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Josh-D. S. Davis

Xaminmo / Omnimax / Max Omni / Mad Scientist / Midnight Shadow / Radiation Master

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The value of a woman's life
JR BoB Dobbs
A government task force has recently stated that it's not cost effective for women under age 50 to get mammograms. Current screening starts at age 40 and only saves 1 life in 1000, but has a 47% false positive rate. Instead of working on reducing the false positive rate, it's better to just not screen women at age 40. In fact, women should also stop self-examination, because it just leads to overdiagnosis.
Ref: http://www.dallasnews.com/sharedcontent/dws/dn/latestnews/stories/111709dnnatmammograms.3e17e77.html

Cancer.org references what appears to be the same study which was done in 2005.
Ref: http://cisnet.cancer.gov/breast/achievements.html

The NIH has info on the cost of false positives.
Those 470 out of 1000 women would cost $524,607.60
ie, one woman's life is officially worth less than $524,607.60.
Ref: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2349888/

Per 2008 census estimates, there were 22,327,592 women aged 40 to 49 in the US.
So that means another 22,328 women would get to die,
The cost in false positives to save them would be $11,713,224,452,899.20,
Ref: http://www.census.gov/popest/national/asrh/NC-EST2008-sa.html

A woman who's 40 now would have been born in 1969. Her life expectancy would be estimated at about 75 years.
Ref: http://mchb.hrsa.gov/whusa09/hstat/hi/pages/207le.html

Per the Bureau of Labor, full-time wage earning women averaged $638 per week. 52 weeks times 35 years (40-75) equals $1,161,160 per working woman during the time period of age 40 through 75.
Ref: http://www.bls.gov/cps/earnings.htm#demographics

Number of women age 40 to 70? 61,574,780
Ref: http://www.census.gov/popest/national/asrh/NC-EST2008-sa.html

Percentage of women working full time in 2008?
72 million women (59.5 percent) were labor force participants—working or looking for work.
68 million women (56.2 percent) were employed in the U.S.
75 percent of employed women worked on full-time jobs
Extrapolate 56.2% of 61,574,780 is 34,604,009
Extrapolate 75% of 34,604,009 is 25,953,006
Extrapolate net dollars earned over the next 35 years by those 25,953,006 women? $30,135,592,965,164
Ref: http://www.dol.gov/wb/stats/main.htm

The average number of hours worked by part-time women?
5h/day vs 7.5h/day (0.66666666666666666666666666666667)
54.3% of days worked vs 69.7% of days worked. (0.77905308464849354375896700143472)
Ref: http://www.bls.gov/opub/ted/2009/jun/wk4/art04.htm

That's another $3,912,871,109,537 earned by part time women over the same time period.
That's a total of $34,048,464,074,701 earned by women from age 40 to 75.

I'm not sure how to calculate the value of the women in this age range who are not working.
40.5% of women were not working per the above. In the 40-75 range, that's roughly 24,937,786 women in 2008.
Let's assume the average woman in that category provides child care services. We'll ignore cooking, cleaning, grocery shopping, and all other domestic, volunteer, counsellor, and other functions and assign a value of $160/week per non-working woman.

That's a gross value for those women at $7,261,883,254,080
Add that in, and the gross value of the 61,574,780 women from age 40 to 75 is $41,310,347,328,781
Average value per woman age 40 is $670,897.20

Lifetime screening is $151,434 dollars per LYS. 30y (midpoint b/t 35 and 25) saved for 22,328 women means allowing them to die saves an additional 101,436,550,560.
Ref: http://www.ncbi.nlm.nih.gov/pubmed/15987322

5y cost for breast cancer averages $40,574.17 per person.
10 years for 22328 women would be another $1,811,880,142.19
Total savings by letting those 22328 women die would be $103,248,430,702
Ref: http://appliedresearch.cancer.gov/cgi-bin-pubsearch/pubsearch/index.pl?page=abstract&ID=450&project=arp

The cost to lose 22,328 more women to cancer: $14,979,792,622.19
The cost to save those women from cancer: $11,816,472,883,601.39 ($11,713,224,452,899.20 + $103,248,430,702)

We spend $788.83 in medical care to save $1 in womanly GDP value.

