The cost of lazy health reporting - Macleans.ca
 

The cost of lazy health reporting

Colby Cosh look at the math behind the headlines


 

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“It is estimated that mental illness costs the economy more than $50 billion a year.” This is the kind of sentence you might encounter in any old issue of a newspaper, though it’s actually from the Oct. 13 Globe and Mail. When I say you would encounter it, I am not suggesting you would read it. It’s the kind of claim we are so used to encountering in the press that the eye slides right past it. We don’t usually sit down and think about what $50 billion literally means, contrasted with $1 billion or $500 billion. In the context of a news story mongering war against some social ill or disease category, all such numbers are simply read as “a huge amount.”

The annual gross domestic product of the country is about $1.8 trillion, with human labour’s share being about half. So the figure of $50 billion, which comes from a study issued earlier this year by the Mental Health Commission of Canada, represents a loss of about 5.5 per cent in the potential annual output of Canadian workers. Is this a realistic number? Is it in the nature, let us stop to ask for once, of a true assertion?

It is realistic in the sense of resulting from a conservative calculation. When one probes social-cost claims made by do-gooders, they often turn out to incorporate laughable or downright dumb assumptions. When a politician screams about the costs of smoking, you can be sure he is always including every dime of hospital costs for lung-cancer treatment, and never subtracting the years of senior care and pension payments saved by the public-spirited unhealthy.

But mental illness doesn’t have apparent benefits that need to be weighed in the balance, and 5.5 per cent is pretty reasonable on its face. You know plenty of people whose incomes are 20 per cent, or 100 per cent, less than they might be because of mental or emotional disorders. The commission’s actual report calculates that we spend $29 billion a year directly on care for the mentally ill, so that is the bulk of the $50 billion right there. Another $21 billion in lost productivity does not seem like a lot to ask of our credulity.

The real problem is what we mean by “lost productivity.” What is being postulated here is a sad, spiritually afflicted populace whose “economy” could be bigger if absolutely everyone were well enough to work to their full capacity. We all sacrifice some part of “the economy” to personal happiness or to the well-being of our families and loved ones. Probably we all sacrifice some to personal pathologies, whether or not they could be characterized as mental illnesses. Is being somewhat lazy a mental illness? How about having an IQ of 88? “Costs to the economy” are, in this sense, hard to take seriously: human imperfections defy accounting.

When it comes to mental illness, the incremental loss “to the economy” of diminished human productivity is only relevant to policy to the degree that it could be corrected at no compensating expense. Otherwise, cost claims amount to the difference in earnings between ourselves and hypothetical, perfectly rational gods. The irony of mental health advocates waving the $50 billion figure around is that they explicitly want to increase it by pouring more money into public mental-health programs. Give them $100 billion more and they would quickly be using that in their argument for the next $100 billion.

If the economy, rather than humanity, is the relevant guiding principle here, it might make more sense to ask what, if anything, the $29 billion a year we already spend gets us. Schizophrenia, to take perhaps the most horrendous single form of mental illness, is still a “disease” with constantly shifting diagnostic criteria, a hundred etiological theories, no biological test and an array of drug therapies that work well for the exceedingly few people who will stick to them reliably. The Globe story advocates a “social movement that will . . . do for mental health” what other foundations have done for cancer and heart disease. Is it gauche to observe that doctors can actually cure some cancers, and that there are strong validated treatments for heart disease?

We treat the mentally ill in the name of hope, not GDP. The Mental Health Commission’s $50-billion figure is really nothing but attention-getting ad copy. It does not seem to have been torqued upward by use of sleazy mathematical assumptions—but it could have been, if the original number were not impressive enough, and it is not as though anybody would check. So what’s it doing in a newspaper anyway?

On the web: For more Colby Cosh, visit his blog at macleans.ca/colbycosh


 
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The cost of lazy health reporting

  1. Colby, you have approached the subject of mental illness in what looks like an analytical way but because some of your suppositions are incorrect, you resulting reasoning isn’t valid. For instance, with regard to Schizophrenia, it is a kind of psychosis. Psychosis is believed to occur due to the actions of one or two neuro transmitters that in essence “flood” the brain, doing damage. Most often, the symptoms are such that the diagnosis is quite clear (the person hallucinates). With early and consistent treatment, many people with this illness are now able to live almost normal lives. Certainly many go to school and get married, etc. We learn more and more about the illness through research/treatment programs like the Early Psychosis Treatment Service that was started in Australia and has been emulated in several different countries. Investing the money in the care and research is a good idea. The same can be said for other mental illnesses. We are doing research into electrode implants for people with intractable depression. There is a constant development occurring for therapies and medications with better efficacy and less side effects. Also in Alberta we now have community treatment orders for those who are chronically mentally ill and tend to go off their medications requiring many re-hospitalizations. The truth of the matter is we are not sufficiently funded. We don’t have enough community resources and we are short of hospital beds. Now, if you are really interested, one can see the difference in the brain of a person who suffers from Schizophrenia…the ventricles are larger (1 and 3) and the grey matter is decreased.

    • The problem is that, despite your pop account, we haven’t found a particular neurotransmitter theory of schizophrenia we can make sit up and behave. We can’t, for example, artificially induce schizophrenia chemically. Nor can we diagnose it in any terms at all but those of behaviour–and even that is tricky, as the number of “bipolar” people who end up expressing schizoid psychosis in horrible headline-grabbing ways suggests. I hear all the time that “one can see the difference in the brain”, and the pictures are even convincing, but there are no asymptomatic schizophrenics who haven’t yet started talking to Mars, and until there are, we are stuck in the Stone Age as far as this disorder is concerned.

