U.S. Preventive Services Task Force Guidlines

[red10]

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"insert words into mouth here"

What you can imagine and what the general populace does is most likely two different things. I've seen people stick Yankee candles in their anus.... I never imagined that one, I can tell you that.

you lack imagination then.🙄

 

[7starmantis]

you lack imagination then.🙄

So here you see it folks, Red10 sits around imagining people sticking Yankee candles up their asses. 😀

You stepped into that one.

 

[red10]

So here you see it folks, Red10 sits around imagining people sticking Yankee candles up their asses. 😀

You stepped into that one.

I've honestly heard of much much worse thanks to working in a GI department. a Yankee candle is almost a logical object choice. I've heard of TV remotes and much much worse.

 

[MegaProjectile]

LOL

Well at least you can make those personal attacks 😀 Glad I can motivate you.

The "facts" have been presented in the article I referenced didn't think it was necessary to present them again (speaking of dense). Just read the study used.

In your haste to call me names you overlooked the idea that the guidelines say to STOP DOING SELF EXAMS. That means you wouldn't be going in after finding a lump! And I'm the dense one!!

The US Task Force study showed that self-exams had zero effect on mortality rate. In fact, the American Cancer Society and Komen group no longer advocate formal teaching of self-exams.

 

[7starmantis]

I've honestly heard of much much worse thanks to working in a GI department. a Yankee candle is almost a logical object choice. I've heard of TV remotes and much much worse.

Ya, watched the removal of a light bulb once. But the sheer size of a yankee candle was impressive to me.

Ok, back on topic....

The circular logic in this thread is dizzying.

1.) We support the new guidelines because we certainly can't tell people to irradiate people in their 30's, 20's, etc. But then they are "just guidelines not mandates from heaven". So if they are just guidelines and dont really affect anyone, why not have guidelines to screen newborns? In fact we could do a new pre-birth screening campaign.

2.) We support a government task force making guidelines (because they are after all just guidelines) but then support a government run healthcare option that would follow these guidelines.

3.) We say the guidelines don't really matter, its unimaginable (and you talk about my imagination) a doctor would stop teaching self exams but then support the idea that there are 47 million (yeah, I know its a bogus number but many still blindly believe) uninsured. This means women who don't see a doctor. Surely we don't believe that only trained, educated, insured women who regularly see a doctor are the only ones doing self exams or are in need of screenings? You can say it doesn't matter because they can't see a doctor anyway, but thats just not true and a different issue altogether. It changes nothing about the need for screenings.

4.) We have to have limits on what a government option would pay for. We certainly can't have them pay for everything that a doctor finds medically relevant; after all these are the same doctors that refuse to listen to new guidelines and refuse to stop teaching their patients self exam procedures.

 

[boaz]

Preventative medicine focuses too much on routine tests and too little on lifestyle issues. Being careful with one's sex life is a much better prophylactic than doing regular pap smears.

 

[7starmantis]

The US Task Force study showed that self-exams had zero effect on mortality rate. In fact, the American Cancer Society and Komen group no longer advocate formal teaching of self-exams.

NBCF - Self Examination: Nearly 70% of all breast cancers are found through self-exams...

ACS - Self Examination: Research has shown that BSE plays a small role in finding breast cancer compared with finding a breast lump by chance or simply being aware of what is normal for each woman.

Syracuse radiologist explains those confusing mammogram / breast self-exam recommendations.

 

[Parts Unknown]

Food for thought:

So much for comparative effectiveness:

"What a golden opportunity has been missed to educate Americans about the implications of their health care choices. Otis W. Brawley, the chief medical officer of the American Cancer Society, in an op-ed in today's Washington Post condemning the USPSTF guidelines, confirms that mass screening would only save at a maximum 600 out of the 4,000 women under 50 who die of breast cancer annually. What he failed to point out is that 1.14 million American women would have to be screened annually for ten years to achieve that goal. To cover the entire cohort (all women between 40 and 49) to replicate that benefit every year would require screening 11.4 million women annually. The cost, at $200 per mammogram (my initial estimate was accurate, according to this New York Times business section article), would come to $2.24 billion annually for the health care system."

