Page 2 of 2 FirstFirst 12
Results 21 to 31 of 31
  1. #21  
    Quote Originally Posted by davidra View Post
    Your "experience" with mammograms is anecdotal. It's never a good idea to determine policy based on anecdotes. That's why EVIDENCE is important. Believe me, my experience with mammograms is very recent as well, as were the references I posted. I was just pointing out that mammograms have been suspect for a long long time by people that understand screening and diagnostic testing issues. The recommendations by AHRQ did not deny anyone screening. They simply pointed out the facts, and suggested that physicians discuss these with their patients and then make a joint decision. If someone has a first-order relative, their pretest likelihood goes up and it might be more reasonable to screen those women. That's what clinical judgment is about. Your comments suggest that there was some limitation put on whether or not women could get mammograms. And you feel free to rely on anyone's guidelines you want, whether they make sense or not. The American College of Ob-GYN recommends getting pap smears much more frequently than AHRQ. Not that I would suggest there is bias involved as their specialists get paid for doing pap smears, but it is an interesting observation. The ACS in general has always been more aggressive in their recommendations. That doesn't mean they are any better than AHRQ/Preventive Services Task Force recommendation. I'll stick to my guns, too, when I say you don't really provide any evidence that what you are saying is correct.

    Oh...and with regard to the one case you seem to know something about, your mother-in-law was not diagnosed by screening mammography, and you have no idea if she would have been either. You also have no idea if her outcome would have been any different if she hadn't done self exam. But you're not interested in thinking about alternatives, are you?
    So you start a thread *****ing about insurance companies and then cheerlead the .gov empowering them not to cover a certain age group of women. priceless.

    Apparently you missed the part where they recommended that self exams NOT be taught, to reduce false positives. again this was about cutting costs nothing more.

    Since the CANCER that was found was Mal. I'm sure the outcome would have been different if left alone to spread.

    Welcome to the new improved health care where accountants crunching #'s decide which side of the stat's you'll reside on.
  2.    #22  
    Quote Originally Posted by cjgem View Post
    So you start a thread *****ing about insurance companies and then cheerlead the .gov empowering them not to cover a certain age group of women. priceless.

    Apparently you missed the part where they recommended that self exams NOT be taught, to reduce false positives. again this was about cutting costs nothing more.

    Since the CANCER that was found was Mal. I'm sure the outcome would have been different if left alone to spread.

    Welcome to the new improved health care where accountants crunching #'s decide which side of the stat's you'll reside on.
    Not surprisingly, you miss the point. Just because her cancer was malignant doesn't mean it wouldn't have been detected by her other than during SBE, or during a physical exam. You just don't get it. Most breast cancers have been present for 8 or ten years by the time they are diagnosed, whether by mammograms, SBE or by physical exam. That's why screening only marginally improves survival. But don't let facts intefere with your reality.

    You keep saying it's about cutting costs and nothing more, and you are 100% wrong. It's about protecting women from inappropriate and dangerous testing. Please answer my question: when do you want to start mammography? Pre-teen? Twenty?

    Nobody was empowered to not cover anyone. These were recommendations. Would you like to look up the definition of recommendations so you don't confuse it with your own confused perspective?

    And none of the people involved in these recommendations are accountants. That might make a great talking point, but like everything else you have stated, it's not based in fact.
  3. groovy's Avatar
    Posts
    941 Posts
    Global Posts
    955 Global Posts
    #23  
    Can we all agree that each of us has at least an average adult level of knowledge and comprehension? Or can we at least agree that pointing out each other's level of comprehension does little to further this debate?

    Let's try to keep it civil.
    Last edited by groovy; 04/23/2010 at 11:58 AM.
  4. #24  
    Quote Originally Posted by groovy View Post
    Can we all agree that each of us has at least an average adult level of knowledge and comprehension? Or can we at least agree that pointing out each other's level of comprehension does little to further this debate?

    Let's try to keep it civil.
    Sorry
  5. #25  
    Quote Originally Posted by davidra View Post
    Not surprisingly, you miss the point. Just because her cancer was malignant doesn't mean it wouldn't have been detected by her other than during SBE, or during a physical exam. You just don't get it. Most breast cancers have been present for 8 or ten years by the time they are diagnosed, whether by mammograms, SBE or by physical exam. That's why screening only marginally improves survival. But don't let facts intefere with your reality.

    You keep saying it's about cutting costs and nothing more, and you are 100% wrong. It's about protecting women from inappropriate and dangerous testing. Please answer my question: when do you want to start mammography? Pre-teen? Twenty?

    Nobody was empowered to not cover anyone. These were recommendations. Would you like to look up the definition of recommendations so you don't confuse it with your own confused perspective?

    And none of the people involved in these recommendations are accountants. That might make a great talking point, but like everything else you have stated, it's not based in fact.

    As I stated in 2 other posts the current system and recommendations from ACS and ACR work just fine.

    I can only assume your trying to feel me out with your pre-teen, twenty question. You and I both know that Mammography would be the absolute last choice for suspected breast cancer in so young of a patient.
  6.    #26  
    Quote Originally Posted by cjgem View Post
    As I stated in 2 other posts the current system and recommendations from ACS and ACR work just fine.

    I can only assume your trying to feel me out with your pre-teen, twenty question. You and I both know that Mammography would be the absolute last choice for suspected breast cancer in so young of a patient.

