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.
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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.
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.
Let us use our Liberty and our Constitution to RATION GOVERNMENT!
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”?
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.
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.
Spin the wheel geezer .... your living or dying hangs in the balance .... click, click, click .....
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.
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.
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...
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.
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.
Sorry. I guess I misunderstood you.
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