 

[7starmantis]

"What a golden opportunity has been missed to educate Americans about the implications of their health care choices. Otis W. Brawley, the chief medical officer of the American Cancer Society, in an op-ed in today's Washington Post condemning the USPSTF guidelines, confirms that mass screening would only save at a maximum 600 out of the 4,000 women under 50 who die of breast cancer annually. What he failed to point out is that 1.14 million American women would have to be screened annually for ten years to achieve that goal. To cover the entire cohort (all women between 40 and 49) to replicate that benefit every year would require screening 11.4 million women annually. The cost, at $200 per mammogram (my initial estimate was accurate, according to this New York Times business section article), would come to $2.24 billion annually for the health care system."

1. Things might change if your mom, sister, or wife was one of the 600 eh?
2. Sounds like a good reason to support private insurance and personal responsibility and not a "public option" that would pay for all of that. Its incorrect to associate procedure costs with "the health care system" as if its some sort of entity that will be paying for everything. Again circular logic, I thought those women with insurance and regular PCP visits would continue their current regime of screening? So the new guideline would only be affecting those without insurance, those needing the "public option" to pay for their screenings?
3. U.S. Preventive Services Task Force “reviewed a series of trials that are quite old. Some were begun 25 to 30 years ago. The trials take a long time to perform, and when these trials were originally set up, many years ago, they weren’t specifically designed to answer some of the questions we want to know now. The trials weren’t originally designed to answer the specific question about screening under age 50. They were designed to ask, ‘does mammography work at all?’. Consider this: As treatments for breast cancer improve, women live longer, and the breast cancer death rates drop – which would also drop that risk reduction percentage, and the benefit of mammography would seem to drop. That’s one reason Montgomery is critical of relying on studies designed in the 1970s to shape recommendations for today. In addition, the screening technology available today – digital mammography and ultrasounds and magnetic resonance imaging – far surpasses what was available in the 1970s.(source)

 

[Parts Unknown]

1. Things might change if your mom, sister, or wife was one of the 600 eh?

I have already lost a close family member to a preventable illness. No, it doesn't really change anything.

Allow me to rephrase the question: if you found $2.24 billion in your couch and wanted to save some lives, would you put it towards screening mammography for women 40-49?

 

[7starmantis]

I have already lost a close family member to a preventable illness. No, it doesn't really change anything.

Allow me to rephrase the question: if you found $2.24 billion in your couch and wanted to save some lives, would you put it towards screening mammography for women 40-49?

lol, that whole post and this is all you can respond to? Thats ok because:

You win a kewpie doll!!

This is by far the grossest misrepresentation and oversimplification of "sound bite" talking points I've ever seen.

 

[Parts Unknown]

This is by far the grossest misrepresentation and oversimplification of "sound bite" talking points I've ever seen.

Care to answer it?

 

[7starmantis]

Care to answer it?

Why would I? Its nonsensical at best. If newborn baby blood cured cancer would you bleed your children dry? To make fantastical arguments based on nothing more than wishful thinking is not only wrong but a dishonest mechanism to try and sway a discussion. Provide me a factual and logical argument and I'll be happy to answer it.

If anyone found 2.2 billion in their couch and wanting to save lives spent it on any type of screening I would support waterboarding again. The premise of your twisted little pseudo situational ethics question is ridiculous. Stick to facts and logical arguments and we can continue, until then, you win. I'm not interested in playing faulty logic games based on fantasy and "what if" gotcha posts.

Again, you won another kewpie doll!! Another first for me on the SDN site.

 

[Parts Unknown]

Why would I?

Because it is a fairly staightforward question. I suspect you are really just afraid that if you answer the question honestly you will be forced to admit that cost effectiveness is a valid concern when assessing screening strategies for disease.

 

[7starmantis]

Because it is a fairly staightforward question. I suspect you are really just afraid that if you answer the question honestly you will be forced to admit that cost effectiveness is a valid concern when assessing screening strategies for disease.

wow...lol

No, its not a straightforward question (as I pointed out last post), I actually did answer it as best I could (refer to water boarding reference) and I never said cost effectiveness was not a valid concern.

You misquote, twist, and misrepresent more than anyone I have seen. You still refuse to respond to my posts that in regards to the actual topic of this thread. Imagine that 🙄

 

[Parts Unknown]

No, its not a straightforward question (as I pointed out last post),

Sure it is. Imagine you are the head of the CDC and you have $2 billion to put towards a heath care initiative aimed at saving lives. How would you allocate the money?

