Fixing Healthcare

[Technologic 2]

Originally Posted by zelgo

The recent recommendation by the expert, non-governmental panel (all seated originally Bush, by the way) took that balance into account.

And that makes it better?

More procedures don't automatically make people healthier--the essence of America's healthcare problem.

But less screenings positively misses some cancers.

Originally Posted by davidra

Ahhh. Research methodology. I'll give it a try. For something to be "statistically significant" it's effectiveness has to be statistically different from the alternative treatment/intervention/test. Because statistical significance is related to sample size and the frequency that self-exam detects cancer, it is very likely that some women will be helped by self-exam....even though it misses a lot of cancers and overdiagnoses (since one can't tell whether lumps are cancer or not). At the same time, it doesn't cost anything and isn't dangerous....except that women might not go for a complete breast exam based on their normal self exam. So statistically, in order for a test to be effective statistically, a certain number of women need to be diagnosed via selfexam above and beyond those diagnosed in regular care. It is actually quite hard to reach significance in this situation, but that doesn't mean the test can't be useful in the right circumstances. That is determined by things like the density of the breasts and the amount of instruction the woman is given about how to do the exam. Lots of variables. Saying something isn't effective in a population is not saying it won't work in some people....just not enough of them for the difference to be statistically important.

By making a recommendation about self-exams isn't that inherently making recommendations to individuals? If there is no harm in performing a self exam, why discourage it?

KAM

[clemgrad85]

Spoke to a female friend of mine tonight and she told me her breast cancer was back....she is 50. Fortunately, it was caught early and the outlook is very good. I asked her what she thought about this "recommendation" out there involving no mammograms for women in their 40s. She told me had that been in place they would not have found her cancer the first time as it was discovered by a mammogram about 3 years ago....when....yup....she was 47. So everyone can throw around statistics and what studies show and anything else, but she believes she was saved because of a mammogram in her 40s. Would it be fair to toss aside the women who were likely saved by a mammogram in their 40s? Where is the sympathy for these women?

[daThomas]

Really. We're going to give into the hysterical reaction of this recommendation which has been made in the past. A conclusion based on actual data analysis with the ULTIMATE conclusion to be to INDIVIDUALIZE tests to the patient.

Read it yourself please!

The direct quote:

The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take into account patient context, including the patient's values regarding specific benefits and harms.

The recommendation clearly stipulates the patient's final desire for or against screening mammography is the deciding factor after they have been given the advantages and disadvantages.

So please stop waving your arms about and running around in circles.

[davidra]

Originally Posted by KAM1138

By making a recommendation about self-exams isn't that inherently making recommendations to individuals? If there is no harm in performing a self exam, why discourage it?

KAM

But there is harm. The harm that was found in two large studies included an increased number of negative biopsies, and women less likely to go for physician breast exams if they were taught BSE (breast self exam). Additionally, neither study showed any improvement in survival from breast cancer. daThomas linked to the summary; this is the full article that describes why they recommended what they did, with specifics about the studies.

PDF: Breast cancer screening

[davidra]

Originally Posted by Technologic 2

And that makes it better?



But less screenings positively misses some cancers.

Yep. It sure does. And more screenings in women less likely to have cancer causes more harm. Do some reading.

[davidra]

Originally Posted by clemgrad85

Spoke to a female friend of mine tonight and she told me her breast cancer was back....she is 50. Fortunately, it was caught early and the outlook is very good. I asked her what she thought about this "recommendation" out there involving no mammograms for women in their 40s. She told me had that been in place they would not have found her cancer the first time as it was discovered by a mammogram about 3 years ago....when....yup....she was 47. So everyone can throw around statistics and what studies show and anything else, but she believes she was saved because of a mammogram in her 40s. Would it be fair to toss aside the women who were likely saved by a mammogram in their 40s? Where is the sympathy for these women?

