Beauty Health for Life

Disease Management Care Blog readers saw it here first.

Months ago, the DMCB presciently argued that cancer patients appetite for high expense and low yield treatments was based on more than desperation.  It said it was also based on doctors and patients quite rational realization that these treatments could rarely result in meaningful life prolongation.  In other words, while an "average" life expectancy from a particular treatment might be reported to be "only" six months, knowing that some persons make it to 12 or more months while others died immediately (zero months) could prompt a reasonable cancer patient to choose a shot at getting the twelve months.

The prestigious medical journal Health Affairs has finally caught up the the DMCB.  In the latest issue, Darius Lakdawalla and colleagues surveyed 150 persons with either breast cancer (N=47, 20 of whom had advanced disease), melanoma (N=20) or other types of cancer (N=83). 

There were two surveys dealing with breast cancer and melanoma that presented two nominally equal chemotherapy treatment scenarios.  One used a "hypothetical" survival outcome based on the usual kind of "average survival" statistics.  The other presented a "hopeful" survival outcome that reported a "spread" of survival statistics that included the small number of persons with shortened as well as prolonged lifespans.  The surveys were conducted face-to-face using interviews on representative patients drawn from multiple cancer treatment centers nationwide.

According to the authors, the survey was designed to test the appetite for risk among cancer patients. Behavioral economists have long known that persons generally per the "sure bets" ($100 now) over equivalently valued "hopeful gambles" (a coin flip to win $200 or lose it all).

Its also known that persons who are not well-off have a greater appetite for the hopeful gamble.  Betting a relatively small amount with a large upside explains the luster of low odds state lotteries for socioeconomically disadvantaged persons. It could also account for the willingness of very sick cancer patients - who have little to lose - to demand long shot treatments, even if theyre toxic and experimental. 

The results showed that 77% of the survey participants perred the hopeful gamble scenario. 71% of the patients with the melanoma scenario were prepared to "bet" two years of life in return for a 20% chance of living 4½ years. Among the patients with the breast cancer scenario, 83% were willing to bet 1½ years for a 10% chance of living 4 years. 

These perences were also accompanied by a willingness to spend a lot of money to access the bet. On average, the melanoma patients were willing to pay at least $45,000, while the breast cancer scenario patients were willing to pay at least $90,000.  Persons with higher income levels were willing to pay even more.

While the authors correctly note that more research is needed, the DMCB suspects this could explain the decision-making thats leading many cancer patients to demand insurance coverage of experimental, high cost and low yield treatments.  Not only does it make intuitive sense, but popular media extolls the intrepid hero who prevails and gets the girl, wins the talent show or defeats the aliens despite little chance of winning.  Were a culture inculcated with high stakes gambles,especially if there is little to lose.

The DMCB recalls one of its middle aged patients with colon cancer that had spread to his liver.  After multiple rounds of surgery (half his liver was removed), chemo and radiation, he was swollen, sickly, tired, gaunt and moribund.  He agreed the treatments were pretty bad - until he considered the alternative.

Assuming IPAB survives, do we really think their pronouncements based on the usual approaches to comparative outcomes will really convince cancer patients to not seek hope?  Will they really determine that hope is not medically necessary?

Nearly 10,000 people walked along Benjamin Franklin Parkway to the Art Museum Sunday in support of a cure for type 1 diabetes.



Mayor Nutter was in attendance:

"This walk, this effort is critically important and its great to see so many young people and families out. This really is a family event and a fantastic day as well."

________

Yesterday, we asked you readers for the best deals at the major big box stores - CostCo, BJs Wholesale Club, and Sams Club. Your responses were comprehensive and, excuse my language, pretty farging great. (Quinoa! Who knew?)

Wiki Ken Hammond

Last night, I compiled those responses into this, a master list of Big Box Bargains – like a cheat sheet - which should help you find the best deals next time you visit a glorious warehouse. (For me, see: tonight.) Its useful! Its extensive! Its pretty!

About the process: Every product mention got one vote. (So, if three different commenters wrote "mushrooms," it got three votes.) Some things, like mattresses, elicited one clear vote and were easy to tally. Others, like cheese, were much more varied, producing several similar-but-not-exactly-alike answers. In those cases, I tallied the category as a whole, and then elaborated on individual responses within parentheses. (Um … if that makes sense, which it only kind of does. But youll see.)

