Elvado
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Post by Elvado on Nov 17, 2009 15:53:58 GMT -5
that a government-sponsored medical panel announced that women need fewer mammograms starting later? I may be particularly ssensitive to this issue having lost family to breast cancer, but this sounds like medical decisions being dictated and handled by bureaucrats. Could this be the first sterp toward rationed medical care? Will the new "Public option" only pay for these less frequent and later mammograms?
The American Cancer Society is outraged and so am i.
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TC
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Post by TC on Nov 17, 2009 16:48:12 GMT -5
Could this be the first sterp toward rationed medical care? What do you mean first step? We already have medical care rationed by insurance companies.
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nychoya3
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Post by nychoya3 on Nov 17, 2009 17:07:49 GMT -5
I'm not very well-versed in any of this, but the aforementioned panel is, I think, made up of various researchers and medical practitioners. They could certainly be wrong, but I do not believe or see any evidence that they reached this conclusion in anything other than a good faith attempt to weigh the pluses and minuses of the screening standard.
Also, correct me if I'm wrong, but wouldn't doctors be able to depart from this recommendation if they felt it was warranted?
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Post by hoyawatcher on Nov 17, 2009 23:14:36 GMT -5
Welcome to the new world order Emotionally I am right there with you about this. My wife had breast cancer at an early age and this would have been an impediment to her being cured. There are women who get cancer early and the only way to detect it is either looking for lumps and/or mamograms. There is no doubt strictly following this guideline would cost lives. I haven't read the guidelines myself yet, but the reports I saw today were doctors Editeded because there were not radiologists or oncologists making the guidelines. Docs are incredibly parochial. Now let me switch my hat and speak from a pharmacoeconomic point of view. There is an established value for a human life. Sometimes expressed in life years but for a middle aged person usually a set number - I think it is $350K but I am very dated and going off memory. Point being when you have this value you can easily calculate whether a procedure, test or drug or whatever is "cost effective". I will assume that is what this group did - what is the cost of all the mamorgrams for women between 40 and 50 versus how many lives does it save times the value of those lives. This is the model that the cost reductions on health care reform are supposed to be based on. Today a guideline like this does not really affect what your doctor and you decide to do. They don't have any force of law, reimbursement or anything like that - yet. But the model for Obama is the UK's National Institute for Health and Clinical Excellence (aptly nicknamed NICE). In the UK structure this group makes such guidelines and has control of the purse to enforce them. They control what the government will and won't pay for. They already have a guideline for mamograms that already says you have to be 50 to get a routine mamogram - unless you are in an identified high risk group. Yes that means that some UK women will die that wouldn't in the US but in their view of life it isn't cost effective to save them. This is the political consensus between the population and government to control costs in the UK that doesn't exist in the US. In the UK NICE has the authority to dictate what procedures are available for patients by what they will pay for (note that means severe restrictions on things like stem cell transplants) plus they have the ability dictate what drugs are available for what indication (above and beyond the safety and efficacy approval of the European version of the FDA). With this many of the high end expensive drugs available in the US are either not available in the UK or their use is severely restricted. Lifesaving protocols that are routinely available in the US are not available in the UK because they are not "cost effective". Again as with the issue of mamograms people die but the consensus is that a life only has a certain value. As an aside and in response to an earlier comment, US insurance companies today really have limited ability to ration care. With some very rare exceptions their ability to deny care was truncated by a series of lawsuits which pretty much destroyed the HMO concept which was supposed to be their method for controlling medical costs. HMOs actually worked for a while but there was no political consensus that anyone or anything should limit a US citizen's right to anything that might help them. Can't get between them and their doctor you know. Now to be fair and balanced the UK system does do a better job of allocating resources to younger folks and to primary care applications.
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Buckets
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Post by Buckets on Nov 18, 2009 1:42:39 GMT -5
Welcome to the new world order Emotionally I am right there with you about this. My wife had breast cancer at an early age and this would have been an impediment to her being cured. There are women who get cancer early and the only way to detect it is either looking for lumps and/or mamograms. There is no doubt strictly following this guideline would cost lives. I haven't read the guidelines myself yet, but the reports I saw today were doctors Editeded because there were not radiologists or oncologists making the guidelines. Docs are incredibly parochial. Now let me switch my hat and speak from a pharmacoeconomic point of view. There is an established value for a human life. Sometimes expressed in life years but for a middle aged person usually a set number - I think it is $350K but I am very dated and going off memory. Point being when you have this value you can easily calculate whether a procedure, test or drug or whatever is "cost effective". I will assume that is what this group did - what is the cost of all the mamorgrams for women between 40 and 50 versus how many lives does it save times the value of those lives. This is the model that the cost reductions on health care reform are supposed to be based on. Today a guideline like this does not really affect what your doctor and you decide to do. They don't have any force of law, reimbursement or anything like that - yet. But the model for Obama is the UK's National Institute for Health and Clinical Excellence (aptly nicknamed NICE). In the UK structure this group makes such guidelines and has control of the purse to enforce them. They control what the government will and won't pay for. They already have a guideline for mamograms that already says you have to be 50 to get a routine mamogram - unless you are in an identified high risk group. Yes that means that some UK women will die that wouldn't in the US but in their view of life it isn't cost effective to save them. This is the political consensus between the population and government to control costs in the UK that doesn't exist in the US. In the UK NICE has the authority to dictate what procedures are available for