Let me say it again: She and you have no idea whether or not she was "saved" by having a mammogram. In fact, there are excellent odds that she would have been "saved" anyway. I know this is hard to grasp, but early diagnosis doesn't always result in improved outcomes. Another example: do you think that by doing chest xrays on everybody, or even just smokers, every six months, we could prevent deaths from lung cancer? That would make sense, right? No, it doesn't. And it doesn't because by the time lung cancer is detected by screening x rays, there is no benefit of survival over those people who are diagnosed based on their symptoms. There is no question about this; it's been studied many times in thousands of patients. Regardless of your perceptions, or anecdotal cases of women claiming to be "saved" by mammograms, we have no idea if they were or weren't. In fact data suggests it wouldn't have made any difference, and that they would have survived regardless. I realize this is counter-intuitive...but it's the truth. And you cannot make policy based on anecdotes...otherwise I would be ordering screening colonscopies on every 18 year old patient because I saw a case of colon cancer in an 18 year old once. There are many unintended negative consequences of screening programs. Read some of the articles that are linked if you really want to get a feel for what is going on here.

[clemgrad85]

Originally Posted by davidra

Let me say it again: She and you have no idea whether or not she was "saved" by having a mammogram. In fact, there are excellent odds that she would have been "saved" anyway. I know this is hard to grasp, but early diagnosis doesn't always result in improved outcomes. Another example: do you think that by doing chest xrays on everybody, or even just smokers, every six months, we could prevent deaths from lung cancer? That would make sense, right? No, it doesn't. And it doesn't because by the time lung cancer is detected by screening x rays, there is no benefit of survival over those people who are diagnosed based on their symptoms. There is no question about this; it's been studied many times in thousands of patients. Regardless of your perceptions, or anecdotal cases of women claiming to be "saved" by mammograms, we have no idea if they were or weren't. In fact data suggests it wouldn't have made any difference, and that they would have survived regardless. I realize this is counter-intuitive...but it's the truth. And you cannot make policy based on anecdotes...otherwise I would be ordering screening colonscopies on every 18 year old patient because I saw a case of colon cancer in an 18 year old once. There are many unintended negative consequences of screening programs. Read some of the articles that are linked if you really want to get a feel for what is going on here.

Okay....so let me get this straight. Since there is no proof that the mammogram may or may not have saved her life, we should lean towards the side that it didn't? I am all for the woman making the choice herself to do it, but to say that since we have no way of proving it was advantageous to discover the cancer early we might as well delay the finding of it is nutty. Are you saying that it really doesn't matter when you discover breast cancer as long as you discover it before the woman dies?

As for the example of a colonoscopy on an 18 year old, I think we can certainly go to the extreme on anything. But I would have to think you, as a phsycian, know of many women who were diagnosed with breast cancer in their 40s. I can think of at least 5 or 6 women that I know, without even putting much thought into it. But, I guess if we can save a dollar so that another person can better afford health coverage, it is worth it.

Originally Posted by davidra

But there is harm. The harm that was found in two large studies included an increased number of negative biopsies, and women less likely to go for physician breast exams if they were taught BSE (breast self exam). Additionally, neither study showed any improvement in survival from breast cancer. daThomas linked to the summary; this is the full article that describes why they recommended what they did, with specifics about the studies.

PDF: Breast cancer screening

Ok, I was taking that from what you had said: At the same time, it doesn't cost anything and isn't dangerous....except that women might not go for a complete breast exam based on their normal self exam.

Other than using a self exam to justify not having other exams, I was under the impression that you were saying it was a good thing. However, if the choice is between not doing any kind of exam (before 50), or doing just self exams, they aren't then avoiding anything that would otherwise be recommended (assuming that the no mammogram before 40 applies to them). If it is giving a bunch of false positives, that could be a problem, but again, with cancer, I'm not sure many people wouldn't prefer "better safe than sorry."

Given that there are plenty of anecdotes that appears to refute this recommendation, this is going to be a tough sell--despite the data and its validity. Again--I'm not here to advocate anything on this issue, just gathering information.

I'll read that information, for my own information, but I really don't have anything further to add. I appreciate your time outlining these things.

KAM

[davidra]

Originally Posted by clemgrad85

Okay....so let me get this straight. Since there is no proof that the mammogram may or may not have saved her life, we should lean towards the side that it didn't? I am all for the woman making the choice herself to do it, but to say that since we have no way of proving it was advantageous to discover the cancer early we might as well delay the finding of it is nutty. Are you saying that it really doesn't matter when you discover breast cancer as long as you discover it before the woman dies?

As for the example of a colonoscopy on an 18 year old, I think we can certainly go to the extreme on anything. But I would have to think you, as a phsycian, know of many women who were diagnosed with breast cancer in their 40s. I can think of at least 5 or 6 women that I know, without even putting much thought into it. But, I guess if we can save a dollar so that another person can better afford health coverage, it is worth it.

