We only find the less deadly cancers.
"A new report raises fresh questions about the value of mammograms. The rate of cancers that have already spread far beyond the breast when they are discovered has stayed stable for decades, suggesting that screening and early detection are not preventing the most dangerous forms of the disease. The report, in Thursday's New England Journal of Medicine, is by three prominent cancer specialists and is based on federal statistics going back to the 1970s. It comes a week after the American Cancer Society scaled back its mammography advice, saying most women should start annual screening at age 45, not 40, and switch to every other year at 55. A government task force recommends even less -- every other year starting at 50. "We're undergoing what I think for the public is a very confusing debate" about screening, but it's really "a course correction" prompted by more awareness of its risks and benefits to various groups of women, said Dr. H. Gilbert Welch, a health policy expert at Dartmouth Medical School. "All they heard for years was, 'there are only benefits.' " He is the lead author of the report, co-written with Dr. David Gorski of Wayne State University School of Medicine in Detroit and Dr. Peter Albertsen of the University of Connecticut Health Center in Farmington. "Screening offers hope that cancer can be detected in an early, localized phase when it's more amenable to treatment," they write, but that assumes that cancer starts in one place, grows and then spreads. If that was always true, screening would reduce the rate of advanced cancers. And that has not happened. The rate of breast cancers detected at an advanced stage has been stable since 1975, despite wide use of mammography since the 1980s. The average age of women diagnosed with cancer also has remained around 63, another sign cancers are not being found sooner. The trends suggest that some breast cancers are already "systemic" or widely spread from the start, and that finding them sooner has limited impact. "Screening mammography has been unable to identify those bad cancers, destined to become metastatic, at an earlier stage. That doesn't say mammography doesn't help less aggressive cancers," but those are less likely to prove deadly, Welch said." The rate of cancers that have already spread far beyond the breast when they are discovered has stayed stable for decades – Lowell Tech Air - Albany Daily Star Gazette This is true for many cancers. We need to seriously rethink the hype we are hearing surrounding preventative medicine, and testing. Much of this is little more than cross selling for doctors who own shares in the lab. Nearly every doctor to whom I speak with has a litany of anecdotes of people helped by their pet procedure, whether mammography, PSA, colonoscopy, or something else. But when I ask about problems, negative outcomes, and the like, its is as if they have never heard of such a thing. Yet as a litigator handling medical cases, I saw these, commonly. If we allow government to infringe on our medical payments we will see a significant reduction in quality of care. Instead of careful analysis of whether colonoscopy, sigmoidoscopy, FIT or some other non-invasive test is better, we will see the wizened mandarines simply making a decision and then subjecting us to their dictate. Are their good quality comparative studies in the medical literature about the long term efficacy of these testing procedures, have they been studied comparatively? No. The colonoscopy became the gold standard because Medicare agreed to pay for the procedure even without high quality comparative studies, because it looks at more, and thus, must be better. So, they dictated this outcome without evidence. The insurance companies all but had to go along since every gastroenterologist bought a colonoscopy machine. Why not, it pays the doctor far more than the competitor machine. Europe has been doing some minor comparative studies which seem to show the colonoscopy is no better than the sigmoidoscopy but does have higher incidence of complications. Whether cancer, or other medical treatment, these issues need to be much more front and center in our debate. To get a baseline grasp on this problem I suggest reading: Overdiagnosed: Making People Sick in the Pursuit of Health 1st Edition by H. Gilbert Welch Should I Be Tested for Cancer?: Maybe Not and Here's Why Paperback – March 6, 2006 by H. Gilbert Welch Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care 1st Edition by Gilbert Welch Know Your Chances: Understanding Health Statistics Paperback – November 30, 2008 by Steven Woloshin M.D.M.S.