I actually did answer it as best I could (refer to water boarding reference)

Sorry, thought you were kidding.

and I never said cost effectiveness was not a valid concern.

If it's a valid concern then what price would you set on a year of human life?

 

[redsquareblack]

What do you guys think about this whole ordeal? Looks like political pundits are quickly jumping aboard to spin their own version, but it seems a little odd to me. Are we looking at an early trial for budgeting healthcare in the new "public option" bills? In my opinion this is a terrible start for constraining healthcare costs. Is this what we have to look forward to when helathcare is under governmental budget constraints?

Opinions, ideas?

Anyway, as much fun as it is watching the wheels spin on this one, I figured I'd bring it back to the original post.

No, we're not looking at an "early trial for budgeting healthcare in the new 'public option' bills". Furthermore, it's not just about constraining health care costs, unless you include the nontrivial harm done by screening at 40 (in exchange for marginal benefits).

It has nothing to do with "governmental budget constraints".

You asked for opinions, that is mine.

Also, your implication that the recommendations are related to budgeting for "government-run health care" is misguided at best, and your attempt to cast yourself as neutral (a la "Looks like political pundits are quickly jumping aboard to spin their own version, but it seems a little odd to me.") falls flat on its face. We get it. You like Fox News. No biggie, we can all fit under one tent.

 

[7starmantis]

Furthermore, it's not just about constraining health care costs, unless you include the nontrivial harm done by screening at 40 (in exchange for marginal benefits).

Your entitled to your opinion and entitled to be wrong. Your in direct opposition of nearly all cancer organizations and groups in the US. I'm sure your good with that because after all, you are a pre-med student! Your use of the terms "nontrivial" and "marginal", while a cute attempt, are just incorrect. but you are entitled to your opinion.

It has nothing to do with "governmental budget constraints".
You asked for opinions, that is mine.

I'm glad you brought that back up because you have still not answered my question.

your saying that you honestly believe that a government task force comes out with new guidlines but a government run health insurance program is going to ignore it and just keep paying for those younger women's screenings?

We get it. You like Fox News. No biggie, we can all fit under one tent.

lol Lets try to demonize rather than logically prove wrong. I dont actually watch fox much, but your attempt to make it relevant to this thread is sad. I mean we can go back and forth right? Its easy to see you like Van Jones, no biggie, we can all fit under one tent. What the hell does that bring to the conversation exactly aside from emotionally charged red herrings?

 

[redsquareblack]

Your entitled to your opinion and entitled to be wrong. Your in direct opposition of nearly all cancer organizations and groups in the US. I'm sure your good with that because after all, you are a pre-med student! Your use of the terms "nontrivial" and "marginal", while a cute attempt, are just incorrect. but you are entitled to your opinion.

That's what you asked for, that's what I gave you.

There is nontrivial harm caused by screening programs, and the younger you start those screening programs, the benefit becomes marginal. I'm not sure what the issue is here.

These are recommendations, 7-star, not law. My personal belief is that physicians should follow current standard of care until that changes. These recommendations are merely the first volley in a long, difficult conversation that needs to be had about the costs (not just monetary) vs. benefits of screening programs, and when to begin them.

Also, "nearly all cancer organizations and groups"? I'm not even gonna ask how you quantified that one.

I'm glad you brought that back up because you have still not answered my question.

your saying that you honestly believe that a government task force comes out with new guidlines but a government run health insurance program is going to ignore it and just keep paying for those younger women's screenings?

Look, man, if government-run health insurance doesn't cover it once the recommendations become integrated in standard of care, that's not proof that it was done for the specific purpose of governmental cost constraint. You've been a big fan of accusing others of logical fallacies and weak arguments, surely you recognize this?

lol Lets try to demonize rather than logically prove wrong. I dont actually watch fox much, but your attempt to make it relevant to this thread is sad. I mean we can go back and forth right? Its easy to see you like Van Jones, no biggie, we can all fit under one tent. What the hell does that bring to the conversation exactly aside from emotionally charged red herrings?

My point was merely that you probably shouldn't pretend neutrality when it's relatively clear you're not.

