Kritiek op het Gupta-rapport weerlegd

nieuwscheckers.nl has it Gupta report: The cuckoo song called COVID 'news checked'. The Gupta report published on May 20, 2020 states that more years of life have been lost than have been gained with the corona approach in healthcare (even 10x as many). Gupta Strategists is an independent consultancy for organizations in the healthcare sector, at home and abroad.

Conclusion of the news check

"Hoewel the suspension of regular hospital care during the COVID crisis has certainly resulted in lost years of life, is de omvang van dat probleem nog moeilijk te kwantificeren. De conclusies van Gupta Strategists zijn gebaseerd op aannames waar veel vraagtekens bij te zetten zijn. Het is daarom onbewezen dat voor elk gezond levensjaar dat COVID-zorg in ziekenhuizen heeft opgeleverd, er tien levensjaren verloren zijn gegaan door het opschorten van reguliere ziekenhuiszorg." Hier de link naar the complete 'news check'

Enith Vlooswijk, Nieuwscheckers.nl and science journalist. In a previous article achtte zij het verband tussen luchtvochtigheid en corona-besmettingsgevaar "onbewezen".

Pepijn van Erp (van kloptdatwel.nl, een van mijn favoriete websites) zegt dat er heel wat op het rapport is af te dingen en verwees naar de nieuwscheckers-link. Dat begrijp ik niet helemaal als de nieuwscheckers in hun conclusie zelfs bevestigen dat "the suspension of regular hospital care during the COVID crisis has certainly resulted in lost years of life".

We zijn het eens: aanpak Corona heeft averechts gewerkt

We zijn het er dus eigenlijk over eens dat de aanpak averechts heeft gewerkt op de volksgezondheid en zelfs als je alleen al naar de verloren levensjaren kijkt. Er wordt dus puur gebekvecht over de exacte aantallen, die niemand heeft gemeten, geforecast, geëvalueerd of zelfs maar geschat. Sterker nog, ook de productie- en kostencijfers waarmee wordt gewerkt zijn kennelijk niet bekend bij veel zorgverleners. Toch is er 'beleid' gemaakt.

Logisch dat van Erp de kritiek mild noemt: ze hebben ook niks substantieels in te brengen, behalve een teneur van "daar schrikken we van, dat lijkt ons dus niet te kloppen maar we weten het niet". Plus wat andere inschattingen waarmee ze tot wat lagere schattingen komen. Dat is inderdaad 'afdingen', geneuzel in de marge op dit moment. We zijn nu nog in het stadium dat we proberen te bepalen of de aanpak doelmatig is of niet. "Flatten the curve" is weliswaar voorbij maar we zitten immers nog steeds in hetzelfde "1,5 meter regime", een vuistregel uit de dertiger jaren die ooit in een boek terecht is gekomen en daaraan kennelijk bewijskracht ontleent.

Kenmerkende kritiekpunten op het Gupta-rapport

Some telling quotes from the report of the news checkers, who also consult healthcare providers and medical professors:

“He thinks that doctors will generally have thought carefully about the choice of whether or not to proceed with a treatment.”

About Matthijs Versteegh, director of theInstitute for Medical Technology Assessment

He may think that and it is therefore nothing more than an assumption. Moreover, even thinking carefully does not always mean that the social interest is taken into account, nor the influence on general public health. For a doctor, the patient's interests come first. Treatments may also have been canceled because patients simply did not report, were not referred or simply did not show up.

“They also assume that this care will not be overtaken in the future. That is quite something.”

Matthijs Versteegh, director of theInstitute for Medical Technology Assessment

Yes, that's definitely something. There will be no further argument. So? You call that sensible criticism?

"The most urgent care has taken place. The number of operations and admissions in oncology has also fallen less rapidly than in other forms of care, according to the IKNL."

Integrated Cancer Center Netherlands (IKNL)

OK, so the slightly less urgent care has been canceled. What numbers are we talking about? Do I have to read that report? And apparently things have been less favorable for non-oncological conditions, where operations and admissions have fallen sharply. (Cardiovascular? Neurological? Gastroentological? That can be calculated, right?)

“To prevent negative health consequences, the backlog will have to be caught up.”

Integrated Cancer Center Netherlands (IKNL)

If urgent cases can be overtaken, we are not talking about urgent cases. Anyone who thinks that you can catch up on urgent care later can still 'think carefully', but then I still fear that poor considerations will be made.

