Monday, September 11, 2017

Medical Statistics II: Figures Don't Lie, But Liars Figure

So, as I noted in yesterday's tease, medicine moved two centuries ago from a secretive witch doctor model of care, to a statistics-driven evidentiary model of care.

And then there's the press/media: You can count the number of reporters with a "B" grade or better in any class beyond high school geometry on the thumbs of one eye.

Anytime a reporter sees more than ten numbers that aren't a bar waitress' phone number all arrayed in the same zip code, they generally don't know whether to shit or go blind, so they usually shift to their default setting, get drunk and make shit up.

Blogging is only a fraction better, but with the occasional insightful brilliance.
Comments generally demonstrate that the IQ bell curve I showed you a couple of days ago goes all the way to both tails.

This is why reporting on anything statistical is generally akin to watching monkeys attempt anal rape on a football.

Enter the current horseshit meme about opioid overdoses, etc.

Exemplar du jour here.

(You would think a mainly financial market website like Zero Hedge would have a clue with statistics, but if this is typical of market commentary, let the fisking of this article, and associated "commentary" stand as the clearest explanation why the stock market is a Ponzi scheme for stupid people.)
The California Department of Public Health just dropped some staggering statistics about the level of opioid abuse in America's progressive paradise of the left coast.  As the Sacramento Bee points out, there are a remarkable number of counties in California where annual prescriptions for pain killers actually exceed the population.
Trinity County is the state’s fourth-smallest, and ended last year with an estimated population of 13,628 people.
Its residents also filled prescriptions for oxycodone, hydrocodone and other opioids 18,439 times, the highest per capita rate in California.
Besides Trinity, other counties with more prescriptions than people include Lake, Shasta, Tuolumne and Del Norte counties. In the Sacramento region, El Dorado, Placer and Sacramento counties had prescription rates above the statewide average, with Yolo County slightly below the state average.
A county’s prescription total represents all opioids dispensed via prescriptions filled at a pharmacy and tracked by the state. Statewide, 15 percent of Californians were prescribed opioids in 2016, ranging from 7.3 percent of residents in tiny Alpine County to almost 27 percent in Lake County.
As might be expected, the scripts per capita are highest in California's more rural northern counties.
Waitagoddamminute here, Tyler, you ignorant fuck.
Point of Order: Those aren't statistics on "opioid abuse", you fact-free moron, those are reports on the rate of opiate Rx prescriptions (scrips) per 1000 people. Calling someone acquiring drugs by going to a doctor, getting a scrip, and taking it to a pharmacy an "opiate abuser" is like calling someone filling out a 4473, waiting 10 days (hereabouts), and picking up an AR-15 clone and grabbing an ammo can of M855 on his way to the register a "mass-murderer".
So fuck right the hell off with that casual horseshit and retarded-sloppy level of misequation, asshole.

Secondly, the places where one "might expect" the rate of drug abuse to be the highest are in the most populous regions: Los Angeles, San Francisco (and Bay Area), Orange, San Diego, San Bernardino and Riverside counties. Which, as the map makes plain, is exactly and precisely where that's NOT happening.