After all, the attempt to tie these recommendations to cost-saving for government-run health care is, itself, a red herring. I mention Fox News because they tend to be the fishmonger offering deep discounts on this particular one.

 

[7starmantis]

That's what you asked for, that's what I gave you.

There is nontrivial harm caused by screening programs, and the younger you start those screening programs, the benefit becomes marginal. I'm not sure what the issue is here.

I'm glad you gave your opinion, I simply responded with my own. Thats how these things work, right?

The "issue" is that the gain for screening women in the 40-49 group is nearly identical to the gain for screening women in the 50-59 group. So why not avoid screening until 60. Then by the current "guidelines" we only have to pay for 15 years of screening for each women. That would save a lot more money. The assumption inherent in this argument is that "we" are paying for all the screenings. The continued use of the terms "health care system" as a payer. This is simply incorrect and really a disingenuous way to side step the real issues. Also, my issues have been posted with sources this whole thread, I'm certainly not going to re hatch them now.

These are recommendations, 7-star, not law. My personal belief is that physicians should follow current standard of care until that changes. These recommendations are merely the first volley in a long, difficult conversation that needs to be had about the costs (not just monetary) vs. benefits of screening programs, and when to begin them.

The truth is its easier to redefine my position and argue that than address my points. I never said anything about these being "law" but that they are governmental guidelines and a governmental payer is going to follow them. Thats going to create the same issues we have seen in many other "universal healthcare" systems where people die who could have been treated and cured if screened earlier. When it comes to screening, this is the best argument for HSA's. If the patient gets to decide on their screening schedule using their own money (or government donation) we avoid the issue altogether and leave the true decision in the hands of the patient and doctor. Its the same issue we say we want to fix with insurance companies that drop people with illness or refuse to pay for needed tests, etc. If that is so terrible, why would we create a solution that contains those very same mistakes?

Also, "nearly all cancer organizations and groups"? I'm not even gonna ask how you quantified that one.

Oh, sorry, my bad. I forgot, pre-meds love their "quantify" arguments. Just Google "US cancer organizations" and start reading their statements.

Look, man, if government-run health insurance doesn't cover it once the recommendations become integrated in standard of care, that's not proof that it was done for the specific purpose of governmental cost constraint. You've been a big fan of accusing others of logical fallacies and weak arguments, surely you recognize this?

I'm not arguing the intent behind the guidelines but the extent of their consequences. I think its extremely naive and "head in the sand" to think so valiantly about our elected officials, but to each his/her own. The problem is the guidelines are based on the argument of monetary savings. The studies used are old and incomplete, and not even designed to answer some of these questions. Plus, this whole thread is about the monetary gain created by the new guidelines. Dont change your tone now, I don't mind so much the debate about monetary gain, just when we let it blind us to the suffering and the dying.

My point was merely that you probably shouldn't pretend neutrality when it's relatively clear you're not.

I wasn't pretending neutrality or anything else, just asking questions and posting how I felt about them. Not sure why what I do or don't do has bearing on the facts and discussion at hand, but you can believe what you want about me, I could care less. Just present me facts and logical arguments and we're cool.

 

[redsquareblack]

The "issue" is that the gain for screening women in the 40-49 group is nearly identical to the gain for screening women in the 50-59 group.

Which is precisely the reason I'm not surprised these new recommendations set the age at 50, as opposed to the previous threshold of 40. By starting at 50, you reap the benefit of early detection and lives saved as a result, without adding to the harm of overdiagnosis and overtreatment.

The communication of these recommendations leaves quite a bit to be desired. And the issue is by no means resolved with the release of these recommendations. However, it is high time we as a nation begin discussing the costs vs. benefits of screening programs.

So why not avoid screening until 60. Then by the current "guidelines" we only have to pay for 15 years of screening for each women. That would save a lot more money.

That's a fair question (leaving aside the point that the costs aren't just monetary), 7star, and one I suspect will be debated in the near future.

The assumption inherent in this argument is that "we" are paying for all the screenings. The continued use of the terms "health care system" as a payer. This is simply incorrect and really a disingenuous way to side step the real issues. Also, my issues have been posted with sources this whole thread, I'm certainly not going to re hatch them now.

