Medical EV problem

[malorum]

In the UK a blood test is taken from pregnant women to determine their risk of having a downs syndrome child.

the test can identify the "high risk" of 1 in 300.

If the risk is in this region an amniocentesis is normally performed which will give a near certain diagnosis but carries with it a 1 in 50 chance of causing an abortion.

So the diagnositc proceedure has a higher risk of fetal death, than the risk of disability used to justify the test.

I am guessing the assumption is that the negative utility of having a disabled child is much higher than the negative utility of accidentally killing the unborn feotus.
An example of how "pure EV" is not applied in the scientific field.

thoughts plz

[chezlaw]

[ QUOTE ]
An example of how "pure EV" is not applied in the scientific field.

[/ QUOTE ]

You can't conclude that without assuming your personal value system.

Surely the mother is given the choice, its not compulsory is it? They will apply there own value system and make a choice (I suspect many will find it fairly easy one way or the other and many will find it tough).

chez

[purnell]

[ QUOTE ]
In the UK a blood test is taken from pregnant women to determine their risk of having a downs syndrome child.

the test can identify the "high risk" of 1 in 300.

If the risk is in this region an amniocentesis is normally performed which will give a near certain diagnosis but carries with it a 1 in 50 chance of causing an abortion.

So the diagnositc proceedure has a higher risk of fetal death, than the risk of disability used to justify the test.

I am guessing the assumption is that the negative utility of having a disabled child is much higher than the negative utility of accidentally killing the unborn feotus.
An example of how "pure EV" is not applied in the scientific field.

thoughts plz

[/ QUOTE ]

From an economic perspective it's pretty obvious. The net contribution to the economy of a random person is probably positive, while providing for a severely disabled child costs a fortune. But what about the parents' civil rights? Can a person refuse the procedure?

[Bez]

This is not Nazi Germany, therefore, no they can't.

[chezlaw]

[ QUOTE ]
[ QUOTE ]
In the UK a blood test is taken from pregnant women to determine their risk of having a downs syndrome child.

the test can identify the "high risk" of 1 in 300.

If the risk is in this region an amniocentesis is normally performed which will give a near certain diagnosis but carries with it a 1 in 50 chance of causing an abortion.

So the diagnositc proceedure has a higher risk of fetal death, than the risk of disability used to justify the test.

I am guessing the assumption is that the negative utility of having a disabled child is much higher than the negative utility of accidentally killing the unborn feotus.
An example of how "pure EV" is not applied in the scientific field.

thoughts plz

[/ QUOTE ]

From an economic perspective it's pretty obvious. The net contribution to the economy of a random person is probably positive, while providing for a severely disabled child costs a fortune. But what about the parents' civil rights? Can a person refuse the procedure?

[/ QUOTE ]

Its unthinkable that in the uk the person cannot refuse the procedure. I seriously doubt that there is even any sort of official recommendation to take the test.

chez

[chezlaw]

From the BUPA website (BUPA is a big private healthcare provider in the uk)

[ QUOTE ]
It can be difficult to decide whether or not to have these diagnostic tests. The woman must consider how the result, whatever it might be, would affect her decision to continue with the pregnancy. She must also weigh up the risk of miscarriage associated with the tests.



[/ QUOTE ]

chez

An 'elective' amneocentisis can be rejected by either parent in the US. However, most applications of these tests are not elective, but rather forced by a doctor to either protect the life of the baby or the mother. Performing this test to determine the genetic make-up of the unborn child is not the primary function of the test. Securing the safety of the mother & child (whether genetically diseased or not) is paramount.

Thus, assuming your 1 in 50 shot of the child dying, I would postulate that the test isn't forced on the mother unless there is a greater than 1 in 50 shot either the mother or child dies without the added information of the test.

Edited: The comments in the first paragraph were learned from my wife's doctor not 1 month ago.

[purnell]

LOL. We hear stories about the evils of "socialized medicine" on the radio here. Just curious. I'm glad to know human rights are resoected in the UK.