Let's try again. because for some reason you seem to think that the USPSTF making these recommendations somehow will affect financial expenditures for other health care. It has NOTHING to do with any other issue other than breast cancer, and it is NOT about saving money, only using what money you have more efficiently. I think you'd probably agree that somewhere there is a finite amount of money available for spending on health care. At least conservatives certainly seem to feel that way. Given that, and given the fact that we have a high rate of women not receiving prenatal care in this country, does it make more sense to spend money on mammograms that have not been proven to provide a survival advantage, or spend that money on prenatal care, which has been proven to be effective? This is what policy is about. It's not about politics, it's not about left or right, it's about scientifically-based decisions about expenditures. But that's not the only reason. There are harms that go along with excessive care, as has been mentioned numerous times, and those harms are totally independent of cost. How would you feel if your spouse was overdiagnosed with breast cancer and treated when she didn't really need to be treated? If you read the data, you will see that happens in certain groups when mammograms are done routinely.

Try to understand that you don't make policy based on anecdotes. You make policy based on the best available evidence in population data. There is very good evidence that if you take 15 women just like your friend, that is with breast cancer and having had mammograms, around 8 of them would survive five years. If you take 15 women with breast cancer but without any mammograms, about 7 of them will survive 5 years. And it would take screening 2000 women to get that advantage of one life saved (and it may be more than that, depending on which study you read).

This is a hard concept to get across to students as well, because for some reason people make assumptions that are incorrect. One would be that if you don't have a mammogram and get diagnosed during a physical exam, you are at a greater risk of dying. The evidence from the literature just does not back that up for younger age group women. Lay people additionally have a hard time understanding that tests are imperfect, and that overdiagnosis and underdiagnosis happens all the time, and can be really harmful.

The probability of a false-positive screening
mammography result was estimated at 0.9% to 6.5% in
a meta-analysis of studies of sensitivity and specificity of
mammography published 10 years ago (38). The cumulative
risk for false-positive mammography results has been
reported as 21% to 49% after 10 mammography examinations
for women in general (39–41), and up to 56% for
women aged 40 to 49 years (41).

Data from the BCSC for regularly screened women
that are based on results from a single screening round
indicate that false-positive mammography results are common
in all age groups but are most common among
women aged 40 to 49 years (97.8 per 1000 women per
screening round)

Note that this addresses the diagnosis of breast cancer, not survival, which is really the key outcome, right? But it gives you some idea of how inaccurate testing can be, and how many studies need to be done to find one case.

The BCSC results indicate
that for every case of invasive breast cancer detected by
mammography screening in women aged 40 to 49 years,
556 women have mammography, 47 have additional imaging,
and 5 have biopsies.

[Technologic 2]

It is obvious to me that those supporting Obamacare think it is the best thing since sliced bread. They called for preventative care and early detections, then they say it is not always necessary. When this panel says screenings aren't needed as much, they say that it is individual choice if they want more (until this Health care bill won't pay because it is not recommended).

I still say that healthcare bill is not about helping more people get healthcare, it is about power and spending money. Check out the promises being given to Sen. Landrieu trying to bribe her to get her support. I just hope she doesn't pay their ransom by voting for this bill.

[Micael]

Originally Posted by davidra

Right. Just trying to point out the quality of your resources. Do I need to copy your comment saying that the study sponsored by his "front organization" was non-partisan? I guess what I'm saying is that you were wrong, you didn't check your sources, and you claimed a horribly biased source was "non-partisan". Nope, not much to do with Harry Reed....just shines a light on your comments and their validity.

Again, your accusations are meaningless. Try addressing the points of the document I reference? Of course not, because you can't... or just too lazy.

[Micael]

Originally Posted by daThomas

Really. We're going to give into the hysterical reaction of this recommendation which has been made in the past. A conclusion based on actual data analysis with the ULTIMATE conclusion to be to INDIVIDUALIZE tests to the patient.

Read it yourself please!

The direct quote:


The recommendation clearly stipulates the patient's final desire for or against screening mammography is the deciding factor after they have been given the advantages and disadvantages.

So please stop waving your arms about and running around in circles.

This study's "release date" is suspect, at the very least. I'd say it's worth investigating. At the very least, a second opinion is called for?