No one is suggesting that the "health care system" is a payor. "We" are paying for the screenings in the sense that annual screenings and their concomitant risks of overdiagnosis, overtreatment, etc., are expensive. If private health insurance premiums are affected by the volume of health care expenditures, then surely you can see that reducing the volume of expenditures might be a good thing. No one's trying to sidestep the issue. The health care system is one through which an awful lot of money moves on a daily basis. The more money that moves through unnecessarily or unwisely, the more that will be reflected in increased premiums.

Personally, I don't think the importance of these new recommendations is so much related to cost savings as I do think they represent a very significant step forward for evidence-based medicine. It will be an interesting discussion going forward, one which I hope will bear fruit.

The truth is its easier to redefine my position and argue that than address my points. I never said anything about these being "law" but that they are governmental guidelines and a governmental payer is going to follow them.

No, that's not right at all. USPSTF is an independent organization that makes recommendations. The USPSTF was created under Public Law, and has fulfilled its role since 1989, when it released its Guide to Clinical Preventive Services.

Whether those recommendations are adopted and become the standard of care is another thing altogether, and relies on providers to reach a consensus about their implementation.

Thats going to create the same issues we have seen in many other "universal healthcare" systems where people die who could have been treated and cured if screened earlier. When it comes to screening, this is the best argument for HSA's. If the patient gets to decide on their screening schedule using their own money (or government donation) we avoid the issue altogether and leave the true decision in the hands of the patient and doctor. Its the same issue we say we want to fix with insurance companies that drop people with illness or refuse to pay for needed tests, etc. If that is so terrible, why would we create a solution that contains those very same mistakes?

They're not the very same mistakes, 7star. But either way, HSA's aren't a great solution, either. Just ask Singapore what it thinks about such accounts. Total failure as a system. Perhaps as an adjunct, sure, but it's certainly not a solution to any particular problem.

Oh, sorry, my bad. I forgot, pre-meds love their "quantify" arguments. Just Google "US cancer organizations" and start reading their statements.

Dude, there's no reason to start getting derisive. Yes, I'm a pre-med. What of it?

I'm not arguing the intent behind the guidelines but the extent of their consequences. I think its extremely naive and "head in the sand" to think so valiantly about our elected officials, but to each his/her own. The problem is the guidelines are based on the argument of monetary savings.

By far the clearest indication thusfar that you've not actually read the USPSTF's recommendations.

The studies used are old and incomplete, and not even designed to answer some of these questions. Plus, this whole thread is about the monetary gain created by the new guidelines. Dont change your tone now, I don't mind so much the debate about monetary gain, just when we let it blind us to the suffering and the dying.

Um, actually these recommendations are based on new studies in addition to the studies that informed the 2002 recommendations.

I wasn't pretending neutrality or anything else, just asking questions and posting how I felt about them. Not sure why what I do or don't do has bearing on the facts and discussion at hand, but you can believe what you want about me, I could care less. Just present me facts and logical arguments and we're cool.

Personally, I find you to be an arrogant prick when you're arguing.

If you want opinions, then be content with them. If you'd prefer a debate with facts and logical arguments, specify such.

 

[7starmantis]

Which is precisely the reason I'm not surprised these new recommendations set the age at 50, as opposed to the previous threshold of 40. By starting at 50, you reap the benefit of early detection and lives saved as a result, without adding to the harm of overdiagnosis and overtreatment.

The communication of these recommendations leaves quite a bit to be desired. And the issue is by no means resolved with the release of these recommendations. However, it is high time we as a nation begin discussing the costs vs. benefits of screening programs.

That's a fair question (leaving aside the point that the costs aren't just monetary), 7star, and one I suspect will be debated in the near future.

You would need to show some proof that your "nontrivial harm" becomes "trivial" by starting at age 50 rather than 40 to support your post. Can you do so? You only reap the "benefits of early detection" for a certain age group while ignoring the nearly identical "benefits of early detection" for another age group. I'm sure your not implying "we as a nation" have not been discussing cost vs benefits of screening programs are you? If so, you are simply misinformed.

I was being sarcastic about not screening until age 60....its scary that you found that completely acceptable and logical.