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BrothersJudd Blog: A RUN OF THE MILL MALTHUSIAN:
Well, these wankers do! "Prominent MIT economist and dean Lester Thurow dies at 77 : Scholar and public intellectual examined globalization and its consequences. (Peter Dizikes, 3/30/16, MIT News Office ) The influential MIT economist and public intellectual Lester Thurow, whose work addressed the many consequences of an increasingly global economy, died on Friday at his home in Westport, Massachusetts. Thurow, who also served as dean of the MIT Sloan School of Management, was 77 years old. [...] In many years of engagement with the public and government officials -- and in a series of bestselling books -- Thurow advocated a distinctive set of policy ideas that defied simple political labeling. He was just lucky that there are no consequences for intellectuals when everything they say turns out to be wrong, Zero-Sum Fallacies (Rich Karlgaard) At the dawn of the U.S. economic boom in 1980 MIT economist Lester C. Thurow looked backward into the dark night. He called his sad new book The Zero-Sum Society: Distribution and the Possibilities for Economic Change. Here is a description on Amazon: "Interpreting macroeconomics as a zero-sum game, Thurow proposes that the American economy will not solve its most trenchant problems-inflation, slow economic growth, the environment-until the political economy can support, in theory and in practice, the idea that certain members of society will have to bear the brunt of taxation and other government-sponsored economic actions." That yawner of a 58-word sentence gives you the flavor of the book. Nevertheless, the famed Harvard economist John Kenneth Galbraith called Zero-Sum Society "an extraordinarily good and lucid examination of current economic difficulties." Galbraith was wrong about prose and prophecy. It was a horrible book and a crimped way of looking at economics and the human spirit. President Ronald Reagan neglected to read it. One assumes the founders and backers of Apple, Sun Microsystems, Microsoft, Dell, Oracle, Cisco, Palm, Yahoo and Google passed on it, too. Zero-sum implies no net progress in human affairs. The facts scream otherwise. Global production in 2006 amounted to $66 tril-lion, or $10,200 per person. Two hundred years ago per capita income was about $300. Five thousand years ago it was equivalent to $200. For the mass of mankind there was no detectable economic progress for 4,800 years. Then came the Industrial Revolution with its hockey-stick curve in income and life span. Yet the zero-sum myth lives on. Like a retrovirus it burrows and hides and waits. In 1968 it popped up in the form of a bestselling book by Paul R. Ehrlich entitled The Population Bomb. As investor Gary Alexander recounted in a recent speech: "[Ehrlich] opened famously by saying, 'The battle to feed [all of] humanity is over. In the 1970s and 1980s hundreds of millions of people will starve to death in spite of any crash programs embarked upon now.' Writing in Ramparts magazine, Ehrlich went even further, 'Millions of people will soon perish in smog disasters in New York and Los Angeles the oceans will die of DDT poisoning by 1979 the U.S. life expectancy will drop to 42 years by 1980, due to cancer epidemics.' Hepatitis and dysentery would sweep America by 1980 and nearly all of us would wear gas masks. Over 65 million Americans would starve in the 1980s, leaving only 22.6 million starved Americans alive in 1990." Then, to Ehrlich's apparent dismay, the inventive human spirit intervened. While Ehrlich was gnashing his teeth, Alexander writes, "Dr. Norman Borlaug was launching the Green Revolution, which has managed to feed billions more people on moderately more arable soil than in the 1960s. Instead of starving against our will, millions of us are trying to starve voluntarily-by dieting. Food is far cheaper, relative to the overall growth of the cost of living, than in the 1960s. From 1977 to 1994 food costs fell 77% in real terms.'" Today seems to be progressive, and neoMalthusian claptrap day. All of the environmental, neoMalthusian, zero sum fads like population bomb, global cooling, DDT, fluoridated drinking water, peak oil, Club of Rome over-population, acid rain, high tension electromagnetic fields, ozone hole, radon, dioxin, mad cow disease, mercury, global warming, climate change are nothing more than fadish beliefs which make us feel important and special. The reality is we are not. We no more need to band together to save the world than we can band together to climb to the moon. These beliefs are destructive. This should be pointed out at every turn. What cures the ills behind by these scares is wealth. The wealthier the people, the cleaner the environment, and the more limited the family size. Human ingenuity will conquer the problems facing us in the future, as it has in the past. fearfully fretting like a spinster aunt is a worthless endeavor, don't engage in it. When you see others engaging in it, mock them, point out their folly. Be merciless about it! Google Makes Its $149 Photo Editing Software Now Completely Free to Download
. . . and allowed tech driven deflation to reduce the cost of medical care to zero! Psychology is in crisis. This scientist's striking confession explains how we got here.
