Tuesday, April 21, 2009

What does it mean to 'save a life'?

I have been reading some great articles about poor science journalism, and gross misrepresentation of the facts. These articles got me thinking about what it actually means when a new drug, vaccine, surgery, or other medical intervention has the possibility of ‘saving thousands of lives’. What exactly does the phrase ‘save a life’ mean?

My starting point for this analysis is that everyone dies. Therefore, we cannot save someone from death; at best we can postpone death – from being the direct result of condition X, to being the result of some unknown future event.

The question is further complicated if we consider the flow on effects from death. For example, a child (A) may die from disease X, but the flow on effect from this one death is the birth of another child (B) by the couple, who would not have chosen not to have that child (B), had the first child (A) not died young.

So here we have a theoretical conundrum. In the previous case if child A had be ‘saved’ by a new drug or surgery, child B would never had been born. Imagine then comparing two hypothetical scenarios:

Scenario 1 -
Child A is ‘saved’ by a new drug or surgery.
Child B is never born
Child A lives until the age of 60.

Scenario 2 –
Child A is not saved and dies
Child B is born
Child B lives until the age of 90

If we consider a year of life to have an equal value amongst all individuals, we can say that Scenario 2 provides more life. The net effect of the drug/surgery is to postpone the death of Child A by, say 55 years, and eliminate the chance of Child B being born. Scenario 1 provides 35 years less combined life years than Scenario 2.

In a more general sense, do we need some death to create life?

Another hypothetical can let us examine this question. Imagine a new drug is invented that, for example, promotes tissue repair, and the life expectancy of the population rises dramatically over just a few years. Does this prolonged life of existing generations come at the expense of future generations? If the birth rate did not slow as a reaction to this, population growth would also see a dramatic spike in population growth.

We can think about the ambiguity of ‘save a life’ more when we consider treatments for the elderly. If a drug cures one life threatening disease in an 80 year old, and they die a year later from a different disease, did the drug still ‘save a life’? Again, I would say that we can just postpone death. In this case, the drug postponed death by one year.

But if the same drug could be used on a child, it may postpone death by quite a number of years. Does it then ‘save a life’?

Economists know that a very large chunk of government health expenditure goes to treatments in the last 30 days of someone’s life. All we can derive from this is that we are getting some very poor ‘life returns’ on our health investments. It is a much better investment in terms of ‘life returns’ to fund medical care for the young.

I guess my point is that if we don’t think about saving lives, but rather about postponing death, we get a much better perspective on the effectiveness, and usefulness of various medical claims. We also need to consider that postponing death is not inherently a good thing for society as a whole, although it often is for the individual person whose life is prolonged. I hope anti-abortion and anti-euthanasia activists can think deeply about these issues before launching their next hysterical propaganda campaign.

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