If you expected different, you're a clueless jackass. Here's the map in question:
A few observations:
1) the highest incidence counties above are, with 1:1 correspondence, those counties known statewide as Potville (not Jefferson), because that's where the bulk of it is grown, going back only as far as the 1960s, and forward to forever.
So what you've established is an undeniable link between pot use and progression to opioid use.
2) In the high-pop. counties, where opioid scrips are lowest, the doctor:patient ratio is recockulous. Doctors get tons of patients, little time to spend with each one, and just getting in to see a practitioner takes weeks for many specialities, and just finding a GP/family practice doc who's even taking new patients can take months.
In those more rural, it's nothing like as bad. So, shocker, people actually seeing a doctor results in more prescriptions. Stop the presses!
Pray, continue with the statistical misdiagnosis.
So who is participating most in this deadly epidemic?  Well, according the Centers for Disease Control and Prevention, the biggest abusers of opioids are high-school educated, unemployed, white people living in small towns...
“The following characteristics were associated with higher amounts of opioids prescribed: a larger percentage of non-Hispanic whites; higher rates of uninsured and Medicaid enrollment; lower educational attainment; higher rates of unemployment; (small-town) status; more dentists and physicians per capita; a higher prevalence of diagnosed diabetes, arthritis, and disability; and higher suicide rates,” concluded the authors of a Centers for Disease Control and Prevention study released in July.
“What you’re seeing in California is what you’re seeing in many parts of the country, including Oregon,” Korthuis said. “There are still a lot of rural counties around the U.S. that are awash in prescription opioids.”
...oh, and grandma and grandpa are getting high on the reg as well.
In California, residents aged 15 to 29 got 1.7 million prescriptions in 2016, representing 7.2 percent of the state total. That’s down from the 1.9 million prescriptions in 2015, which represented about 7.8 percent of the state total. The age range that featured the largest prescription rate increase were 70- to74-year-olds, whose prescriptions grew from almost 1,354 per 1,000 people in 2015 to 1,394 per 1,000 people in 2016.
So, we've established that white people with a high-school education are more likely to go see a doctor than Hispanics with a grade-school dropout education, or a CA public school GED (which latter two are functionally the same thing.)
And that people with less education don't have jobs with insurance. WHO KNEW?!?
And that people with less education can't get jobs in the big cities. WHO KNEW?!?
And that people working in harder, lower-paying jobs, with less insurance have more diagnosed cases of chronic debilitating illnesses. WHO KNEW?!?
I'm still waiting for the shocker. And waiting. And waiting.
We'll get back to a few other things in a bit.
For now, back to the bullshit farm.
There's your shocker, Fucktard.
The people you "might expect" to be abusing opioids are the 10-30 year olds.
But instead they're the lowest incidence of those prescriptions.
Scrips for meds don't even hit the >gasp< 1:1 ratio until the 55-and-older free Denny's Senior Citizen card crowd. WHO KNEW?!?
But no, reality doesn't break out that way.
1) The young have access to harder drugs.
2) They are young and healthy, and have even less insurance than the middle-aged and elderly.
3) They are YOUNG AND HEALTHY, and thus need less access to insurance, let alone opioid pain relievers, than the middle-aged and elderly.
4) Pain scrips are going to those who're nearly or fully SENIOR CITIZENS. WHO KNEW?!?
Once again, back to the bullshit farm:
Of course, growth in opioid addiction is hardly just a California phenomenon.  According to the CDC's Annual Surveillance Report of Drug-Related Risks and Outcomes, addiction-related deaths are far more prevalent in the rural 'rust-belt' states of the Midwest.
Waitwaitwaitwaitwait!!! You just got through lie-splaining that CA had a full-blown opioid-fueled Woodstock-on-the-coast-party level of epidemic prescription opioid abuse.
Yet the death rate there from opioids there is the second-lowest tier in the nation (of six), and less than a quarter the rate of the worst states.
Apples, meet oranges.
So what you've ACTUALLY demonstrated is that the death rate has Jack and Shit to do with opioid prescriptions, (and Jack left town) because those aren't killing people like flies in rural CA counties, like you just tried to correlate and causate in one fell swoop of statistical asstardery last seen with selling us Obozocare.
Well-played, Fucktards. You must have a degree in Mathemagics, undoubtedly from the Alchemy Department of Whatsamatta U. Usually you need a board-certified Anthropogenic GloBull Warming VooDoo Magician to find this level of horseshit masquerading as science, but clearly, it's a shared specialty, with a lot of media crossover.
Once again, back into the fields of the Bullshit farm:

Meanwhile, the epidemic is growing far more severe every year with overdose deaths up 167% across the country since 1999.
The rate of drug overdose deaths increased from 6.1 per 100,000 population in 1999 to 16.3 in 2015; for unintenttional drug overdose deaths, the rate increased from 4.0 per 100,000 in 1999 to 13.8 in 2015; for drug overdose deaths involving any opioid, the rate increased from 2.9 per 100,000 in 1999 to 10.4 in 2015

But don't worry too much because, as Princeton Economist Alan Krueger told us yesterday, there is a simple solution to the opioid epidemic in the U.S...apparently it can all be solved with just a little more Obamacare.

So, leaving the world capitol of bullshit farming behind us, let's decamp to Reality.

Now, for a few other facts the story "forgot" to consider.
The people in most of the counties in the map, the ones getting the opioid prescriptions?
They work in agriculture, ranching, timber harvesting, etc.
And, lest we forget, they're mainly 55-85+.

They work at hard, physical jobs, at hugely higher rates than pussified city dwellers in the low-incidence counties. So they have a history of OTJ injuries, falls, crashes, accidents, broken bones, plates, screws, rods, and pins in them as a result, knee replacements, hip replacements, spinal fusions, atherosclerosis, high blood pressure, diabetes, heart attacks, strokes, and oh yeah, 57 KINDS OF FUCKING CANCER at rates that would make 10-year olds and 20-somethings shit their pants and kill themselves at age 30. And which does tend to lead to depression and suicide at a steadily progressing rate, once intractable chronic daily pain, inability to work, disability, being house-, wheelchair-, and bed-bound, incontinent, unproductive, poor, neglected, and just a wee bit unsatisfied with their resultant (lack of) quality of life sets in, physically and mentally.