    Sorry. Incorrect. We are talking about screening. Screening takes place in totally asymptomatic persons. If breast cancer is suspected, the test is no longer a screening test, but a diagnostic test. That has totally different ramifications. Since you seem to be so familiar with these issues, then by all means, tell me at what age you would start screening, and on what basis you will make those recommendations? Twenty? We have 20 year old women who get breast cancer. Should we screen all 20 year old women?

    I realize I'm arrogant about this topic...but I don't have an "average adult level of comprehension" about this topic. I am an expert, and I have been working on these issues and teaching about them for many many years, totally independently of the government. And your throwaway lines are misleading, based on nothing other than your own opinion, and are just plain wrong. If I get banned for pointing that out, and being "uncivil", so be it. I'm not trying to "feel you out". I'm trying to get you to understand that you are over your head in this discussion, and that claiming that expert specialized independent physicians that spend hundreds of hours of their own time developing evidence-based guidelines deserve more respect than to be called bean-counters and accountants by people that don't even have a basic understanding of what clinical guidelines are. That would represent some civility, even if I don't.
  7. #27  
    Quote Originally Posted by davidra View Post
    Sorry. Incorrect. We are talking about screening. Screening takes place in totally asymptomatic persons. If breast cancer is suspected, the test is no longer a screening test, but a diagnostic test. That has totally different ramifications. Since you seem to be so familiar with these issues, then by all means, tell me at what age you would start screening, and on what basis you will make those recommendations? Twenty? We have 20 year old women who get breast cancer. Should we screen all 20 year old women?

    I realize I'm arrogant about this topic...but I don't have an "average adult level of comprehension" about this topic. I am an expert, and I have been working on these issues and teaching about them for many many years, totally independently of the government. And your throwaway lines are misleading, based on nothing other than your own opinion, and are just plain wrong. If I get banned for pointing that out, and being "uncivil", so be it. I'm not trying to "feel you out". I'm trying to get you to understand that you are over your head in this discussion, and that claiming that expert specialized independent physicians that spend hundreds of hours of their own time developing evidence-based guidelines deserve more respect than to be called bean-counters and accountants by people that don't even have a basic understanding of what clinical guidelines are. That would represent some civility, even if I don't.
    Again, Yes ACR and ACS both have recommended screening schedules for asymptomatic patients. As for patients that young, If they have family history there are other tests and procedures that would be far more beneficial than screening Mamms.

    Does your expert opinion agree with the panel that Self examinations not be taught?
  8. #28  
    Quote Originally Posted by spopyu View Post
    no, the government advised to start screenings later. it has nothing to do with money. it was due to a study which reported that the amount of radiation one receives when taking those tests is worse than the benefits of earlier screenings.

    get your facts together before you make claims like that. that means change the channel from the bs they're feeding you on fox news
    \

    While I agree my original question was not worded correctly, it was indeed about reducing costs of false positives.

    So what is the AGD of 50/50 4.5 cm compressed breast?
    Last edited by cjgem; 04/23/2010 at 05:33 PM.
  9. #29  
    Quote Originally Posted by cjgem View Post
    \

    While I agree my original question was not worded correctly, it was indeed about reducing costs of false positives.
    As verified where (outside of a partisan Op/Ed or blog post)?
  10. Habious's Avatar
    Posts
    245 Posts
    Global Posts
    887 Global Posts
    #30  
    So, what's the solution?

    Talking about the situation brought up in the OP...we're obviously only getting one side of the story.

    Yes, the insurance company audits a file for fraud when a claim comes in that's going to cost them a lot of money. Now, the insurance company is not/will not discuss the specifics of each case...so we don't know what rationalization they used to cancel these policies. We have the other side's story...the women saying "I've done nothing wrong, ever, and never missed a policy payment." Of course, they're NOT going to say "Well, 2 years ago I filed a ton of false claims for prescription medicine reimbursement." Just like everyone in prison is "innocent"...just ask them.

    I'm not saying the insurance company isn't wrong...I'm not saying the women in the story are lying...I'm just saying that we don't have all of the information to draw a conclusion.

    But...wait...we're talking about literally life-saving treatment that's being denied!!

    So, what's the solution?...if we transition to a single-payer system, do people who get caught scamming the system STILL get to be covered by the system? With a single-payer system, is there NO WAY to ever be declined? "Yes, yes, I know my last 7 claims were found to be fraudulent...but you don't understand...I needed the money, and this time I really AM sick!"
  11.    #31  
    Quote Originally Posted by Habious View Post

    So, what's the solution?...if we transition to a single-payer system, do people who get caught scamming the system STILL get to be covered by the system? With a single-payer system, is there NO WAY to ever be declined? "Yes, yes, I know my last 7 claims were found to be fraudulent...but you don't understand...I needed the money, and this time I really AM sick!"
    From the standpoint of the patient, it's pretty hard to "scam" the system when your care is provided. Not so from the doctor standpoint, however. That doesn't mean everything is provided; there should be evidence-based guidelines that determine that, for instance, doing routine colonoscopies in 30 year olds is not a productive expenditure of money, and won't be reimbursed. So yes, there should be guidelines for what procedures will be provided, but not who gets them if appropriate. Everyone eligible for a screening mammogram at age 55 should be able to have one.
Page 2 of 2 FirstFirst 12

Posting Permissions