Even if you factor in loss of work due to grieving, bump up earnings to those of men, etc, you're not going to come close to a payoff.

Where does the service come from? Equiment is not free. Medical education is not free. Where do you draw the line? You're spending 2.35% of the country's GDP to save 0.007% of the population from only one of the many ways we can die.

Everything has a value and a cost. If you loved in the woods, would you yell at the trees for not fixing you? If you were a superpower, would you invade a country to steal their natural resources so you could have enough to support your own people? Would you manipulate the world's economy in a non-sustainable manner so that you could improve resource availability for a generation?

This is the problem. We have been in the privileged class so we expect our privileges. We don't know any other way. Shifts in power, resources, and global equality are further reducing the benefits of a hidden, disposable, low-cost workforce.

Throw in that using medical science to family lines alive that have a history of illness only serves to weaken society and increase the requirement for further medical expenses in current and future generations.

Yet, I have a friend who is 38 and is undergoing treatment for breast cancer. No exams under 50, no self examination, her tumor wouldn't have been found until it was visible without palpation. By the time she'd found the tumor under the new recommendations, she would have likely been past the point of hope.

Luckily, she knew of family history, and found the tumor, not "early", but early enough for hope. She's enduring her second round of treatments now, and will reassess options at the end of this sequence.

Not everyone with a history would know, or would think to check on their own if it weren't recommended.

I could never be a doctor, because when it's one on one, personal, you have to save every single patient. Every life is precious.

However, when you look at reality, and the big picture, you just can't save every patient, even if you use the resources of the whole country. Somewhere, you have to draw a line so the healthy people can have enough resources to survive.

It's all pretty depressing. Really REALLY depressing.

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Correct me if I'm wrong, but isn't this recommendation only in effect for those women without significant risk factors? The previous recommendation would stand for those women with a family history of breast cancer, IOW.

I believe that's the intent, though other than the Dallas Morning News article, I can't find corroboration for that.

It was what they said in the NPR coverage of it this morning.

I think it's possible and necessary to put a dollar value on saving lives, but I don't think looking at people's contributions to GDP is an appropriate way to think about it. One way to estimate how much money should be spent to save a life is to figure how many lives could be saved by spending the same money differently; is it ethical to spend $524,607.60 saving one life if you could save 100 lives by spending that money on treating malaria in the 3rd world? Another way to think about it is to estimate how much value you're adding to the life of the patient, but that's a much trickier problem. This NYT article (via) explains a lot about how health economists do that.

Also, what Skwid said.

Ah, but calculating by lives does nothing to fund the life saving efforts.

Also, from my feeble modeling abilities, I don't have forecasting abilities to show how the average person will help others, etc.

All in all, the report was going for the risk/reward along a cost basis. My original intent was to prove that it was economical, but it's not.

Ultimately, to save a life, it costs resources, and there are not enough resources to go around to save all at-risk lives. The researchers were suggesting that this was one place to reduce the expense of resources substantially with little statistical impact.

So while it may not be appropriate to translate people into dollar worth, ultimately, that's what it boils down to. You have a dollar worth, and an intrinsic, personal, or emotional worth to others. Once you translate all of the other factors into dollars, there is such a huge gap in risk/reward, that you can't appeal to the bean counters to keep the lower screening age.

Where the net problem comes in is that the "freed resources" will not go into other, more effective, life-saving programs. It will go to the general fund as tax cuts, funding for other programs, etc.

Likely, this would go to fund healthcare for those who don't have it. That does have a disputably proven impact on net mortality rates.

An issue with that is that whenever you take from one group to give to another, people become unhappy.

This is why I like to set new things up, or improve on existing things, but I don't like to remove or replace things because of the psychology involved in 'losing' something.

I'm glad I'm not a politician because nothing I did would be "OK".

I'm glad I'm not a DR because my mistakes are less likely to cause death.

I'm just a geek, on the sidelines, making low-quality analysis of available information whenever I read about something particularly emotional.

The article link on QALY is pretty awesome.

I'm just a geek, on the sidelines, making low-quality analysis of available information whenever I read about something particularly emotional.

And please continue doing it. I find it fascinating.

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