Trial Report Specialist physiotherapy for functional motor disorder in England and Scotland (Physio4FMD):... 2024 Nielsen, Stone, Carson, Edwards et al

Exactly. It had a meaningful effect on them - they get paid!

 

Joanne Hunt and others argue that the state is committing democide through those mechanisms. I’m inclined to agree with them.

Edit: so yes, the calculations would be different for ME/CFS if we include all costs and not just the ones that the government wants to consider.

 

Even then, they have to operate on a limited time frame. Over 5 years it makes sense. At 10 it starts making a lot less sense. At the 20-30 years range, developing solutions so that the problem effectively ceases to exist because it's routinely treated makes much more economic sense.

They still end up paying a lot. It's a small fraction of it, but the alternative of paying nothing obviously makes more sense, but that would require long-term thinking and policies. Governments are just as much to blame about this. Where even in an industry that needs to have long-term stability, they still mostly focus on the next quarter earnings, governments are often even more myopic in that they know they will be out of power if, and when, by the time someone clues on what they did.

 

No question about that, IMO. It's very clearly eugenicist policies. And just because everyone enforces them doesn't make them any less than what they are. We are, in realpolitik terms, undesirables, disposable.

Even though it would pay for itself many times over to work out solutions instead. Humanity is just this constant struggle between doing good things and kicking others in the face on an industrial scale.

 

Agreed

 

Right, but beyond that...they added up so many various items and it's hard to tell how accurate these accounts are and also whether they really reflect whether or not someone did or did not get the intervention. It all seems pretty arbitrary.

 

Absolutely! If you ask an accountant what this year’s result is they’ll ask you «what do you want it do be?»

That’s a bit of a joke of course, but it’s very easy to manipulate an analysis like this. And even when you do your honest best, there’s no guarantee that the analysis is exhaustive or representative.

 

One big problem, IMO, is how they used a tiny marginal difference, and extrapolated from that:

This amounts to about a 4% difference, when the total costs will often vary by more than that. It's far too small to extrapolate anything, especially on a measly 0.03 QALYs. It's the kind of thing that academics should genuinely laugh at, if amateurs did it, use as an example of how to be bad at doing their job.

 

This difference showed that TAU cost less.

What they «showed», is that they can add 1 QALY at a rate of less than £20,000 per person per year, so they argue that it’s «profitable» from a societal economics perspective.

One thing that I just thought of now is that I don’t remember that they showed any actual savings in terms of lower expenditures etc. as a result of this increased QALY. So they are arguing that the government should pay for something with no meaningful benefit to the patient, and that doesn’t save them any money, just because the cost is low enough relative to the meaningless effect for the patients.