Lies, D*** lies & Statistics

[TomAiello]

From someone who is "inside the business," there is more left out of this discussion than included to keep the balance. I've done the grad school doctor thing too and was entertained by this statistical thread before doctor's titles derailed it.

No offense, but almost everyone inside the business of medicine in the USA has a strong profit incentive to confuse the public on this issue. Hospital corporations, health insurance corporations and a whole string of other businesses (as well as a bunch of people who are being misrepresented as physicians, by their own intention or not) create massive profits for a system that sells their services to the unsuspecting public as the more valuable (but no more expensive--see where the profit comes from?) services of a much more qualified individual.

[Mike Blue]

I agree with you Tom, that the system floats on money. It's a very similar concept to the "tooth to tail" ratio in other organized systems. One person provides a livelihood for ten others.

Next time you see a doctor or nurse practitioner or physician assistant, aka the worker bees or sled dogs, who provides a service to you, ask them how much that visit costs. I'd bet that you'll have to ratchet downward your estimate that "almost everyone" has a strong profit incentive. Especially when they have no knowledge of what their services cost to the patient or the insurance companies. Or the cost of medications.

For the most part, make your cut just one layer above them into administration and you'll draw blood.

[OldHoosier62]

For anyone that cares...Latest CDC report states that COVID-19 mortality rate probability is even LOWER than most US independent projections...0.26% in the most likely scenario and does not exceed 1.0% until infected subjects age is past 70yo. Even lower than I stated in "the other thread"....Link directly to CDC report with charts in the narrative.

https://www.conservativereview.com/news ... ate-media/

[TomAiello]

Next time you see a doctor or nurse practitioner or physician assistant, aka the worker bees or sled dogs, who provides a service to you, ask them how much that visit costs.

I am extremely familiar with medical billings. Also, because I pay my medical expenses out of pocket, I'm very familiar with how much they cost.

In general, the 'visit cost' is only a minority of the cost that gets billed. The 'hospital fee,' which is applied even to outpatient visits within a remote clinic building owned by a hospital system, is often greater than the 'visit cost' for an NP or PA visit. The hospital corporation (which laughingly is often called 'non-profit') has a strong incentive to engage in 'churning' by creating as many visits for mid-levels (i.e. NPs and PAs) as possible, so that it can add extra hospital fees to the repeated billings. The same profit incentive applies to the healthcare finance corporations that rule our medical-financial world. Such churning would be illegal if we were talking about stockbrokers, but it's accepted business practice for healthcare corporations.

When we dig into the actual costs being billed, it becomes quite obvious that the use of lower skilled workers to "extend" (that's a politically correct way to say "impersonate") those with higher levels of training and education is highly advantageous to the bottom line of the large corporations that structure the system. Unfortunately, many of those same workers (who, to my mind, are being taken advantage of and put into situations where they are dangerously over their heads and have little or no ability to ask for help) often support this game because it increase their perceived social status.

[Mike Blue]

Next time you see a doctor or nurse practitioner or physician assistant, aka the worker bees or sled dogs, who provides a service to you, ask them how much that visit costs.

I am extremely familiar with medical billings. Also, because I pay my medical expenses out of pocket, I'm very familiar with how much they cost.

In general, the 'visit cost' is only a minority of the cost that gets billed. The 'hospital fee,' which is applied even to outpatient visits within a remote clinic building owned by a hospital system, is often greater than the 'visit cost' for an NP or PA visit. The hospital corporation (which laughingly is often called 'non-profit') has a strong incentive to engage in 'churning' by creating as many visits for mid-levels (i.e. NPs and PAs) as possible, so that it can add extra hospital fees to the repeated billings. The same profit incentive applies to the healthcare finance corporations that rule our medical-financial world. Such churning would be illegal if we were talking about stockbrokers, but it's accepted business practice for healthcare corporations.

