Applied Genius. Maximum Utility.

Analysis of Texas Cervical Cancer Vaccine Decision

Texas Governor Rick Perry has ordered that all Texas 6th-grade girls receive the Gardasil vaccine to prevent HPV (and, by extension, reduce the chance of cervical cancer.)  This is controversial for a number of reasons.  But since this is Applied Genius and not Fulminating Bloviator, I thought I'd provide a few facts and a little bit of basic math: 

(1) According to Wikipedia (citing the WHO), "Worldwide, cervical cancer is the fifth most frequent cancer in women, when ordered by number of deaths. Cervical cancer affects about 16 per 100,000 women per year and causes death in about 9 per 100,000 per year. "  Last year, 1,169 new cases were reported and almost 400 Texas women died from it. (Dallas Morning News).  If 1 in 6,250 women get cervical cancer EVERY YEAR, it's obviously not mathematically correct that only 1 in 20,923 (the 2002 SEER estimate) will get it EVER.  SEER estimates for the Hispanic population in the USA range from 14.6-17.1 per 100K women, consistent with the 16 WHO estimate.   If 9 per 100K (about 1 in 11K) die per year and 400 died last year in Texas, that would imply that Texas has roughly 4.4 million women; the 2000 Census shows about 10.5 million women, which would seem to indicate that either (a) there are unreported cervical cancer deaths in Texas, (b) that Texas women are unusually resistant to it, or (c) that the definition of "women" that the WHO is using is more restrictive than the Census' version, probably limited by age.

(2) The vaccine costs $360 retail; hopefully the state will get a volume discount.

(3) The vaccine apparently prevents 70% of the cervical cancer cases.

(4) There are approximately 170,000 6th-grade girls in Texas; the vaccine for them would cost approximately $60 million (New York Times.)

Let's look at the math on a year-by-year basis.  Texas spends $60 million to save 280 lives (70% of 400) and save money for cancer treatment for 538 patients (70% of the 769 new cases who didn't die.)  I don't know how much cervical cancer treatment costs (and hope never to find out) but let's assume it's $50,000 on a present-value basis.   If the $50K figure is right, that's $40.9 million in medical savings alone.  That means that the lives were saved at a cost of only $68,214 each.  Given that wrongful death settlements are approximately $2 million each, the benefit/cost ratio seems to be about 30:1.   If the cancer treatment costs $75K rather than $50K, the lives saved are FREE.

How about this deal: rather than doing the vaccine now, we can simply wait until 280 girls (who are in sixth grade this year but will grow up to be women, of course) eventually die of cervical cancer.  Then the state of Texas can pay their families $68,000 each, for having failed to prevent the cancer when we could.  (Everyone who opposes the vaccine can chip in.)  Do you think the families would be happier to have lost their child but gained $68K because they avoided the vaccination?

This vaccine is a no-brainer.  Sure, Texas should get a big discount for buying a lot of it, and $60 million sounds like a lot, and it looks shady that Merck will get a lot of money after donating to the Governor's campaign -- but the savings are 30x the cost, even at retail prices.

P.S.  It's tempting to say "Since 280 women die each year, and 1,169 get cervical cancer, each day that we delay vaccinations costs us about 4 cases, including nearly 1 death."  Although I admire the attempt at quantification, this is fuzzy thinking at its worst.   Even if the deaths and incidence of cancer are indeed randomly distributed thoughout the year, earlier vaccination doesn't prevent the early deaths -- it only prevents the INITIAL INFECTION, and I haven't seen any info on when that happens.    In particular, I would guess that the number of 6th-grade girls in Texas who contract HPV between now and when school starts, who THEN go on to have cervical cancer, is either none or 1., with a high likelihood of "none."  After all, only 1 in 21,000 women gets cervical cancer over the course of her lifetime, which contains about 80x the time delay we're talking about (6 months). 

Protecting Yourself from Myths and Misconceptions

A little learning is a dangerous thing;  Drink deep, or taste not the Pierian spring: There shallow draughts intoxicate the brain, And drinking largely sobers us again.
Alexander Pope:	Essay on Criticism. Part ii. Line 15.

Or, if you prefer the vernacular,

It ain't what a man knows that gets him in trouble, it's what he thinks he knows, but just ain't so.   (Will Rogers)

Here are some links to a few excellent lists of common fallacies -- things everyone "thinks he knows" that "just ain't so".  Being ambivalent on these topics is OK -- but the deadly one-two punch of (1) thinking you're an expert, and (2) acting woth conviction on your false expertise, can definitely get you into trouble!

1. Gas Saving Myths
2. Tornado Safety Myths
3. Myths about Health (emphasizing women's health)
4. Science Myths in K-6 Textbooks and Popular Culture (see also the Packard Foundation Report)
5. Stock Market Myths (lots of competing lists; this is a reasonably thought-out one.)

I'll add more as the week goes on.

How to Sleep

According to legend, an early version of the Boy Scout Handbook started with the topic "How to Get Out of Bed."  (Early Scouts weren't that stupid -- the chapter showed stretching exercises.) 

In that spirit, I would like to dedicate the first Applied Genius topic to sleep -- and in particular, to Dr. James Maas of Cornell University and his masterpiece Power Sleep.  This book, and the method for curing sleep deprivation described therein, changed my life.  I had stumbled through graduate school at least 1 hour short of sleep, per day, for years.  When I forced myself to adopt the Maas method described below,  I got noticeably smarter (and happier).  I lost weight.  I was significantly more effective at work.  And my wife claims that there were other, ahem, improvements.

Sleep is vital to our health.  Most of us are chronically short on sleep.   Being sleep-deprived makes you cranky, stupid, and a dangerous driver.  When you're short on sleep, there's only one way to fix the problem:  go to bed earlier. (Sleeping late doesn't work, even though you think it does.)  Here's how.

1. Set your alarm clock for the time you'd like to awaken (e.g., 7:00 am.)  The first day, go to bed at your normal hour.  You will notice that the alarm clock will wake you up.  "Duh!", we hear you say.  But needing an alarm clock is a telltale symptom that you are sleep-deprived.
   
   
2. Go to bed 15 minutes earlier each day until you wake up naturally a little before the alarm clock rings.
   
   
3. When you no longer need the alarm clock to wake up at the right time, you are getting enough sleep -- possibly for the first time in a very long time.   (You might want to keep the alarm clock set anyhow, just to make sure.)
   
4. A 20-minute power nap in the middle of the day works wonders -- but don't sleep longer than that, no matter how tired you are.  Instead, wait an hour or two and have another short nap if you're still groggy.

Dr. Maas, I thank you profoundly for your work in Power Sleep.  I hope that Applied Genius readers purchase many, many copies.