[chezlaw]

[ QUOTE ]
An 'elective' amneocentisis can be rejected by either parent in the US. However, most applications of these tests are not elective, but rather forced by a doctor to either protect the life of the baby or the mother. Performing this test to determine the genetic make-up of the unborn child is not the primary function of the test. Securing the safety of the mother & child (whether genetically diseased or not) is paramount.

Thus, assuming your 1 in 50 shot of the child dying, I would postulate that the test isn't forced on the mother unless there is a greater than 1 in 50 shot either the mother or child dies without the added information of the test.

Edited: The comments in the first paragraph were learned from my wife's doctor not 1 month ago.

[/ QUOTE ]

Forced, in the uk?

If it is forced to protect life then its not just a test to detect downs syndrome.

chez

[malorum]

[ QUOTE ]
Its unthinkable that in the uk the person cannot refuse the procedure. I seriously doubt that there is even any sort of official recommendation to take the test.

[/ QUOTE ]

Of course you can refuse proceedures, but remember in the UK this is the National health service, and individuals generally accept the recomended proceedure. Doctors and health care trusts are paid extra to meet targets, such as ensuring a certain percentage of patients are tested (same idea applies to immunisation). When the goverment is paying there can be a lot of pressure to do what the doctors say is best.
The official recommendation is clear though. There is incredible pressure to take the initial blood test, and the secondary proceedure is recommended if the test suggests a 1 in 300 chance of Downs syndrome.

I have personal experience of this, as my wife refused the initial test repeatedly on the basis that the possibility Down syndrome would not affect our decision to proceed with a pregnancy (termination would not be an option for us in this case).
The background in the UK is also of course that termination is far less controversial than it is in the US and the health service makes its proceedures accordingly.

[tylerdurden]

[ QUOTE ]
If the risk is in this region an amniocentesis is normally performed which will give a near certain diagnosis but carries with it a 1 in 50 chance of causing an abortion.

[/ QUOTE ]

This is incorrect. The total "complication" rate is about 1 in 50, but the loss of pregnancy rate is more like 1 in 200.

[malorum]

[ QUOTE ]
An 'elective' amneocentisis can be rejected by either parent in the US. However, most applications of these tests are not elective, but rather forced by a doctor to either protect the life of the baby or the mother.

[/ QUOTE ]

Does this apply to the diagnosis of Downs Syndrome? I think the usual clinical argument is that the childs or parents life would not be worth living. I know a few people with Down's syndrome who rather enjoy their lives, and would resent being terminated to 'protect' their own or their parents quality of life.

[tylerdurden]

[ QUOTE ]
An 'elective' amneocentisis can be rejected by either parent in the US. However, most applications of these tests are not elective, but rather forced by a doctor to either protect the life of the baby or the mother.

[/ QUOTE ]

This is incorrect. You (assuming you are competent) can not be forced to undergo any test for any reason. Any doctor that administers an amnio without consent is committing battery.

EDIT: this is in the US. I don't know about other places.

[malorum]

[ QUOTE ]
From the BUPA website (BUPA is a big private healthcare provider in the uk)


[/ QUOTE ]

UK healthcare is predominantly undertaken by the National Health service, not by private providers like BUPA.
Companies like Bupa are generally more wary of litigation, and all proceedures are essentially elective, because they provide a secondary alternative to the primary care system for a restricted range of treatments.

[chezlaw]

[ QUOTE ]
[ QUOTE ]
From the BUPA website (BUPA is a big private healthcare provider in the uk)


[/ QUOTE ]

UK healthcare is predominantly undertaken by the National Health service, not by private providers like BUPA.
Companies like Bupa are generally more wary of litigation, and all proceedures are essentially elective, because they provide a secondary alternative to the primary care system for a restricted range of treatments.

[/ QUOTE ]

I just reference BUPA because it came up on google. I agree in general with your other point that targets distort the way the NHS provides heathcare. However thats a problem with the mechanism of tragets and is nothing to do with an EV calculation based on the values involved.

If your post was criticising targets as a way of providing heathcare, as implemented in the uk, then I would agree with you.

chez