May 22, 2006
Kolata: Ignoring the Real Story
Once again New York Times health reporter Gina Kolata has outdone herself with getting facts wrong and presenting an incomplete picture of scientific studies. In yesterday’s Week in Review, she debunked a recent NIH-funded study out of Great Britain that showed Americans self-reporting worse health than their British counterparts.
She argued that we're probably sicker because we test and screen for sickness to a far greater extent than our British cousins. She also points to “disease mongering,” which medical providers like the pharmaceutical industry use to convince many Americans they are sick.
Her bottom line was that the difference in life expectancy (77.6 in Great Britain and 77.1 in the U.S.) was “almost identical.” Pretty clever -- using a progressive critique of the "over-medicalization" in our health care system to bash the progressive idea that we're somehow not getting bang for our buck when it comes to health care spending.
I immediately because curious about her data. Were the Brits and us really about the same? So I went to the OECD website this morning and discovered that the 30 member nations’ last report (2003 data) showed the United Kingdom at 78.5 years life expectancy at birth compared to 77.2 in the U.S., a substantial 1.3 years difference. Indeed, UK was precisely at the midpoint (Japan was highest at 81.8; Turkey lowest at 68.7) while the U.S. was tied for 21st. At the glacial pace at which these numbers change, this puts the U.S. a full decade behind the UK.
But my real complaint about the article was that it ignored the most significant findings of the study. The report emphasized that no matter which country you looked at – the UK or the U.S. – health status was highly correlated with income and status. People in the highest third of the income strata was significantly healthier than people in the bottom third.
I chose to cover this angle when I first reported the study, and it was the same angle that Paul Krugman emphasized in his column in the Times a few days later. For Kolata, though, the idea that the maldistribution of wealth and income might have something to do with health is simply idée non grata, even when it is prominently featured in the study on which she is opining.
As I long ago learned, when it comes to a Kolata story, let the reader beware.
Posted by gooznews at May 22, 2006 09:03 AMboth Kolata and Gooznews make sense. Dueling tentative hypotheses are basic to science. Question is whether these public disputes help or hurt the public. Politics requires at least the appearance of certainty and is the antithesis of science in that regard. Conflicting takes are a recipe for doing nothing. Should we stop doing mammograms and psa tests in the US and use the money saved to provide indigent care?
Posted by: Jim Jaffe at May 23, 2006 08:50 AMGina's right that our perception of our health is deeply colored by disease mongering and hyper-screening. And Merrill's right that income and social status have a marked effect on health. But the most important statistic to extract from the comparison between the US and the UK is that we spend twice as much per capita on health care to achieve virtually the same life expectancy. In other words, the US health care system isn't doing a very efficient job of improving health.
Now maybe Merrill is suggesting that the real solution to our poor showing on the international health statistics is to redistribute income. There are many reasons to have a flatter income distribution, health being just one of them. But barring a dramatic change in our tax code, there's plenty we can do to improve American health care, beginning with reducing unnecessary care and providing access to the 40 million people without health insurance.
Jim Jaffe seems to be saying that it would be a bad idea to stop doing mammograms and psa tests in order to pay for indigent care. I'd argue for helping patients understand the true downsides to mammography and psa tests and then letting them decide what risks they are more willing to take -- there are significant side effects of being treated for cancers that would not have bothered them had they been caught later (or even never). While most of the public thinks cancer screening is an unmitigated good, it isn't so clear cut. Many men opt out of psa testing when they have been fully informed of the risks and benefits.
Posted by: Shannon at May 23, 2006 10:51 AMKolata is a snotty industry mouthpiece who, when downplaying the toxicity of dioxins (almost as toxic as, and more toxic endpoints, than plutonium)was forced to admit she made up the phrase in a story attibuted to an un-named scientist, "a teaspoon of dioxin is no more risky than a year in the sun" (from my memory; after that she was apparently forced by her bosses to take a several year leave from the NYT . Unfortunately, they let her return to mass distribution.
Posted by: Tony Tweedale at May 23, 2006 04:58 PM