM PST by wildbill (You're just jealous because the Voices talk only to me.)
[ Post Reply | Private Reply | To 1 | View Replies]

To: wagglebee

Spin the wheel geezer .... your living or dying hangs in the balance .... click, click, click .....


11 posted on 01/14/2012 6:39:05 PM PST by RetiredTexasVet (There's a pill for just about everything ... except stupid!)
[ Post Reply | Private Reply | To 1 | View Replies]

To: gleeaikin

OK, so the fascists want to ration care base on years of quality of life expected. Appently, an older person’s year of life is less equal than a younger person. The elderly are being viewed more and more like the pre-born- disposable. What if the ante is raised by the rationing of health care resources by tax revenue generated per person. That would deny care to society’s ‘takers’. Here, the fascists would face a dilemma between their desire to deny care in general, and their desire to aid their welfare constiuency.
The Dims are all about one thing-power. Benefits will be doled out to their supporters and their opponents will be punished. All they want is total power. Instead of the rule of law, we will have the law of the jungle, sheer tribalism.


12 posted on 01/14/2012 6:39:11 PM PST by grumpygresh (Democrats delenda est; zero sera dans l'enfer bientot.)
[ Post Reply | Private Reply | To 5 | View Replies]

To: grumpygresh; wagglebee
That is one of the best comments I've ever seen on this subject. I'm going to repeat it!!!

OK, so the fascists want to ration care base on years of quality of life expected. Appently, an older person’s year of life is less equal than a younger person. The elderly are being viewed more and more like the pre-born- disposable. What if the ante is raised by the rationing of health care resources by tax revenue generated per person. That would deny care to society’s ‘takers’. Here, the fascists would face a dilemma between their desire to deny care in general, and their desire to aid their welfare constiuency.

The Dims are all about one thing-power. Benefits will be doled out to their supporters and their opponents will be punished. All they want is total power. Instead of the rule of law, we will have the law of the jungle, sheer tribalism.

13 posted on 01/14/2012 6:53:47 PM PST by little jeremiah (We will have to go through hell to get out of hell)
[ Post Reply | Private Reply | To 12 | View Replies]


14 posted on 01/14/2012 7:26:16 PM PST by RedMDer (Forward With Confidence!)
[ Post Reply | Private Reply | View Replies]

To: wagglebee

I expect that the Death Panel techies will check w/their colleagues over at the Climate Change IT shop to see what can be done to make all that “difficult” data produce the proper answers...


15 posted on 01/14/2012 7:36:39 PM PST by Clioman
[ Post Reply | Private Reply | To 1 | View Replies]

To: BfloGuy; All

You have exactly restated my point, so I don’t know why you disagree. When our mechanic says we have a problem with our machinery, then we need to take responsibility for our bad driving habits or failures of preventive maintenance. And as with a car, sometimes there is no fix available. In my mother’s case she had a defective mitral valve replaced by a pig valve at age 78. It turns out these valves had a useful life of about 10 years. At 88 she was too frail for another surgery and thus died at 89 of congestive heart failure.


16 posted on 01/14/2012 11:01:22 PM PST by gleeaikin
[ Post Reply | Private Reply | To 9 | View Replies]

To: grumpygresh; All

I said nothing about rationing care. I merely pointed out that with experience it is possible to estimate how much time is left. Thus one can choose to seek more agressive treatment, spend more time with the grandchildren, clean out a lifetime collection of personal junk, distribute possessions to family and charity, take one more beautiful trip, etc.


17 posted on 01/14/2012 11:06:29 PM PST by gleeaikin
[ Post Reply | Private Reply | To 12 | View Replies]

To: gleeaikin

Sorry. I guess I misunderstood you.


18 posted on 01/15/2012 5:29:21 AM PST by BfloGuy (The final outcome of the credit expansion is general impoverishment.)
[ Post Reply | Private Reply | To 16 | View Replies]

To: gleeaikin
The identical thing happened to my MIL.

She had her valve replaced at 57, and her health deteriorated when she was 66. I took her for consultations, and the doctors said that she wouldn't survive the surgery to replace the valve, and she died at 67.

We had her autopsied to see if the valve had failed. It had not. Her other, natural valve had failed, and she was in otherwise great shape and would have easily survived the surgery to replace both valves.

The Kaiser doctor (HMO - may Ted Kennedy rot in hell - this was not the first relative that I lost to Kaiser incompetence) killed her as sure as I'm sitting here.

This happened in 1996. I wonder if they were executing old people as early as that, you know, just to try out their system of extermination.
19 posted on 01/15/2012 7:15:41 AM PST by TheOldLady (FReepmail me to get ON or OFF the ZOT LIGHTNING ping list)
[ Post Reply | Private Reply | To 16 | View Replies]

To: gleeaikin
You were a wonderful child to your parents. A blessing to our parents. Your family has a long lifeline, and (your parents) were blessed with long life. Counting your families blessing is constantly a reminder of God's Hand in and on our lives. Thanks for this ping gleeaikin. Your post was a blessing to me.
20 posted on 01/15/2012 8:45:27 AM PST by no-to-illegals (Please God, Protect and Bless Our Men and Women in Uniform with Victory. Amen.)
[ Post Reply | Private Reply | To 5 | View Replies]

To: wagglebee

I hope they’re more accurate than the computer models used for global warming research...


