Why doctors don't do much good, and how you can do more

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Why doctors dont do much good, and how you can do more

Why doctors dont do much good, and how you can do moreDr Gregory LewisEA Global Oxford20/11/2016

OutlineIntroductionContours of health and disease What does medicine contribute?My researchA comparison to charitable givingPeregrinationsWhere to go next

OutlineIntroductionContours of health and disease What does medicine contribute?My researchA comparison to charitable givingPeregrinationsWhere to go next

Photo credit: Wendy Darling

Lewis (2006)I want to study medicine because of a desire I have to help others, and so the chance of spending a career doing something worthwhile I cant resist. Of course, Doctors dont have a monopoly on altruism, but I believe the attributes I have lend themselves best to medicine, as opposed to all the other work I could do instead.

OutlineIntroductionContours of health and disease What does medicine contribute?My researchA comparison to charitable givingOther peregrinationsWhere to go next

Source: Clio-Infra Project

Source: Max Roser

OutlineIntroductionContours of health and disease What does medicine contribute?My researchA comparison to charitable givingOther peregrinationsWhere to go next

McKeown (1977)

McKinlay and McKinlay (1979)

Excursus: QALYs

Source: Wikipedia

Bunkers approachTrial data for length and quality of life benefits for #1 most commonly used medical interventionTrial data for length and quality of life benefits for #2 most commonly used medical interventionTrial data for length and quality of life benefits for #3 most commonly used medical interventionTrial data for length and quality of life benefits for #1 most commonly used medical interventionTrial data for length and quality of life benefits for #1 most commonly used medical interventionTrial data for length and quality of life benefits for #1 most commonly used medical interventionTrial data for length and quality of life benefits for #1 most commonly used medical interventionTrial data for length and quality of life benefits for #1 most commonly used medical interventionTrial data for length and quality of life benefits for #1 most commonly used medical interventionTrial data for length and quality of life benefits for #1 most commonly used medical interventionTrial data for length and quality of life benefits for #1 most commonly used medical interventionTrial data for length and quality of life benefits for #1 most commonly used medical interventionTrial data for length and quality of life benefits for #n most commonly used medical interventionTotal impact of medicine

Bunkers bottom line5 Years extended lifespan5 QALYs5 Years free from disability2.5 QALYs0.5 Years lost (medical error)- 0.5 QALYsGrand total7 QALYs

Average per person benefit in the US

Per person QALY benefit7Number of people in UK~ 62.6 millionNumber of doctors in UK~ 172 000Impact per doctor2250 QALYs(~~ 2 lives saved each year)

Saving a life ~ 30 QALYs, career of 40 years

Making a difference?

OutlineIntroductionContours of health and disease What does medicine contribute?My researchA comparison to charitable givingOther peregrinationsWhere to go next

A Global natural experiment

Data: WHODALY ~inverse QALY

More marginal marginal returns

DALYs @ UK Docs (289 / 100k) =26738

DALYs @ UK Docs +1 =26732

Impact of another UK doctor ~ 6 DALYs per year, ~ 240 per career

But confounding factors!DoctorsHealthSanitationWealthEducation

But confounding factors!DoctorsHealthSanitationWealthEducation

Even more marginal returnsVariableCoefficientStandard errorP value(Intercept)133023.5122058.14