When we dig into the actual costs being billed, it becomes quite obvious that the use of lower skilled workers to "extend" (that's a politically correct way to say "impersonate") those with higher levels of training and education is highly advantageous to the bottom line of the large corporations that structure the system. ...

My point was that the medical workers have no knowledge of what they cost the patient. Which was to say they are not involved in any incentivization of the process.

The relative cost to the clinic between a physician and a physician extender is much lower for a lesser trained similar work employee. Hence those employees are much more common in primary care these days as the cost of running a clinic is lower with them on staff than it would be full of MDs or DOs.

The use of the word "churning" is incorrect or confusing. There is such a thing as patient churning. I can't tell from your context which one you refer to.

Yes, there are legal proscriptions against certain kinds of medical fraud.

[ChrisinHove]

https://www.economist.com/graphic-detai ... -countries

It seems to me that the very high mortality % rates that we have seen and discussed clearly reflect a lack of testing i.e. the number of non hospitalised or non symptomatic cases is simply guesswork in many countries because of testing is/was largely done of suspected covid cases in hospital only, of which a relatively high proportion will have tragically succumbed.

“Excess Deaths” appears to me to be the most useful statistic (i.e. how may more people have died than is typical for the time of year) but is also imperfect as non-covid medical interventions will have diminished, but on the other hand so will have road, industrial and other accidents etc.

Political intervention in published statistics is also evident, such as the UK not including Care Home deaths in mortality figures until recently, and the implausible Russian statistics bear little detailed scrutiny at all. As for the developing world ...

There are going to be doctorates and phd’s written on the subject for decades, that’s for sure. I just hope they’re qualified!

[ChrisinHove]

For anyone that cares...Latest CDC report states that COVID-19 mortality rate probability is even LOWER than most US independent projections...0.26% in the most likely scenario and does not exceed 1.0% until infected subjects age is past 70yo. Even lower than I stated in "the other thread"....Link directly to CDC report with charts in the narrative.

https://www.conservativereview.com/news ... ate-media/

Interesting that the mortality rate was guessed at about that from the start. 0.26% doesn’t sound a lot but would be over 850,000 Americans and 170,000 Brits.

Whether or not those numbers of deaths really are “remarkably low” is another debate entirely, as is the cost of those lives.

[The Deacon]

Having worked for several government agencies where I was tasked on more than one occasion with crafting database queries that would produce results in line with the agency's agenda, I'm extremely skeptical of any government statistics and at least as skeptical of any from non-governmental sources. My working theory is that everyone who publishes statistics has an agenda and is therefore unlikely they will willingly publish anything that does not support that agenda.

[TomAiello]

Whether or not those numbers of deaths really are “remarkably low” is another debate entirely, as is the cost of those lives.

It's still a trade off. There are human costs to a lockdown too. Malnutrition, death, domestic abuse...some of them will have long term consequences for many years after this pandemic is over. Unfortunately, we don't have statistics on those--and we can't have them until years from now. That makes it very hard to make reasonable decisions, because we are getting a bunch of numbers about one thing (Coronavirus) and no real numbers on the cost of our response.

It's important to remember that every action has costs and that some of the costs of lockdowns are _also_ measured in human lives. We simply don't have statistics on the human costs yet.

[TomAiello]

My working theory is that everyone who publishes statistics has an agenda and is therefore unlikely they will willingly publish anything that does not support that agenda.

I'd say you're going to be right about 99% of the time. I've definitely seen a few remarkable cases where statistics were published that didn't support the initial agenda of the group/person gathering them, but they were almost always published because the statistics themselves changed the view of the publisher.

[OldHoosier62]

For anyone that cares...Latest CDC report states that COVID-19 mortality rate probability is even LOWER than most US independent projections...0.26% in the most likely scenario and does not exceed 1.0% until infected subjects age is past 70yo. Even lower than I stated in "the other thread"....Link directly to CDC report with charts in the narrative.

https://www.conservativereview.com/news ... ate-media/

Interesting that the mortality rate was guessed at about that from the start. 0.26% doesn’t sound a lot but would be over 850,000 Americans and 170,000 Brits.

