Antiretroviral therapy has SAVED 3 MILLION life-years
Posted by Henry Bauer on 2008/07/01
It used to be understood, at least by statistics gurus and the few statistically literate observers, that there are “Lies, damned lies, and statistics”, because the data can be arranged so easily to serve any desired mis-interpretation; just as survey researchers and social scientists know that they can get any desired result from a poll by phrasing suitably the questions they ask. Nowadays, however, the preferred way to fool the public is by means of computer models [HIV NONSENSE: TODAY AND EVERY DAY, 22 November; HIV/AIDS: NUMBERS THAT DON’T ADD UP, 29 November 2007].
A brother-in-law of mine years ago had been one of several vice-presidents of a major corporation. One of the VPs always succeeded in getting what he asked for in the way of annual budget, but none of the others did. Eventually those others asked the successful one for his secret. He explained that he always presented his request to the Budget Committee of the Board in the form of a computer print-out. Who would have the temerity to argue with that? Computers don’t lie, do they?
Far too many people are far too easily misled by computer outputs. Computers don’t think. They are more gullible than any human being. They believe whatever you tell them, no matter how absurd or how obviously wrong. Hence
GIGO: Garbage In, Garbage Out.
But only computer gurus and the few computer-literate users know that. Most people dissolve in obeisance when presented with something spewed out by a computer.
More illustrations pop up all the time of commentariat, media, and policy makers accepting conclusions based on computer models instead of on happenings in the real world. Yet those computer outputs are no better than the assumptions and uncertainties fed into the computer in the first place. Computers can only say, “IF this is so, then that follows”—PROVIDED WE UNDERSTAND EVERYTHING ABOUT ALL THE PROCESSES INVOLVED.
If even one assumption in the model is wrong, then the model’s output is worth not even as much as an informed guess; it will likely be totally misleading.
HIV/AIDS has offered innumerable illustrations of Garbage Out, in the form of computer-model estimates of HIV and AIDS numbers issued for two decades by UNAIDS, the World Health Organization, the Centers for Disease Control and Prevention, and in peer-reviewed articles. Several insiders have recently been forced to acknowledge that those estimates were wildly off the mark—so wildly that predicted epidemics never happened, and rates of “HIV-positive” have had to be revised drastically downwards across the globe [WHO SAYS that WE’VE BEEN VERY WRONG about HIV and AIDS? (Clue: WHO = World Health Organization), 10 June 2008].
Recently I came across an outstanding specific example of computer-model nonsense, the assertion that through antiretroviral therapy, “at least three million years of life have been saved in the United States alone” (Anthony S. Fauci, “Twenty-five years of HIV/AIDS” (Op-Ed), Manila Times, 29 May 2007) . Op-Ed pieces don’t bother giving citations, but Googling for that assertion immediately revealed its source: “The survival benefits of AIDS treatment in the United States”, Walensky et al., Journal of Infectious Diseases 194  11-19; abstracted, unsurprisingly enough, among the News items on the website of Fauci’s Institute.
The raison d’être for the Walensky effort was that, since the US Government was allocating $21 billion to HIV/AIDS activities in 2006, questions might well be raised about what benefit the United States was getting in return.
Here’s some back-of-the envelope arithmetic. The Walensky calculation is for life-years saved through 2003. Funding began at zero in 1981 and rose steadily. If the increase was linear, then by 2003 roughly $225 billion would have been spent to save 3 million life-years, in other words, about $75,000 per life-year. Given an average lifespan of 75 years, that works out at well over $5 million per human life.
I personally don’t much care for such calculations. I think comparing lives and dollars is rather like comparing dogs and rocks. But I recognize that insurance companies, lawyers, and similar realities of modern life do need to make such calculations, and for their purposes, $5 million per life might not seem out of whack. Unless, of course, one thinks not of the rare court cases that make headlines but of all citizens. In terms of pay, benefits, and compensation for injuries, we certainly don’t compensate most members of our armed forces at $75,000 per life-year or $5 million per life. And if 300 million Americans are each worth $5 million, then our population’s total value is more than a thousand trillion dollars — 1015 —, which seems a bit high. After all, our annual Gross Domestic Product per capita is about $45,000, which on a human-capital investment of $5 million represents an unattractively low yield of less than 1%.
So if you must value people in dollar terms, the Walensky calculation suggests that we are spending significantly too much on HIV/AIDS. Of course neither the Walensky article nor the Fauci commentary made this sort of calculation. They left it at trumpeting millions of life-years saved, which the unwary might easily confuse with millions of actual LIVES saved. But at a lifespan of 75 years, 3 million life-years represents 40,000 lives, not quite so impressive a number. After all, by 2003 there had been more than 520,000 AIDS deaths in the United States, according to the Centers for Disease Control and Prevention (HIV/AIDS Surveillance Report for 2003, vol. 15). The Walensky calculation therefore amounts to a claimed saving of only about 7% of AIDS victims (40,000 out of [520,000 + 40,000] patients; 40/560 = .071) .
Again, I don’t myself care to calculate like this, because I think every life is literally invaluable. But if one insists on cost-benefit calculations to justify expenditures, as Fauci and Walensky et al. do, this 7% success-rate is somewhat less than impressive—especially for treatment that they like to describe as lifesaving, as having converted a fatal illness into a chronic, manageable one.
But perhaps one should consider only the HAART era, beginning in 1995, with the really successful treatment by “cocktail” or “combination” antiretroviral therapy?
From 1996 to 2003, Walensky et al. calculate 2.35 million life-years saved. At 75 years per life, that yields about 31,000 lives, compared to about 200,000 reported AIDS deaths during that period. So “lifesaving” HAART actually saved the lives of 13% of AIDS patients. That’s much better than 7%, of course, but not exactly what most people would understand by “lifesaving”.
Consider again costs and benefits: To save the lives of 13% of “AIDS” victims, we apparently need to spend $21 billion annually. Therefore to save all the victims, we would presumably need to spend about $160 billion a year.
I do apologize if some readers find this rather flippant, tongue-in-cheek commentary offensive. For my part, I find offensive this propaganda about millions of life-years saved when the reality is so much less impressive. The article begins by citing expenditures as the reason for calculating benefits, but then fails to compare costs and savings. As sketched out above, such a comparison indicates that the savings have been bought at a very steep price; one that society would probably be reluctant to pay were it given the choice—especially if the information were also provided about how disproportionate are these expenditures on HIV/AIDS in comparison to funds aimed at the major causes of death, cancer and heart disease [STOPPING THE HIV/AIDS BANDWAGON—Part II, 1 February 2008]. Moreover, under the Ryan White Care Act, the government acts as payer of last resort and “provides some level of care for around 500,000 people a year and, in 2004, provided funds to 2,567 organizations. The Ryan White program also funds and provides technical assistance to local and state primary medical care providers, support services, healthcare provider and training programs” (http://en.wikipedia.org/wiki/Ryan_White#Ryan_White_Care_Act, where the pertinent official source documents are cited). HIV/AIDS is a unique instance of government-funded socialized medicine in the United States.
The Walensky et al. article is also technically incompetent and dishonest in several respects, as will be discussed in a later post.
This entry was posted on 2008/07/01 at 9:30 pm and is filed under antiretroviral drugs, experts, Funds for HIV/AIDS, HIV/AIDS numbers. Tagged: A. David Paltiel, Anthony Fauci, Bruce R. Schackman, cost-benefit analysis of antiretroviral therapy, Elena Losina, Kenneth A. Freedberg, Lauren M. Mercincavage, Milton C. Weinstein, PaulE.Sax, Rochelle P. Walensky, Ryan White Care Act. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.