Exactly like someone with a higher IQ than the reportards at the Sacto Bee, or blogtards like Tyler Durden at Zero Hedge (and clearly, that's a damned low bar) "might expect".

If anything, the "explosion" of opioid scrips isn't due to granny and grandpa getting high, it's simply the Law of Unintended Consequences kicking the ass of twenty- and thirty-somethings who couldn't pass a grade school long division quiz from 1960.

Because the DEA, the CDC, and idiots in state government here have been cracking down on prescriptions for pain killers. Precisely because of young doper drug-seeking assholes who aren't getting them anymore, as the bar graph above documents. How does that work? Thanks for asking.

Doc Friendly in BFCalifornia used to write Old Man Johnson, busted up ten different ways from 50 years of working with farm equipment, dumbass cattle, or ornery stands of timber, a scrip for 90 days' worth of Vicodin/Norco, so he'd get four scrips a year. If the Doc does that now, the DEA crawls up his ass, and threatens to revoke his federal license to dispense.

Medicine has two names for Doc Friendly, and every other doctor, who can no longer write prescriptions (that would be "deliver proper standard of medical care") to his patients:
If he's well-off enough, and tired of that BS, the AMA and state Medical Board call him a "retiree".
If he's young, and still trying to pay off his hundreds of thousands of dollars of medical education debt, they call him a "barrista".
With or without a shot of whipped cream.

So if he wants to stay a working doctor, instead of writing an Rx for a ninety-day supply of meds for chronic pain, he makes Old Man Johnson come in 12 to 52 times a year, and gives him a scrip for a month (frowned on) or even just a week. So now he generates 52 scrips a year for what used to be 4. Johnson now has more prescriptions, by himself, than 52 other people who never need a single one. And if he's really, really fortunate, he won't have to decide between feeling unspeakable agony as his bones grate on themselves every day, or feeding himself and his sick wife this month.

Then he just has to cope with being unable to even be a greeter at Walmart, chronic opiate constipation problems, and the other 83 burgeoning problems of getting older. Unlike the Mr. Yuppie Golfhandicap who worked in a cubicle for the insurance company for 40 years, never got anything worse than a paper cut, and is sitting on a fairway condo and playing golf on his kids' and grandkids' back until he finally strokes out at 92, totally ignored by his immediate family nine states away, but paid for in full by Social Security and Medicare that'll be there until just before his kids get there to collect any. And by god, unlike Johnson, who can barely drag himself to pick up his doctor appointment scrips, Mr. Yuppie Golfhandicap votes, and damned if he's going to sit still for cutting his Ponzi Scheme payouts. AARP would shit, and he's no dummy.

Time alone precludes discussing the problems when the body becomes habituated to the first opiate prescribed (like you will), requiring a succession of them or multiple ones, and the conga-line of additional scrips that generates, especially for someone with one case of incurable and progressive cancer, which could be hundreds of pain med scrips (dependent solely on the life expectancy of the victim, and the speed of the disease.) That's not abuse, Fucktards, that's called Standard Of U.S. Medical Care. If you're too stupid to know this, nor ask someone with, oh, fifteen seconds of medical experience before you bloviate on the topic in either a professional or amateur pundit status, maybe write that little tidbit on your hands with a laundry pen. And FFS, stay the fuck off the Internet until you do.

The article, the post, and comments to this post, like others, show a blisteringly stupid lack of acquaintance with those basic facts of life. Nor any idea that for nearly a decade, CA has had the CARES system, which means every Schedule Narcotic scrip written to you going back to its inception is tracked, recorded, and available to every medical practitioner in the state in about five mouse-clicks. Doctor-shopping and ER-hopping are over, and have been for the decade prior to this CDC report. Which is WHY the scrips are now 1400:1000 in counties with vastly higher numbers of lesser-educated, hard-working overall-collared job-working white disabled and retirees. They couldn't afford to live in the cities, didn't have the education for the jobs there, and mainly the older, disabled, or retirees live in the hinterlands hereabouts because there aren't many jobs for ANYBODY there, and the ones there are mainly involve heavy animals, heavy equipment, and heavy trees. (Sometime when you're bored, go read any EMT standard textbook , and ponder why there's usually an entire chapter devoted solely and entirely to "Farm Injuries".) Those people worked their asses literally, to the bone, to get their kids a chance to go to college and have a better life, or at least one far less hard. Like everyone back to Cavemen Thag and Og.