Whether or not those numbers of deaths really are “remarkably low” is another debate entirely, as is the cost of those lives.

Considering the WHO and other European models (and the initial CDC estimates) were at 3.4%, I'd call that an immense improvement. The researcher who did the original calculations really botched things up.

[OldHoosier62]

Having worked for several government agencies where I was tasked on more than one occasion with crafting database queries that would produce results in line with the agency's agenda, I'm extremely skeptical of any government statistics and at least as skeptical of any from non-governmental sources. My working theory is that everyone who publishes statistics has an agenda and is therefore unlikely they will willingly publish anything that does not support that agenda.

Precisely....Grandad use to say "Figures lie and liars figure."

I spent many years in the military, and later civilian, ordnance field...it was very common to catch the manufacturers/designers fudging numbers trying to get an edge on the competition...And almost as common to have a superior tell you what he wanted your reports to say before you wrote them. Needless to say my career suffered greatly because I didn't "play ball".

Like Deacon said...EVERYBODY has an agenda.

[Mike Blue]

... Like Deacon said...EVERYBODY has an agenda.

Exactly. This falls into the category of "experimenter bias." No discussion of statistics is complete without including the threats to validity and reliability of those statistics.

[ChrisinHove]

... Like Deacon said...EVERYBODY has an agenda.

Exactly. This falls into the category of "experimenter bias." No discussion of statistics is complete without including the threats to validity and reliability of those statistics.

I wonder how “experimenter bias” compares with the tendency for people to disbelieve statistics that don’t reinforce their existing opinion?

How many times do you read a statement that says, in effect, “I don’t believe those other 99 reports, but I do believe this one”?

[The Deacon]

I wonder how “experimenter bias” compares with the tendency for people to disbelieve statistics that don’t reinforce their existing opinion?

How many times do you read a statement that says, in effect, “I don’t believe those other 99 reports, but I do believe this one”?

Am sure it happens, but just because the report you believe is the minority opinion does not mean it can't be the most accurate. If the 99 were funded by those who had a vested interest in the conclusions matching their position, and the one was not, I'm going to be inclined to give the one more credence than the 99. Then too, if my opinion is based on my personal experiences and observations, I'm going to give one report that corroborates them more credence than 99 that go directly against it.

[TomAiello]

... Like Deacon said...EVERYBODY has an agenda.

Exactly. This falls into the category of "experimenter bias." No discussion of statistics is complete without including the threats to validity and reliability of those statistics.

I wonder how “experimenter bias” compares with the tendency for people to disbelieve statistics that don’t reinforce their existing opinion?

How many times do you read a statement that says, in effect, “I don’t believe those other 99 reports, but I do believe this one”?

It's interesting how this whole debate becomes meaningless if we just don't let centralized authority dictate to us. Then the statistics are just interesting numbers, and everyone gets to do what they individually choose.

Interesting read here: https://en.wikipedia.org/wiki/John_James_Cowperthwaite

He refused to compile GDP statistics arguing that such data was not useful to managing an economy and would lead to officials meddling in the economy.[5] He was once asked what the key thing that poor countries could do to improve their growth. He replied: “They should abolish the office of national statistics.”[6] According to Catherine R. Schenk, Cowperthwaite's policies helped it to develop from one of the poorest places on earth to one of the wealthiest and most prosperous: "Low taxes, lax employment laws, absence of government debt, and free trade are all pillars of the Hong Kong experience of economic development."[7] The Economic Freedom of the World 2015 Report ranks Hong Kong as both the freest economy in the world, a distinction it has held since this index began ranking countries in 1975, and among the most prosperous.[8]

[Mike Blue]

... I wonder how “experimenter bias” compares with the tendency for people to disbelieve statistics that don’t reinforce their existing opinion?

