Miscalculating Public Health: A Response on Statins and More

In a previous post, The Politics of Measurement: Miscalculating Public Health , I wrote of the risk that drug companies will convince us that we are at risk for everything, so that we take many expensive meds to ward off disease. The money that is spent on drugs might do more for our health, I argued, if spent elsewhere (even on public transportation). Along the way, I cited health journalist Shannon Brownlee’s doubts about whether statins should be prescribed for people who have no symptoms of heart disease, and I wondered whether the drug was being expensively over-prescribed in Israel.

Gary Ginsburg, a world-class health economist (and South Jerusualemite), wrote me the following response, which I’m happy to present:

When I studied public health in Chapel Hill, North Carolina, I visited the old bus station and saw the separate doors with their “whites only” and “blacks only” notices written in large red letters. But very few things in life (except for fascism and cigarette smoking) can be viewed in terms of black and white.

My epidemiology teacher, David Kleinbaum, always told us that the answer to every question was “it depends.” Should you care for the elderly and mentally ill in the community? Answer: “It depends” on the level of their functional ability.

Should we vaccinate against the Human Papilloma Virus (HPV), which causes cervical cancer?

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The Politics of Measurement: Miscalculating Public Health

Here’s an update in the value of doubt from veteran health journalist and muckraker (the word is a medal of honor) Shannon Brownlee, writing in the Washington Post:

Striking fear… serves pharmaceutical companies, which want you to worry about diseases, because people who worry are more likely to go to their doctors and ask for drugs than people who don’t. It turns out that much of what we — and our doctors — think we know about many health problems has been shaped by drugmakers and their marketers.

High anxiety happens to be good for the bottom line of some big corporations. But perhaps that money could be better spent

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