. . . it's all science, and especially the pseudo-science's like climate science. Are High Deductibles A Good Thing? Part I
. . . sadly you will have to wait for the follow up article explaining Goodman's Gold Standard Policy. "Because I am often called the “Father of Health Savings Accounts” people sometimes assume that I favor high deductible health insurance. I don’t. In fact, I don’t really favor deductibles at all. Deductibles, along with co-insurance payments, are very crude devices that give patients very imperfect incentives. What I favor instead is self-insurance for many kinds of medical expenses, including almost all primary care and most diagnostic tests. Where third party insurance is involved I favor fixed payments — wherever practical – with the patient self-insuring for any additional expense. (See, for example, Anthem’s experiment with knee and hip replacements in California.)" Goodman nails the problems with todays health care payments policies. I began noticing this problem last year when Regence ash canned our policy and threw us on to the exchange. Exchange policies are packed with costly prepaid medical garbage that the upper middle class want but which are unnecessary, and likely to lead to poor medical outcomes. If you want to get a PSA, it will likely be paid for even though getting a PSA is a terrible idea. Since it is a policy "freebee" you are paying for it. Also here in Oregon all the policies came with multiple "free" annual exams, commonly 3. You are also paying for each of these exams in the premium. I realized those provisions accounted for much of the 2-3 times premium increase. After all, three people receiving 3 exams each year is pretty costly, and then one must add to that the fact that breast exams, prostate exams, colonoscopy, and mental health, among myriad others are all "free" in these policies. The reason for my policy jumping from under $300 per month to over $800 per month with higher deductible, and poorer coverage was obvious. The costs of these "freebees" drove the cost up dramatically. Plus, the exchanges are populated with a sicker cohort of insureds, so, I was likely paying for a significant amount of their premiums as well. Luckily, my wife's business was bought by a larger corporation, and they offered a reasonably priced family health care plan, so we dodged a bullet. Cancer Rates Spiked After Fukushima. But Don’t Blame Radiation
"Turtles are part of what H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, calls the barnyard pen of cancers. The barnyard has three animals, turtles, birds, and rabbits. "The goal of early detection is to fence them in," he says. You can't fence in the birds. They're the super aggressive lethal cancers that are beyond cure. The rabbits, you can maybe do something about if you can spot them and treat them. (Treatments that, by the way says Welch, have gotten better and better.) "But for the turtles," he says, "you don't need fences because they're not going anywhere anyway. And the thyroid is full of turtles." The breast and the prostate are full of turtles too, and just as the thyroid-scanning ultrasound devices are more likely to find little nodules there, an upsurge in mammography has led to a corresponding upsurge in something called ductal carcinoma in situ. Basically cancers that most of the time would just sit around and do nothing if you left well enough alone. In other words, they're indolent (great word), not malignant. Whether or not we treat them (or even look for them) has been a matter of great debate in recent years. It's very hard to know when upticks and outbreaks are quite what they appear. Even infectious disease outbreaks can sometimes be attributed to more-sensitive screening methods. The rise in whooping cough cases has multiple causes of course, but one of them is improved screening methods. Gene-based tests called PCR assays can inflate the number of actual diagnoses, according to a piece by epidemiologist James Cherry in the New England Journal of Medicine. Which is to say, if you start looking for something carefully, and if you use better methods to see what you're looking for, you will often find it. Welch points to an example from the '70s, when some employees at Lawrence Livermore National Labs (who deal with nuclear stuff all day long) were diagnosed with melanoma. Cancer cluster! But no--it was something else. What happened, Welch writes in his book Should I Be Tested for Cancer, is that one person probably got sick. Then, other