QALYtative calculations

A strange piece today from the once-beloved P Toynbee. First she notices that the corona crisis has provided further material for political rivalries and distancing:

Unity has not lasted long – and the rebellion is breaking out from the right.... in what begins to be a[nother] profound culture war – your money or your life....a libertarian crescendo, despite polls showing the country massively in favour of life-saving isolation, with the Queen catching the national mood...How odd that it’s the usually “patriotic” voices, the “blitz spirit” nostalgists on the right who are first to break that solidarity.

Strange that unity and what the polls favour is suddenly so crucial. Yet there is some sense halfway through:

 Yet it’s hard to follow “the science” when epidemiologists fall out

And a sense of calculation rather than simple virtue-signalling:

Poverty kills, infant deaths are rising for the first time in decades, and poorer women are dying younger – though that never worries the right. This economic shutdown will kill and harm: the Institute for Fiscal Studies and the Resolution Foundation show that the youngest, lowest paid and women will be most damaged... curable cancers will become inoperable as treatments stop.

 It is too easy to predict where that ends:

 the admirable National Institute for Health and Care Excellence (Nice) [calculated that]: in treatment costs, one quality-adjusted life year (a qaly) is worth £30,000. ..Will Nice ever evaluate in qalys whether the losses from a stricken economy were worth the gains in life years saved in the lockdown...Dementia is rightly included as an adverse frailty in the score card.

And what are we to make of this callousness:

Casting off the lives of the old to save young futures looks brutal – but for the poorest old, lack of social care and day centres already curtails lives.

She still has it in for us -- serves us right for voting to Leave so selfishly? 

£30k!. Health bureaucrats evaluating your quality of life like a Trump nightmare! Anyone who can show they are worth more than £30k a year gets a free pass? Knowing the system -- eg by reading this article -- must help a lot, but you will need a calming draft to get through the bit about disabled people and their annoying insistence that their lives are valuable too

There may be local variants too. It is an npb lobbyist's dream, probably even better than 'first come first served'. It's objective! It certainly seems more advantageous (or 'fairer' if you are a new petty bourgeois) than just relying on age alone (see below)


Elsewhere, Graun 'balance' appears:

[D Macaskill, chief executive of Scottish Care thinks] some of the guidance already beginning to appear around the country is misplaced, immoral and illegal.”...patient age, “where clinically relevant”, could be a factor in predicting survival in decisions about extending or withholding more intensive treatment, including access to ventilators to support breathing....The extent of any underlying chronic health conditions, as well as frailty “should have greater significance...