Friday, December 4, 2020

BRIAN ROSE: What Is 'QALY' & Why You Need To Know More About It - Profes...

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TRANSCRIPT 
so i appreciate that let me move forward
00:01
to my second point
00:03
and uh i was really honored yesterday to
00:05
have an incredible guest on the show
00:07
and uh this guest his name is professor
00:09
david miles
00:11
he is a professor at imperial college
00:14
london he's a former member of bank of
00:16
england's monetary policy committee all
00:18
right now look i spent 20 years in
00:20
finance
00:21
monetary policy is how governments
00:24
choose
00:24
short-term interest rates and it
00:26
basically controls the economy
00:28
it's one of the most powerful positions
00:29
in government some would argue in
00:31
america
00:32
it's the decision the fed makes it's
00:34
more powerful than what the president
00:35
can decide
00:36
so this man is high ranking he's also
00:39
former chief economist for morgan
00:40
stanley and merrill lynch all right
00:42
former member of the financial services
00:44
authority which polices all the bankers
00:45
here
00:46
and i sat down with professor david
00:48
miles yesterday and we had a discussion
00:49
and the professor said this
00:51
quote uh the three-month lockdown
00:55
earlier this year came
00:56
at an extremely high price relative to
00:59
the health benefits
01:00
and he went on to say that in another
01:03
extremely costly lockdown
01:06
he believes that the benefits may not
01:08
exceed the costs
01:10
we went on further and we concluded that
01:13
we
01:13
cannot survive past 30 days and he
01:16
briefly said this and i'm going to play
01:17
a video of him shortly
01:19
if this lockdown lasts for any longer
01:21
than 30 days and honestly i think he was
01:23
being generous at 30 days
01:25
i think he really wanted to say more
01:26
like two weeks he said literally we
01:28
won't survive
01:29
and he's not talking about surviving the
01:31
disease he's talking about surviving
01:35
as as a people we will no longer
01:38
have the money to even pay for basic
01:41
services
01:42
we will no longer have the funds to keep
01:44
this country going we won't be able to
01:46
pay for our health services
01:48
this is how dire these decisions are
01:50
being made and that's why i want to go
01:52
in deeper on this
01:53
but he also made a really interesting
01:55
point and he talked about something
01:57
called
01:57
quali and this is something that's not
01:59
being talked about and we need to talk
02:01
about it right now
02:02
it's called the quality adjusted life
02:04
year
02:05
quali and this is the measure that the
02:08
nhs
02:08
actually uses to evaluate whether a
02:11
procedure needs to take place on a
02:13
patient in the national health service
02:14
and this is how it works they look at a
02:17
patient and they look at a procedure
02:20
if the procedure can increase the
02:21
patient's lifespan by one year
02:24
then they agree to do that procedure
02:26
only if it costs
02:27
30 000 pounds or less let me repeat that
02:31
say there's a cancer surgery that
02:32
they're about to do or a cancer
02:34
treatment
02:35
if it costs more than thirty thousand
02:37
pounds and it doesn't extend their life
02:39
by more than one year
02:40
they say no we're not going to do the
02:43
procedure
02:43
now you might say well that's really
02:45
callous they should do anything to save
02:46
their life but
02:47
what if that procedure cost three
02:48
million pounds or 300 million pounds or
02:51
3 billion pounds at some point
02:53
it's not cost effective to have that
02:54
procedure for everyone
02:56
and the professor went on to say brian
02:58
our our health budget would be 98
03:00
of gdp if we spent every dollar to save
03:03
every life so at some point we have to
03:05
make a decision
03:06
and these decisions are made every every
03:08
day in our lives the speed limit
03:10
is at i think 70 miles per hour in
03:12
britain because that's the optimal
03:14
uh limit to make sure transportation
03:16
moves and we minimize the loss of life
03:19
if we wanted to eliminate the loss of
03:21
life we would make the speed limit five
03:22
miles an hour so we would all go so slow
03:24
there would be no traffic accidents
03:26
so every day we make decisions that are
03:29
are somewhere in between optimizing for
03:32
loss of life and the economic benefits
03:34
and he went deeper on this quality
03:36
adjusted life here
03:37
and he said that if you save someone
03:39
from covid they're usually in their 80s
03:42
he said on on a maximum scale they had
03:45
ten years
03:46
of expected life left it's probably more
03:48
like five he said if you multiply that
03:50
times thirty thousand when you save a
03:52
life it's
03:52
it's if you want to quantify it it's
03:54
three hundred thousand pounds
03:56
to save that life and uh professor miles
03:59
went in
04:00
and said if you look at that 300 000
04:03
pound figure
04:04
and you multiply it by the potential
04:06
1000 people
04:08
that are gonna die per day according to
04:10
some of these models or even two or
04:11
three thousand
04:12
when you compare that to the 1.8 billion
04:16
pounds
04:16
of loss to the economy every single day
04:19
you start to really see
04:20
a clear cost benefit analysis and you
04:24
start to really understand
04:25
that eliminating the virus