Call me jaded, but it sure "seems" like a set up for the RATIONING that is sure to come once this POS bill gets shoved down our throats.

Expect to see similar "data" supporting a reduction in colon and prostate exams in the near future...

[Micael]

Originally Posted by Technologic 2

I still say that healthcare bill is not about helping more people get healthcare, it is about power and spending money.

You aren't the only one saying that. The facts and data say that.

This bill is destroying more than "healthcare", as we know it.

The overall quality of care will go down; government power and control will go up; and taxation is going to go through the roof.

[Micael]

Here's what the "Patient Protection and Affordable Care Act" buys us, folks:

• Billions in Wasteful Spending and Expanded Government
• Half a Trillion in Damaging Medicare Cuts
• A Half Trillion in New Taxes
• Lost Jobs and Lower Wages
• Increased Premiums and Health Costs
• Government Run Health Care
• Biggest Medicaid Expansion in History
• Allows Federal Funds to pay for Abortions

Hello Everyone,

For anyone who might be interested, here's an article:

washingtonpost.com

The author seems to support the new recommendation, but criticizes the HHS Secretary for her politically motivated handling of this (by backing down from it).

The point of my posting this isn't to take the author's position, but to demonstrate the PR-disaster nature of how this has been handled.

KAM

Hello Everyone,

Here's an article by a Democrat Congressman explaining why he voted against the Healthcare bill.

REP. JASON ALTMIRE: Why I voted no on health reform
An excerpt: Supporters of the House bill have argued that it is fiscally responsible because it does not add to the federal deficit. While this is true, there is a big difference between not adding to the deficit and bringing down health-care costs. The House bill pays for itself primarily by raising taxes, not by making the fundamental reforms necessary to bring down the cost of health care.

We cannot simply add tens of millions of uninsured people into today's inefficient health-care system and expect that it will yield different results. Absent the necessary systemic reforms, this approach would only compound our nation's budgetary problems and do little to make health care more affordable for families and businesses.

The American people deserve better. I am hopeful that Congress ultimately will pass a bill that represents true health-care reform -- a bill that would both expand coverage and lower costs. The issue is too important for us to miss this opportunity.

This issue of dealing with the costs is one I don't think can be ignored, and while I may not agree with the author on all points, one of the promises that has been repeated again and again and again is that this will lower costs. Some people aren't concerned with costs, but I think the vast majority of the population is.

If this issue is not being addressed, the problem is not being solved, and a faux-solution can be worse than the problem. I have my own views on how costs need to be addressed, but I'd be for any reasonable idea. What is out there now does not accomplish this, and as such a fundamental pillar of looking at "reform" at all is being ignored.

KAM

[davidra]

Originally Posted by Technologic 2

It is obvious to me that those supporting Obamacare think it is the best thing since sliced bread. They called for preventative care and early detections, then they say it is not always necessary. When this panel says screenings aren't needed as much, they say that it is individual choice if they want more (until this Health care bill won't pay because it is not recommended).

I still say that healthcare bill is not about helping more people get healthcare, it is about power and spending money. Check out the promises being given to Sen. Landrieu trying to bribe her to get her support. I just hope she doesn't pay their ransom by voting for this bill.

Who is "they"? I support it. I agree that it's too bad it comes down to politicians...but only a fool would think that everyone supports it because of power and spending money. Just because you don't understand complexities doesn't mean you're right. You're not. You're just as wrong as ever.

[davidra]

Originally Posted by Micael

Here's what the "Patient Protection and Affordable Care Act" buys us, folks:

• Billions in Wasteful Spending and Expanded Government
• Half a Trillion in Damaging Medicare Cuts
• A Half Trillion in New Taxes
• Lost Jobs and Lower Wages
• Increased Premiums and Health Costs
• Government Run Health Care
• Biggest Medicaid Expansion in History
• Allows Federal Funds to pay for Abortions

Hey...do you think you could stop spinning and concentrate? Talking points from some republitard is not likely to influence anybody, although I'm sure it makes you more secure in your cluelessness.

[davidra]

Originally Posted by Micael

Again, your accusations are meaningless. Try addressing the points of the document I reference? Of course not, because you can't... or just too lazy.

Yeah, you're right. I'm too lazy to write meaningful posts on this board to try and discuss the reasons for decisions that have been made. Or maybe you're too lazy or unable to understand what I"ve spent much time writing. That's OK...just reinforces my opinions.