And the one benefit to being where they are is that they have dramatically lesser hordes of entitled illegals to wade through at their doctor's office, and so they can actually get in to see Doc Friendly in much less time than it takes to renew your license at the Santa Ana or East L.A. office of the CA DMV.

So since it's not (precisely as the original story demonstrated, had anyone who wrote it or mis-blogged it the wit to note) Grandpa and Granny driving up opioid overdose deaths lately, what is?

Tune in for Part III, tomorrow.

Part I
Part III



Anonymous said...

First thing I thought of when I saw the part about places with more prescriptions than people was that I currently take four prescription drugs (not opiods, two blood pressure and two asthma), I typically get 90 day supplies (because it's cheaper, and I CAN, because no one gets stoned on Amlodipine), so I get 16 prescriptions per year (including refills). I also know opiods generally don't allow refills, and they also don't allow long-term scrips as you noted, so it's not surprising to me that one person could have 12 to 52 (or more) such prescriptions per year.

As they say, there are three types of lies. There are lies, damn lies, and statistics.

Mark D

kirk said...

many physicians are reticent to write opioid prescriptions today for fear of being labeled 'drug dealers' by the legions of bureaucrats watching their every move. such a label will lead to a physician's license being removed, or the physician being placed on a 'watch' list and unable to write ANY opioid prescriptions at all.

these bureaucrats who have never, ever worked hard at anything, save pushing people and paper around, cannot and will not ever understand that after years of real work, bodies break down, produce pain and need relief. today, the 'reward' of a life spent taking care of oneself and one's family is to suffer - needlessly - so that doctors will not be called to the carpet by bureaucrats.

is pain to be endured so the watchers, arrogant and ignorant to the core, will not dig their spurs into some physicians neck and ruin him in the process? that shit sucks and sucks big.

finally, what did bureaucracies ever make better, or save?

Anonymous said...

I can guess what's driving up opioid deaths? At least in a few cases?

Because the government has prevented doctors prescribing what they think is best, people have turned to the black market for their painkillers. Because they're doing that and afraid to tell their doctors, they take too much in an attempt to cut the pain, and stop breathing?

It's a guess. I'm allergic to opiods, which is going to be a problem down the road when the big "C" eventually comes for me. Then again, maybe not, since doctors probably wouldn't be able to take care of me properly anymore anyhow in terms of pain management. It's no wonder more states are becoming "right to die"... who wants to live with excruciating cancerous pain with nobody to help them manage it anymore? Way to make medical costs cheaper, yes indeedy.

Anonymous said...

Thank you for writing this. It it so hard to even discuss chronic pain and how difficult it is to try and have sort of quality of life. You hit the nail on the head about hard work and its outcome. Also are the folks with orthopedic issues. Both of these pools of people are cheerfully lumped into the statistics and used to suppress the availability of medication. My spouse has had 20 major surgeries in the past 10 years, whose medication allows her a somewhat reasonable quality of life, without which, I am sure she would "self exit"....

Badger said...

The credibility of anyone who cites the CDC as a source (other than as an example of the growth industry in the "More Shit We Made Up" discipline) is flushed down the toilet. Full stop.

Anonymous said...

Chronic pain patient for over 23 years. Spinal cord injury w/ severe spine pain and intractable neuropathic pain from the nerve damage from the sci (medically inflicted btw). Been on tramadol for probably 15+ years now. Because someone somewhere might be getting high on tramadol, how I don't know- I take max dose every day for over a decade and never felt anything of the sort, DEA decides it is now a schedule IV which means that instead of 6 month scripts now I have to call every month for a new one which sounds simple but it's not. My doc is 90 minutes away (rural area) and it's a constant struggle to get a damn script called in on time. Furthermore, now since it's monthly I can't get a 3 or 6 month discount and my out of pocket has went up several hundred bucks a year when I'm already living in poverty. Living with a crippling disability is hard. Living with that crippling disability while in constant unrelenting nearly untreatable pain is harder. Having the government make life harder yet is infuriating. Every single one of these gung ho jackbooted drug warriors and politicians needs to spend at least 5 years in chronic unrelenting pain before they're allowed to make any decisions whatsoever concerning the subject. These unspeakable bastards who make the innocent suffer because some fucking junkie somewhere might be getting high deserve a special place in hell.

Aesop said...

Thanks for sharing. That's why I wrote what I wrote.
From the handicap of only dealing with the situation for a living every day for decades.
Pressholes and people who author or blog utter horseshit are only slightly less horrible than the .gov jackholes who create the problems those ignorantii paper over.

Anonymous said...

Smokejumpers used to carry morphine but they aren't allowed to any more because...