04:29
if you try to do that we will not
04:30
survive because we cannot afford to look
04:33
at it that way
04:34
again we need to think about control
04:36
versus elimination
04:38
and we need to find a way to live with
04:40
this virus
04:41
there is no way to eliminate it but
04:43
right now our government has sold you an
04:45
agenda that this is the way to eliminate
04:46
this virus
04:47
and we are literally crushing our
04:50
economy
04:51
our future our livelihoods on the back
04:54
of trying to save
04:55
a small portion of lives that when you
04:57
quantify it does not justify the loss
05:00
from this lockdown i can't put it any
05:02
clearly and again
05:04
every loss of life needs to be minimized
05:06
but this is a disproportionate response
05:08
to the virus
05:09
and it couldn't be made any clearer than
05:12
by this quality score and here's
05:13
a short video of me talking to professor
05:16
miles about this concept and again
05:18
he's very clear on the cost-benefit
05:20
analysis and this is the conversation no
05:22
one's having
05:23
we need to talk about it because it's a
05:25
real reason why we shouldn't be locked
05:26
down right now
05:28
here is professor miles if i was maybe
05:30
just
05:31
just to generalize some of the
05:33
assumptions you made about that model
05:35
i think you said if you save a life
05:37
roughly uh
05:39
10 years of life you might save for that
05:41
person times the 30 000 i guess that's
05:43
300 000
05:44
pounds you would potentially
05:47
uh save with each life is that a rough
05:50
idea
05:53
um yes in a way in a way that's right so
05:56
i mean if if you looked at the average
05:59
age
06:00
of people who you know tragically have
06:01
died with covid
06:03
it's somewhere in the sort of low 80s
06:06
um if you asked what was the life
06:09
expectancy of people
06:11
of that typical age at best probably it
06:14
was about 10 years
06:16
probably actually a little bit less
06:17
given that most of the people who've
06:19
died of that age with kobet had related
06:21
health problems
06:23
um so if you then said well okay suppose
06:25
you apply that national health service
06:27
rule
06:30
how many resources using the nhs rule
06:34
would you want to apply to saving on
06:37
average those kind of lives and the
06:38
answer would be as you say you know
06:40
three or four hundred thousand pounds
06:42
now i stress again this looks like a
06:44
very macabre thing
06:45
to do it looks like the kind of thing a
06:47
kind of heartless economist would do
06:50
attaching money values to lives saved
06:53
but the reality is that that's how
06:56
decisions are made in public health
06:58
systems in pretty much every country in
07:00
the world and in other areas where
07:02
governments have to make rules
07:04
how fast can people drive on our roads
07:07
for example so we're simply applying
07:08
that kind of rule
07:10
and i think had that analysis said well
07:13
it was a close run thing whether the
07:15
lockdown for three months
07:17
was sensible or not i think had to be
07:20
much more open-minded about it but i
07:22
think as it turned out the numbers
07:24
suggested
07:25
that the costs were so much higher
07:29
than the 30 000 pound per
07:32
quali rule would have justified
07:36
that it seemed to me um you'd have to go
07:39
way beyond that national health service
07:41
rule to have justified
07:44
restrictions blanket restrictions kept
07:46
in place for as long as we did
07:47
back in the spring into the summer here
07:49
in the uk
07:50
yeah i think you're right because i
07:52
think the maximum uh deaths
07:54
was back in april i think it was 1200 or
07:57
in one day so if you took that number of
08:00
300 000 which is probably being generous
08:02
for 10 years of life
08:04
and you do the math compared to the gdp
08:06
loss per day which i heard now is about
08:08
1.8 billion in gdp loss per day on
08:10
lockdown maybe i'm off
08:12
but it looks to be orders of magnitude
08:14
uh
08:15
cost-benefit analysis and i know this is
08:18
kind of a macabre topic but like you
08:20
said we make these decisions every day
08:21
in our policy and
08:22
like you said the speed limits the nhs
08:25
so it's something we have to face
08:27
at some point like you said in an
08:28
extended lockdown and say this
08:30
actually just doesn't make sense and if
08:32
we continue this we'll quite literally
08:34
just bankrupt the nation
08:37
well i think i think you know continuing
08:40
to have blanket
08:41
lockdowns switched on for a few months
08:45
then maybe off for a month or so then
08:46
switch them back on
08:48
um is so costly that my guess is that
08:52
that would not pass any sensible cost
08:54
benefit analysis
08:56
again to stress you know that's not the
08:58
current government strategy
08:59
you know we're told that this is going
09:01
to be a four week lock down hopefully it
09:03
will succeed in bringing the infection
09:04
rates down very rapidly
09:06
take off the table much of the risk of
09:08
hospitals being um overwhelmed
09:11
and that that might well be a sensible
09:13
strategy i think what wouldn't be though
09:15
is if we kept getting back into this
09:17
situation
09:18
you know two months on one month off two
09:22
months on one months off
09:23
i think that would be pretty disastrous

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