How many times do you read a statement that says, in effect, “I don’t believe those other 99 reports, but I do believe this one”?

Experimenter bias is a category that includes many expressions of bias. It can represent the bias of the person running the data, or the biases of the people who are being studied. Threats to validity and reliability are multiple and worth accounting for in any discussion of what a number suggests about a population or process. This pandemic is a good example of a historical threat. People are not behaving as they would if it hadn't occurred. Some scientists "want" hydrochloroquine to work. They are motivated by their bias to have any treatment that works to overlook some significant factors and bend the results either positively or negatively. The risk to anyone who might be affected by a result is that a false positive effect means we use a treatment that is dangerous or ineffective, or a false negative effect which means we don't use an effective treatment. Addressing threats to validity narrows the range of uncertainty around the decision point.

It's interesting how this whole debate becomes meaningless if we just don't let centralized authority dictate to us. Then the statistics are just interesting numbers, and everyone gets to do what they individually choose.

Interesting read here: https://en.wikipedia.org/wiki/John_James_Cowperthwaite...

Cowperthwaite is an interesting read. There are a couple threats to validity present in his fortune. He was able to wield the power needed to operate a system that did not subject itself to the office of national statistics and preventing officials from meddling. That he succeeded (his biases) despite those and had a positive outcome for Hong Kong is noteworthy. Sadly his policies do not seem to have survived the next round of officials representing a powerful centralized authority. Individual liberty may be prized, and still lost to a central group that wields more power to support their collective bias.

[ChrisinHove]

... Like Deacon said...EVERYBODY has an agenda.

Exactly. This falls into the category of "experimenter bias." No discussion of statistics is complete without including the threats to validity and reliability of those statistics.

I wonder how “experimenter bias” compares with the tendency for people to disbelieve statistics that don’t reinforce their existing opinion?

How many times do you read a statement that says, in effect, “I don’t believe those other 99 reports, but I do believe this one”?

It's interesting how this whole debate becomes meaningless if we just don't let centralized authority dictate to us. Then the statistics are just interesting numbers, and everyone gets to do what they individually choose.

Interesting read here: https://en.wikipedia.org/wiki/John_James_Cowperthwaite

He refused to compile GDP statistics arguing that such data was not useful to managing an economy and would lead to officials meddling in the economy.[5] He was once asked what the key thing that poor countries could do to improve their growth. He replied: “They should abolish the office of national statistics.”[6] According to Catherine R. Schenk, Cowperthwaite's policies helped it to develop from one of the poorest places on earth to one of the wealthiest and most prosperous: "Low taxes, lax employment laws, absence of government debt, and free trade are all pillars of the Hong Kong experience of economic development."[7] The Economic Freedom of the World 2015 Report ranks Hong Kong as both the freest economy in the world, a distinction it has held since this index began ranking countries in 1975, and among the most prosperous.[8]

Very interesting! Arguably it would have been hard to damage the HK economy over that period, though. I wonder whether illiteracy from his no compulsory primary education policy and no public transport system in such a small, congested region would have eventually done just that.

You hint at a key question - if we don’t let a centralised central authority dictate terms, then will outside forces (rival economies, global pandemics etc) dictate worse ones?

[ChrisinHove]

....

How do you address these threats to validity in current circumstances?

The economic cost of action is enormous, the human cost of inaction is horrendous: finding the acceptable balance between the two is fundamentally a statistical exercise, and support for it is down to how credible those numbers are.

[Mike Blue]

.... You hint at a key question - if we don’t let a centralised central authority dictate terms, then will outside forces (rival economies, global pandemics etc) dictate worse ones?

You ask good questions. My limitation is that I'm not an economist except as an outside observer and consumer.

IMO there is a balance between centralised authorities because there is an advantage of the economy of scale. But that also starves local businesses/producers and when a national emergency occurs for example, no one has a local supply of food if the great rolling warehouse of tractor-trailers and just-in-time-delivery were affected by a fuel crisis.