Health Outcomes - Objective and Subjective

By way of introducing the topic of objective health outcomes, here is a May 2011 report from the Conference Board of Canada presenting current Organization for Economic Cooperation and Development data for three health outcomes based on how much a country spends per head.

From the table you can see, for example, that the US has the highest health expenditures per person, and Japan the least, and also the fact that Japanese life expectancy is the highest and US the lowest. Sweden is best for the other two health outcomes and the US is again number seventeen out of seventeen countries.

The recent subjective outcome that I wish to discuss has been presented with headlines such as this:

Placebo As Good As Asthma Drug, Say Patients

This is incorrect, and the data presented in the New England Journal of Medicine do not support it. Many thanks to Orac at Respectful Insolence for bringing the pertinent data out from behind the NEJM firewall. Patients with mild to moderate asthma who could do without their prescribed inhaled bronchodilator for six hours were either treated with the inhaled bronchodilator albuterol, an inhaled placebo, sham acupuncture, or were not treated. First, the totally expected objective health outcome is presented in the authors' Figure 3.

The large percent increase in the volume of air the patient can force out of their lungs in one second indicates that the albuterol produced the expected objective health outcome and the other treatments or lack of treatment did not.

The authors' Figure 4 report the subjective health outcome of asking the patients in each group to mark a scale for no improvement (zero) to complete resolution (ten) of their wheezing and coughing.

Even the untreated group reported improvement of wheezing and coughing, and the improvement of these symptoms was statistically the same for the albuterol, placebo and sham acupuncture groups. Did the patients' asthma improve in the placebo, sham acupuncture and untreated groups? No it did not! The reported subjective symptoms of wheezing and coughing improved. Asthma by definition is a disease which narrows the airways in the lungs, and only the albuterol objectively improved this symptom, allowing more air to flow.