Enjoy!

17 VOTES
Cheese (2 votes feta, 2 votes Tillamook)
Paper products (10 votes toilet paper, 4 votes paper towels)

16 VOTES
Spices (5 votes cinnamon, 3 votes pepper)

13 VOTES
Olive Oil

8 VOTES
Yeast (reader Jennifer: “Literally 100x cheaper than the envelopes”)

7 VOTES
Nuts (2 votes almonds)

6 VOTES
Pet food & supplies (3 votes dog food, 2 votes supplies, 1 vote cat food)
Salad greens (4 votes organic)

5 VOTES
Butter
Canned tomatoes (1 vote organic)
Dried fruit (2 Craisin votes)
Eggs (2 votes organic)
Milk (1 vote organic)
Quinoa

4 VOTES
Baby supplies (2 votes diapers, 2 votes wipes)
Bread (2 votes "fancy bread")
Chips
Electronics/big appliances (camera, elliptical, computer, etc.)
Gas
Vanilla Extract

3 VOTES
Alcohol (wine, bourbon, etc.)
Baking soda
Bananas
Cleaning products
Movie tickets
Mushrooms
Oatmeal
Peanut butter (1 vote organic)
Produce
Rice (1 vote Basmati)
Sabra Hummus
Soap
Yogurt (1 vote Greek-style)

2 VOTES
Almond butter, Bagels, Beans, Cereal (1 vote Kashi), Clif bars, Coffee, Contact lens solution, Drugs (Kirkland brand Advil, Zyrtec, etc.), Frozen berries, Frozen chicken, Ground turkey, Gum, Kids clothes, Laundry detergent, Lettuce, Maple syrup, Soy milk, Tissues, Toothbrushes/toothpaste, Tortillas, Vinegar, Potatoes, Tomatoes

1 VOTE
Bacon (Kirkland brand), Better than Bouillon chicken base, Bisquick, Books, Breathe-right nose strips, Brita filters, Brown sugar, Canned pineapple, Canned tuna/salmon, Cars (!), Checks, Chicken breasts, Chicken broth, Chicken thighs, Coconut Milk, Cornstarch, Crackers, Cutting boards, Dairy, Dental floss, Deodorant, Dish detergent, Dr. Pepper, Dried onions, Floss, Flour, Food court items, Fresh meats, Frozen edamame, Frozen hamburger patties, Frozen salmon fillets, Frozen shrimp, Frozen strawberries, Frozen vegetables, G2, Garlic, Gelato, Gift card deals (restaurants, movie theaters, etc.), Glasses, Goldfish, Grains, Granulated garlic, Ground flaxmeal, Honey, Hot dogs, Hot sauce, Green chiles, Janitorial supplies, Jarred roasted red peppers, Larabars, Marinated shrimp, Magazines, Marinated artichoke hearts, Mattresses, Nutella, Onions, Organic, Organic apples, Organic carrots, Organic frozen fruit, Organic hamburger, Popcorn (the kind you pop on the stove), Popcorn salt, Prescriptions, Printer paper, Ramen, Rotel, Rotisserie chicken, Salmon, Salmon burgers, Salsa, Shampoo, Shaving gel, Smuckers strawberry jam, Store-brand fish oil, Store-brand naprosyn, Sugar, Strawberries, Sun-dried tomatoes, Sweet potatoes, Tires, Toiletries, Tuna, Tupperware, Udis granola, Veggie burgers

Fun comments:

• Commenter Aryn writes: “Beware the giant box o pens. My husband and I bought 200 pens when we started grad school thinking wed use them up quickly. Its been seven years. We still have about 180 of those pens.” (Aryn! I totally did this once, too, for a friends promotional event. Maybe we can have a pen party?)
• Commenter Ami writes: "I tend to shop with my mom and we split items that neither of us can use in a week - we also split the cost of membership with makes it even more worthwhile."
• Also of note: Readers loved CostCo’s return policy, especially on appliances and electronics.

And thats it! Sweet readers, do you agree/disagree/have anything to add? The comment section is wide open.

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If you like this article, youll flip for:

• Cooking for Small Children: 15 Hows, Whens, and ... Honey, Please Put That Cleaver Down
• The Junk Food Tax: Reader Ideas, Opinions, and Solutions
• Reader Replies: "Healthy" Defined!