“The assumption that 11,500 euros in hospital care provides an extra healthy year of life does not seem to be well founded on evidence.”

Anne Stiggelbout, professor of Medical Decision Making at Leiden University

Evidence? It's unbelievable that she thinks you have to prove that. The standards are known to anyone who has to make global calculations in a hospital. Doctors may not always have an idea of ​​this, they just have to do what is necessary for a patient. Better ask the health insurers if you don't know. At the Dutch Healthcare Institute they also know it, but they don't bite the hand that feeds them. This also applies to hospital boards. They also know what the budget is like, but you won't hear that. That is actually telling: if they could calculate that it is all effective, why don't they do that?

“This report assumes that missing all that care is a bad thing. I absolutely don't think that is the case.”

Anne Stiggelbout, professor of Medical Decision Making at Leiden University

I still want one of those. It doesn't matter anyway, care or not, what is everyone so worried about...

"Furthermore, Stiggelbout doubts that the three hospitals in the report show representative figures. 'Those percentages are very negative, they result in a hugely negative estimate of the loss of care.'"

Yes, that's right too. But because the numbers are so negative, wouldn't they be correct? Is that a valid argument?

“Het productieverlies zou ook 10 of 15 procent kunnen zijn, we hebben geen idee."

Hans Severens, professor of Evaluation in Healthcare

Ik zou zeggen: lees het Gupta-rapport en ga zelf eens cijferen. Iedereen verschuilt zich achter “we hebben geen idee”. Maar intussen wel de samenleving naar de knoppen helpen. Het grote probleem is dat alles wat door het RIVM in gang is gezet aanvankelijk misschien terecht was; in elk geval niet verwijtbaar gezien de angst en paniek, dat alles blijft nu gehandhaafd onder het motto “we hebben geen idee”. Er zijn ook geen tekenen dat men zich überhaupt een idee heeft proberen te vormen.

“het antwoord berust op aannames die ook een eenvoudige toets der kritiek niet doorstaan.”

Matthijs Versteegh, director of theInstitute for Medical Technology Assessment

Which test then? So far only the apparent misconceptions of the 'critical' interviewees. In the commentary they do not get any further than their own unfounded assumptions. The only common thread: ignorance.

“It is therefore unproven that for every healthy year of life gained by COVID care in hospitals, ten years of life have been lost due to the suspension of regular hospital care.”

NEWSCHECKERS - The fact checkers of Leiden University

I agree with that without any problem, 'proving' is something completely different. But a factor of 2 or 3 higher or lower is not at all unlikely and even quite plausible. On balance, in any case, an extremely loss-making operation. That remains unacceptable, especially because no one has conducted a single interim evaluation.

Doctors are there to go through the motions for a patient, at all costs. Public health policy has other goals. The RIVM has failed seriously in this regard: they are supposed to monitor public health. You have to come from a very good background to justify doubling mortality rates in terms of public health.

So to start whining about that factor 10 based on fiddling with figures... that seems like a fun project for a group of students, but Enith Vlaaswijk, the freelance journalist who wrote the article, got rid of it with a Jantje van Leiden.

So much for healthcare. Then public health.

Please note that this report focuses exclusively on healthcare. Care is only one part of Public Health. Millions of Dutch people are in worse shape: psychologically, socially and financially, determining factors for public health. Add that to it, it goes fast. Example: if 10 million Dutch people live 1 day shorter on average due to all the misery and stress, you will simply lose another 27,000 QALYs. Indeed: that's short-sighted, but it does give you a feeling for the effects.

Furthermore, the future economic situation will also put significant pressure on budgets. Some think that will be the case in the next 5 or 10 years. It seems to me that this will not affect healthcare and that will not help in terms of QALYs. Then I assume that lower healthcare budgets lead to less and/or worse care. If that does not have an additional negative effect on public health, then something is seriously wrong.

So much for healthcare. Then the economy and social unrest.

You can keep busy, but I'll stop. Home situations, learning delays, stagnation of mental and social development, introduction of a control society, the list goes on. Healthcare would have had to have saved quite a few lives, or at least broken even, to somewhat defuse the entire disastrous equation above. That did not happen and that was already clear at the beginning of April.