people in the lab started getting checked for moles. Some were funky, so that leads to biopsies, which leads to, in some cases, an actual diagnosis. Then people start really getting worried. The lab kicks off an awareness campaign, so more people go in for checks, leading to more biopsies. "The whole epidemic looked subsequently like it was a pseudoepidemic," he says. "It was an epidemic of diagnosis." The melanomas were mostly turtles. In South Korea, checking more thoroughly has absolutely led to more diagnoses of thyroid cancer. In the late '90s, doctors in South Korea started screening people for thyroid cancer (it was an add-on test to the national cancer screening program), and cancer cases took off. "There was a 15-fold increase," says Welch. "There was nothing like it in the world!" Now, he says, thyroid cancer is the most common cancer in Korea--more common than breast, and colon, and lung. Here's the really pernicious part. People get checked for thyroid cancer, doctor finds a little nodule, does a biopsy, there's some cancery stuff in there, so they remove the thyroid, and the person--saints be praised!--the person lives. (Because of course they lived, they just had a little thing that would never have been a problem in the first place.) They live (without their thyroid) and now they are a survivor and the survival rates for thyroid cancer in South Korea are now really high. Great, right? No. "Once you understand the problem of turtles, you understand you're giving credit to finding the cancers that don't matter," says Welch. How did South Korea combat this surge in cancer cases? A group of doctors (including Welch) wrote a letter in 2014 discouraging screening with ultrasonography. Poof. Thyroid operations dropped by 35 percent in a year. Because the best test "isn't one that finds the most cancer," he says. 'The best test is one that finds the cancers that matter.'" Mostly no. We diagnose lots of the turtles, especially in the breast, and prostate, and then spend millions curing these cancers which need no cure. Then we fete our doctors for finding, and treating something which did not need to be treated. Wonderful! "The team looked at two large, age-matched groups of women in Sweden. Starting in the late 1980s, one cohort of about 300,000 received annual mammograms for six years. A control group underwent no screening for the first four years, then had mammograms in the last two. Conventional thinking would suggest that the cumulative number of cancers found in both groups would be about the same at the end of the six years. Surprisingly, however, the outcome was quite different: The cohort of women who were screened annually — and likely treated when a tumor was found — had accumulated significantly more tumours — 174 more per 100,000." So, preventative testing causes tumors, ok, not really, it just finds self remitting tumors, which cause fear, and medical interventions like biopsy's, mastectomies, and other invasive surgeries, and many of these invasive surgeries will occur on women who's legion would have spontaneously remitted. Brilliant! Butchered by the Witch Doctor to quell fear, is not a medically approved procedure. We are too aggressive, and too fearful of these outcomes. We need to better understand what we are facing, and whether it is a "bird" cancer, super aggressive and untreatable, or a turtle, super slow no treatment necessary, or a rabbit, treatable by fencing it in. Until we do this, our treatments are little more than Witch Doctory, more damaging and deadly than valuable. And we should never fete the doctors who offer these procedures. Just as we no longer fete the Witch Doctor for offering a talisman to ward off breast cancer. And prostate cancer is even worse. Yet our fears of cancer are too high to ignore, so we fall into the fear, and seek even the most invasive treatments without thought. There is malpractice in here somewhere. Hat tip: BrothersJudd Blog Can the cold make you stronger?
. . . whether skiing in -20˚, or spending two hypothermic weeks out of a month long kayak expedition, Maddog does not like being cold. So, if you think this will help, have at it. But don't expect Maddog to attend. If each year we were living shorter lifespans, perhaps this would resonate, but we are living longer, and healthier lives. Being cold for weeks on end, probably makes one morally stronger, but its long term effects are unlikely to be noticeable. |
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