      • The brain is the most complex organ in the human body and you are bemoaning the fact that we can’t explain schizophrenia away in simple terms nor trigger it on demand (although some people do get psychotic when using cannabis). As for the “pop account” regarding the neurotransmitter theory, if it isn’t at all accurate, why do medications such as Clozapine which work on the receptors of neurotransmitters work so successfully to completely stop the positive symptoms of psychosis and treat many of negative symptoms as well?
        Schizophrenia is one type of psychosis. Yes, people with mood disorders, such as bipolar disorder can experience psychosis either during mania or during a severe depression. Psychosis is by definition the inability to tell the difference between fantasy and reality. People also experience psychosis due to severe sleep deprivation or the use of drugs that in some people trigger such a reaction. Schizophrenia is only diagnosed based on a specific length of time the patient experiences the symptoms of psychosis and whether or not they experience a loss of functioning and experience negative symptoms (tendency to be seclusive; stop caring for one’s hygiene, etc) as well as positive systems (hallucinations, delusions). Other types of psychosis are diagnosed if a person experiences a much shorter period of psychosis or if they have a mood component to their psychosis.
        You might think we are “stuck in the Stone Age” but in the many years I have been in this profession we have made leaps and bounds with regard to quality of life for people who receive this diagnosis. We are trying to treat people as early as possible with a variety of therapies so they have as few psychotic episodes as possible and therefore as good of an opportunity as possible for a full rehabilitation. Even teenagers who are under age 16 and showing some negative symptoms are receiving attention before they have their first psychotic episode.
        I am quite taken aback that you believe there aren’t any people who suffer from schizophrenia who remain relatively symptom free. Some people have no symptoms for great periods of time, especially if they remain on medication.

        • That’s not what I meant by “asymptomatic”. What I meant was that schizophrenia is entirely a description of observed behaviour. There is no biological test for it, period, as I said in the article. As for your handwaving that neurotransmitter theories must be right, you do need look at the literature rather than approaching this defensively from personal experience of treating schizophrenics.

          • Colby, do you really believe that I don’t read the literature? Each break thru in research on what causes the trigger of the illness doesn’t change the fact that the medications work on the neurotransmitter receptors of the brain, therefore there has to be some neurotransmitter involvement. I have come to know this through research. I am not married to any theory. I am open to any new research. Anything that gets us closer to a cure, is fantastic.
            As for your concern that there is no biological test to confirm the diagnosis. That is accurate but physicians have been diagnosing many illnesses without biological tests, simply on the strength of symptoms. I can think of quite a few off the top of my head…chicken pox, measles, shingles, migraine headache, pleurisy, asthma, irritable bowel. Many other illness they diagnose by ruling out other illnesses or they make a diagnose and wait for confirmation from the tests they take (ie: scarlet fever). Also, we have many chronic illnesses that have no cure but only treatment. Take a look around at all those who are being treated for diabetes. How many are being cured? Does that mean people cannot productive lives or we shouldn’t put money into finding a cure or better treatments or even perhaps the biggest goal, prevention. Yes, prevention of the illness. That is the goal of those of us who work and do research in mental illness. We want to prevent these illnesses.

          • I bet you can see the difference between chicken pox and schizophrenia if you really try.

          • Sadly Colby, schizophrenia isn’t that difficult to diagnose. The symptoms are pretty obvious. Neither is biplor I disorder. I am sorry you don’t get that. Other mental illnesses can be more subtle but those ones aren’t. Are you this bothered that there is no definitive test for Alzheimers? Do you think it is difficult to diagnose?

          • What part of “schizophrenia is entirely a description of observed behaviour” is unclear? No, it’s not difficult to diagnose once someone is floridly psychotic and behaving destructively. There is just no well-understood biological basis for it: nobody knows for sure what schizophrenia is or even if there is a genuine single “it”. But keep babbling about chicken pox, by all means.

          • Yes that is clear and the criteria for the diagnosis never shift. The medications help many and there are very few accepted theories. I thought I had moved onto babbling about Alzheimers……

  2. Colby- The laziness isn’t just in health reporting. We’re routinely treated to “news” articles that parrot the views of this or that activist organization or group (see: “climate change”). Demonstrably fallacious claims go unchallenged, or the downsides of regulatory initiatives are given short shrift.
    I’ll give you a local example. The City of Red Deer spent a million taxpayer dollars on a bike lane project. The defining impetus was the claim that 3% of all commuters in Red Deer cycled to work. My own daily commute includes several kilometers of the main routes that cyclists supposedly use, yet I encounter less that 3 dozen cyclists per year even though I work from 8 to 5. Not once did any of our local media challenge the 3% figure.
    This happens time and again where I read a news story about a subject in which I have a certain amount of expertise or knowledge above and beyond average, and the article will be chock-a-block full or factual errors and misleading suppositions as to be almost fiction. In most cases there are only two excuses for this kind of thing: laziness or malice.

  3. Enjoyable interaction between CC and “healthcareinsider”. I noticed that the latter invoked “pleurisy” and “irritable bowel” as examples of illnesses which are diagnosed without a diagnostic test. Pleurisy means pleuritis, and is a presentation not a disease. I find it hard to believe any doctor (since the 1960s) would diagnose a patient with “pleurisy” and not do a diagnostic test to rule out any of the possible serious causes. “Irritable bowel” is not a diagnosis but a garbage can, into which any number of patients with vague GI symptoms may be dumped. These patients may very well be ill–but irritable bowel is not a disease so much as a collection of possibly unrelated findings. I would offer, in fact, that pleurisy and irritable bowel are among the worst analogies for schizophrenia, if one is trying to prove that “real” illnesses can be diagnosed without testing. I happen to agree with that latter proposition, as it turns out–but not because schizophrenia is anything like pleurisy or irritable bowel.