Wednesday, February 25, 2009

The magic of numbers

I remember the last time I had an accident in my car. I say an accident, but I was entirely culpable. I was late. It was dark and wet and I was driving too fast for the conditions. As I rounded a bend in the road, doing 43.2 mph I was confronted by the red tail lights of a stack of traffic held up in front of me. I ploughed into the back of a 4X4. No-one was hurt, but my car was damaged enough for me to have to abandon my journey.

The odd thing was that when I looked at the odometer it read 70,000.0 miles.

Of course, that number is no more significant than 72,865.7 but we want to attach significance to round numbers. That old car limped on to 131,875.3 miles, about which I have absolutely nothing to say. Perhaps it would have been more perfect had I scrapped it after the accident. Superstition would have forced me to.

Of course the realy significant number was the 43.2 mph and if you go to this website you will see why.


Terry Hamblin said...

Of course, I have no idea what speed I was doing. I was just looking for a pithy way to end the article.

Burke said...

" I have no idea what speed I was doing."

Uh huh.

Is that what you told the judge?

Anonymous said...

I would like to challenge Prof.Hamblin's statement in his last posting;

''There is no doubt in my mind that the very best healthcare is provided by doctors working in private practise''

Where is his evidence for this immense generalisation?
Surely for a scientific mind like his, even allowing for his spiritual beliefs,some justification (not anecdote) must be offered for such a view.

I look forward to seeing it . . .

Where is the evidence that survival is better/longer for those CLL patients seen privately?

Where is the evidence that heart attack patients do better outwith the NHS?

Where is the evidence that trauma patients do better in the private sector?

Where is the evidence that palliative care is done better in the private arena, rather than in the voluntary/NHS setting?

I rest my case, but await his response with interest

Terry Hamblin said...

I'm not sure why you post on this article rather than the next one, but here goes.

Outcomes in the NHS are certainly very good, but compared to the rest of the world there are some shortcomings.

Hardly any other country in the world has adopted the taxpayer funded system that Britain has, yet consistently the NHS produces results that are worse than those in countries with insurance based systems. I am no fan of the American system, but at its best it produces outcomes that would not be available in the UK. Marrow transplants in Seattle, for example consistently outshine anything in Britain.

As far as CLL is concerned, it may be true that there was no RCT evidence that rituximab brought improvement and that we were justified in witholding it, but CLL8 seems to have told us that we guessed wrong, and that the American system, for all its faults, benefitted patients with CLL, by allowing its use.

I am not sure that I would argue that patients in the UK get better outcomes by going privately. However, that isn't what they are paying for. What they pay for and what they get on the whole is more of the consultant's time, a nicer environment to be ill in, aqnd the convenience of picking their own time for treatment. In the past, though not so much now, they got a shorter wait for treatment.

You mention heart atacks and palliative care. These are certainly area that a community based system excells at, and I would add care of acute stroke and diabetes management. On the other hand there are areas of the NHS that are a disgrace such as psychogeriatrics and 'care in the community' for the mentally ill.

I was making a sweeping generalisation, of course, not a scientific statement, but I doubt whether the question of how is the best healthcare produced can be answered in any scientific manner. It is a matter of opinion, and you may have a different one, but I doubt that you can offer evidence that you are right on such a matter.