> It is completely pointless to talk about "detect cancer earlier AND CHANGE NOTHING ELSE".
No it isn't. I'm trying to ram home the statistical point with a counter-factual. I have to say this extreme because some people Just Don't Get It and keep on trying to talk about something else.
A system that ONLY detects cancers earlier will show better cancer survival numbers even if actual outcomes don't change at all. No, seriously.
Let's lay out an actual example.
Alice, Bob, Charlie, and David exist. Charlie has a minor cancer he won't die if. David has a major cancer he will die of.
In Country B, since detection is heavily correlated with the seriousness of cancer, they detect David has cancer, and David dies. Cancer survival rate = 0 of 1, or 0%.
In Country A, they detect Charlie and David have cancer. David dies, Charlie doesn't. Cancer survival rate = 1 of 2, of 50%.
> If you don't detect cancers, that will not stop people from dying to cancer.
No one said this.
> But early cancer detection is one of the undoubtedly good things.
This is wrong. I know your gut tells you this is true. Your gut is wrong.
Increased detection sometimes helps and sometimes hurts. There are a lot of people, like Charlie in the above example, who would never die of cancer, but because of increased detection they now undergo risky cancer treatment. All treatment involves risk, and for cancer treatment this is particularly true. Again, look up the history of radical chemotherapy. The people who underwent it had worse outcomes than people who had nothing at all done to them.
Researchers usually find that people in palliative care do better than people in active treatment. This isn't enough to say that no treatment is always better, but it is enough to say that some treatment is often worse.
Because so many people have your gut reaction, though, "early detection" is a popular way of throwing money at the problem in America.
> Infant mortality rate in the USA was lower than in my country in 1950; now it is more than double. Cuba is better than United States, if we can trust the statistics.
Here's good questions to ask yourself when looking at infant mortality.
1. What's the difference between a miscarriage, a stillbirth, and a dead newborn? Particularly, what does it mean when this answer changes between countries, and even within countries?
2. How do the numbers change if you compare white Americans to white Canadians and black Americans to black Canadians?
There isn't such a system, anywhere. Even if you could have a public health care that detects and tries not to treat, you still cannot effectively forbid people from getting treatment themselves - if you make a law against it, people will try to escape the country to get treatment. So if you have a better detection rate, there will be actions to treat.
>Increased detection sometimes helps and sometimes hurts.
Perhaps the fallacy here is the belief that the helps/hurts ratio of treatment is 50/50? It isn't.
Of course there are cases where the treatment actually made things worse. There are more cases where the treatment has no significant effect.
But it is rather silly to assume that cancer treatments would have a net negative of zero effect.
Regarding the infant mortality rate, the definitions of miscarriage, stillbirth and dead newborn are not so different between developed nations that it would change this. Where IMR is lower, also stillbirth rate is lower, so it's not really about moving the boundary between these.
No it isn't. I'm trying to ram home the statistical point with a counter-factual. I have to say this extreme because some people Just Don't Get It and keep on trying to talk about something else.
A system that ONLY detects cancers earlier will show better cancer survival numbers even if actual outcomes don't change at all. No, seriously.
Let's lay out an actual example.
Alice, Bob, Charlie, and David exist. Charlie has a minor cancer he won't die if. David has a major cancer he will die of.
In Country B, since detection is heavily correlated with the seriousness of cancer, they detect David has cancer, and David dies. Cancer survival rate = 0 of 1, or 0%.
In Country A, they detect Charlie and David have cancer. David dies, Charlie doesn't. Cancer survival rate = 1 of 2, of 50%.
> If you don't detect cancers, that will not stop people from dying to cancer.
No one said this.
> But early cancer detection is one of the undoubtedly good things.
This is wrong. I know your gut tells you this is true. Your gut is wrong.
Increased detection sometimes helps and sometimes hurts. There are a lot of people, like Charlie in the above example, who would never die of cancer, but because of increased detection they now undergo risky cancer treatment. All treatment involves risk, and for cancer treatment this is particularly true. Again, look up the history of radical chemotherapy. The people who underwent it had worse outcomes than people who had nothing at all done to them.
Researchers usually find that people in palliative care do better than people in active treatment. This isn't enough to say that no treatment is always better, but it is enough to say that some treatment is often worse.
Because so many people have your gut reaction, though, "early detection" is a popular way of throwing money at the problem in America.
> Infant mortality rate in the USA was lower than in my country in 1950; now it is more than double. Cuba is better than United States, if we can trust the statistics.
Here's good questions to ask yourself when looking at infant mortality.
1. What's the difference between a miscarriage, a stillbirth, and a dead newborn? Particularly, what does it mean when this answer changes between countries, and even within countries?
2. How do the numbers change if you compare white Americans to white Canadians and black Americans to black Canadians?