21 posted on 01/15/2012 8:46:24 AM PST by AMitchum
[ Post Reply | Private Reply | To 1 | View Replies]

To: gleeaikin
LOL gleeaikin noted I typed (A blessing to our parents) the word our instead should have been your though in the family of God, my guess is we are all related.
22 posted on 01/15/2012 8:48:31 AM PST by no-to-illegals (Please God, Protect and Bless Our Men and Women in Uniform with Victory. Amen.)
[ Post Reply | Private Reply | To 20 | View Replies]

To: grumpygresh
The Dims are all about one thing-power. Benefits will be doled out to their supporters and their opponents will be punished. All they want is total power. Instead of the rule of law, we will have the law of the jungle, sheer tribalism.

Hopefully, they will realize they are wrong when it bite back at them. I'm a firm believer in karma and they are building up a lot of bad karma and it will bite them in the butt one day. If we also bring the bible into it, they "will reap what they sow." I used to work in IT and since it is the subject here, GIGO also applies, Garbage In, Garbage Out.

Enough analogies. There will be a lot of people denied healthcare, old and perhaps not so old. People have friends, families and so on. If a Tony Soprano is denied healthcare by a bureaucrat, he might find a dead horse's head on the porch. I would hate to be that bureaucrat. Even normal people, when the law of the jungle applies, it will backfire on those that impose that. All I can say is I was the said bureaucrat, avoid dark allies, check under the car all the time, mind your wife and kids and sleep with your eyes open. I know in the bible, "vengence is mine, sayeth the Lord," but many will want to take the first crack at it.

When you create the world of "Lord of the Flies," don't be surprised when ti strikes back. It is and always will be a two way street.
23 posted on 01/15/2012 9:17:43 AM PST by Nowhere Man (General James Mattoon Scott, where are you when we need you? We need a regime change.)
[ Post Reply | Private Reply | To 12 | View Replies]

To: Nowhere Man

bible = Bible, sorry about that, my typing is off today.


24 posted on 01/15/2012 9:19:41 AM PST by Nowhere Man (General James Mattoon Scott, where are you when we need you? We need a regime change.)
[ Post Reply | Private Reply | To 23 | View Replies]

To: Nowhere Man

“It is and always will be a two way street.”

This is what most on the Left always fails to realize. Some on the Left fully understand that their leaders must be ruthless a la Mao and Stalin to retain power. However, some on the Left are deluded by their utopianism and do not think that big government will require subtantial restriction on liberties and a viscious police state.

We will never convince the first group of Leftists because they seek to torment and enslave us. Moreover, the Leftist oligarchs must impose tyranny on their subjects for their own survival. The second group of people are under a grand delusion of Biblical proportions. They have been indoctrinated, drugged and dumbed down by society and their government; they too will be an impediment to everyone else’s liberties.

We must defeat them politically and failing that, we must destroy them through other means. If we fail to do so, they will destroy us.


25 posted on 01/16/2012 8:18:22 AM PST by grumpygresh (Democrats delenda est; zero sera dans l'enfer bientot.)
[ Post Reply | Private Reply | To 23 | View Replies]

To: TheOldLady; All

I’m so sorry to hear you lost your MIL at such a young age. I don’t know if the doctor told my 88 year old mother she would not survive the surgery.

I had cared for her for a week after she came home from a week in the hospital, and two weeks in a rehabilitation nursing home when she was 78. She had been cut open from her throat to her belly, her ribs spread wide apart for the surgey, and she was still fragile and in pain. At 88 both she and I agreed that she could not/would not subject herself to a similar surgery again. She was far more frail and other systems were also giving out. I think she made the right decision, and I don’t blame a doctor for it.


26 posted on 01/16/2012 10:12:04 PM PST by gleeaikin
[ Post Reply | Private Reply | To 19 | View Replies]

To: gleeaikin
I’m so sorry to hear you lost your MIL at such a young age. I don’t know if the doctor told my 88 year old mother she would not survive the surgery.

It was particularly heartbreaking because she had insisted that she was not ready to go, and that she wanted to accomplish more in her life.

I do understand your mother's decision, and it was hers to make under the circumstances. God rest her soul.

27 posted on 01/17/2012 8:46:29 AM PST by TheOldLady (FReepmail me to get ON or OFF the ZOT LIGHTNING ping list)
[ Post Reply | Private Reply | To 26 | View Replies]

Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.

Free Republic
Browse · Search
Bloggers & Personal
Topics · Post Article

FreeRepublic, LLC, PO BOX 9771, FRESNO, CA 93794
FreeRepublic.com is powered by software copyright 2000-2008 John Robinson