patients by what they will pay for (note that means severe restrictions on things like stem cell transplants) plus they have the ability dictate what drugs are available for what indication (above and beyond the safety and efficacy approval of the European version of the FDA). With this many of the high end expensive drugs available in the US are either not available in the UK or their use is severely restricted. Lifesaving protocols that are routinely available in the US are not available in the UK because they are not "cost effective". Again as with the issue of mamograms people die but the consensus is that a life only has a certain value. As an aside and in response to an earlier comment, US insurance companies today really have limited ability to ration care. With some very rare exceptions their ability to deny care was truncated by a series of lawsuits which pretty much destroyed the HMO concept which was supposed to be their method for controlling medical costs. HMOs actually worked for a while but there was no political consensus that anyone or anything should limit a US citizen's right to anything that might help them. Can't get between them and their doctor you know. Now to be fair and balanced the UK system does do a better job of allocating resources to younger folks and to primary care applications. $350K seems pretty low. NHS standards are like 50,000 USD per QALY last time I checked so I really don't think that $350K in the US seems right. The "consensus is that a life only has a certain value" exists everywhere, it's just less explicit on this side of the Atlantic. Why don't we spend even more on healthcare when it will save lives? Does 30% of the GDP sound good? Because we realize that that person could be contributing to society in more effective ways that would enhance -- without extending -- lives. It's only where you draw the line in the sand. The report isn't based principally on cost either, it's based on the harms versus benefits of mammograms at a young age. From the NYT: "A test can trigger unnecessary further tests, like biopsies, that can create extreme anxiety. And mammograms can find cancers that grow so slowly that they never would be noticed in a woman’s lifetime, resulting in unnecessary treatment." Relevant chart is here: www.nytimes.com/imagepages/2009/11/18/health/18mammogram_graph.html
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Post by hoosierhoya on Nov 18, 2009 22:18:17 GMT -5
Over-treatment seems to be a real problem, though. There has been quite a bit of media coverage about the deleterious effects of over-treatment long before this recommendation came out. PSA tests have also been implicated in over-treatment of prostate cancer: www.sciencedaily.com/releases/2009/11/091106145415.htmThat concerns me too, as a member of my family has had his prostate removed (before his 60th birthday) within the past year. Perhaps more research should be done on how to differentiate between invasive cancers that need to be removed and those that don't. That way doctors can better respond to positive PSAs and mammograms.
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Cambridge
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Post by Cambridge on Nov 19, 2009 13:48:39 GMT -5
There was an earlier report on prostate checks. Same finding. Over-treatment is more of a danger than under-screening.
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theexorcist
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Post by theexorcist on Nov 19, 2009 13:59:10 GMT -5
In between its suggestions on how to get around the Constitution to pass health care and why trying KSM has no problems whatsoever, Slate had a really good piece on this: www.slate.com/id/2236028/The problem is the idea that the group is making recommendations for a large number of women, all of whom have different health histories. Given the ancillary problems associated with treating benign tumors (complication from surgery, radiation) and the miniscule chance of surviving breast cancer for the average woman getting regular mammograms in her 40s, the recommendation makes a lot of sense. In cases with high-risk factors (family history, for example), mammography may make more sense. But, as discussed, these are all actuarial considerations. It's awful if the person who would have been saved by regular mammograms who decides not to have them based on this advice is a loved one. But there are many medical examinations that people ignore based on minimal benefit and potential risk - this is just another. EDIT - oh, and I'll add that what sways me on this position is the increased risk of cancer from unnecessary radiation to kill tumors. I could see going for this the only side effect of mammograms detecting benign tumors was anxiety and the risk of surgery - but an increased risk of other cancers seems to weigh in favor of waiting.
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Bando
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Post by Bando on Nov 19, 2009 14:31:33 GMT -5
Elvado, you're an idiot. For anyone actually hankering for some science-based reporting on this issue, see here. This guy is a surgical oncologist focusing on breast cancer. So, you know, way more qualified to talk about this than this board's resident quack.
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Elvado
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Post by Elvado on Nov 19, 2009 16:26:46 GMT -5
Elvado, you're an idiot. For anyone actually hankering for some science-based reporting on this issue, see here. This guy is a surgical oncologist focusing on breast cancer. So, you know, way more qualified to talk about this than this board's resident quack. Nice to see Sebelius' knee-jerk retraction when the heat turned on. Barry O's crowd is nothing if not cowardly wind-twisters.
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Buckets
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Post by Buckets on Nov 19, 2009 17:22:05 GMT -5
Elvado, you're an idiot. For anyone actually hankering for some science-based reporting on this issue, see here. This guy is a surgical oncologist focusing on breast cancer. So, you know, way more qualified to talk about this than this board's resident quack. Nice to see Sebelius' knee-jerk retraction when the heat turned on. Barry O's crowd is nothing if not cowardly wind-twisters. It's pretty obvious from your first post ("medical decisions being dictated and handled by bureaucrats") that you did not get anywhere close to reading the actual guidelines. You saw in some article "fewer mammograms" and then did your best Glenn Beck impression. I'll quote the guidelines here for you: "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 patient context into account, including the patient's values regarding specific benefits and harms." Sebellius says Medicare will definitely and insurance companies almost certainly will continue their same coverage of mammography. This is not a retraction nor "cowardly wind-twisting," it is a reassurance to the people who don't take time to look into anything that resembles fact. You also apparently chose to ignore every other poster who 1) actually read something and 2) pointed out why you're an idiot, and tried to change the subject to Sebellius "retracting" a statement that nobody ever made. Bravo.
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