No one is suggesting that the "health care system" is a payor. "We" are paying for the screenings in the sense that annual screenings and their concomitant risks of overdiagnosis, overtreatment, etc., are expensive. If private health insurance premiums are affected by the volume of health care expenditures, then surely you can see that reducing the volume of expenditures might be a good thing. No one's trying to sidestep the issue. The health care system is one through which an awful lot of money moves on a daily basis. The more money that moves through unnecessarily or unwisely, the more that will be reflected in increased premiums.

Sorry, I get confused between the two "dead horse" threads and was thinking of a quote from the other thread. However, if you believe "we" are paying for it, how do you think a public option is going to change that? The current bills do absolutely nothing to lower costs, in fact some suggest it will raise premiums..... I must be missing something.

Personally, I don't think the importance of these new recommendations is so much related to cost savings as I do think they represent a very significant step forward for evidence-based medicine. It will be an interesting discussion going forward, one which I hope will bear fruit.

Evidence based medicine taken by proxy? Your not talking about a group of oncologists who noticed a trend and did a study. Your talking about flawed logic based on even further flawed studies some over 30 years old, not designed to even address the questions we are trying to answer.

Its obvious you haven't read the links to the articles I posted.

Whether those recommendations are adopted and become the standard of care is another thing altogether, and relies on providers to reach a consensus about their implementation.

Right, because providers make the decisions on how patients afford procedures. 🙄 The insurance companies (which are being increased with a fed insurance company) certainly have no affect on patient care watsoever. 🙄

By far the clearest indication thusfar that you've not actually read the USPSTF's recommendations.

Um, actually these recommendations are based on new studies in addition to the studies that informed the 2002 recommendations.

Yeah so, wrong again, on both accounts.

Personally, I find you to be an arrogant prick when you're arguing.

If you want opinions, then be content with them. If you'd prefer a debate with facts and logical arguments, specify such.

I'm so glad you got that name calling in, it wouldn't have been the same old redsquare with it. I know, I know... your rubber and I'm glue....

I forgot that to ask for opinions meant I couldn't post again in the entire thread, or share my opinions, or discuss already posted opinions. 🙄

I've grown tired of these threads. As much as I enjoy being called names and having sources ignored, the thrill is gone. I'm afraid we have lost that special something.

 

[redsquareblack]

You would need to show some proof that your "nontrivial harm" becomes "trivial" by starting at age 50 rather than 40 to support your post. Can you do so? You only reap the "benefits of early detection" for a certain age group while ignoring the nearly identical "benefits of early detection" for another age group. I'm sure your not implying "we as a nation" have not been discussing cost vs benefits of screening programs are you? If so, you are simply misinformed.

You keep using this word cost. Perhaps it would help if I phrase it in terms of risk vs. benefit instead, as that is what the new recommendations are about, not really cost per se.

I've stated before that when to start screening really boils down to a value judgment. There is a point where risk outweighs benefit, but there isn't really an objective way to identify that point. It's entirely subjective. The USPSTF simply identified the threshold of 50 as that point, rather than the previous threshold identified in the 2002 recommendations.

Your phrasing is a little unclear, so I'm wondering what you mean by "ignoring the nearly identical benefits of early detection for another age group". I think you understand that the reduction in risk is roughly the same, whether you start at 40 or 50. In other words, there isn't a significant difference between starting at 40 or 50 in terms of mortality or risk reduction, but there is a non-zero increase in harm done in the way of overdiagnosis and overtreatment.

If you'd like a source, I'll be happy to supply one in a moment.

I was being sarcastic about not screening until age 60....its scary that you found that completely acceptable and logical.

Again, if you'd actually read the recommendations, you'd find that they discuss just this very item, so it's not all that scary when you use your noggin.

Essentially, they concede that the real benefit is found in screening between the ages of 60-69, and that the increase in benefit drops precipitously when you extend it to younger populations. Again, they simply identified the 50-year threshold as the acceptable balance of risk v. benefit.

Sorry, I get confused between the two "dead horse" threads and was thinking of a quote from the other thread. However, if you believe "we" are paying for it, how do you think a public option is going to change that? The current bills do absolutely nothing to lower costs, in fact some suggest it will raise premiums..... I must be missing something.

I'm not entirely sure when I stumbled into a thread about the public option. I thought I was responding to a thread regarding the Task Force guidelines. Though the two discussions may eventually impinge on one another, they remain distinct issues.

Personally, I don't think the Public Option is a particularly helpful solution to health care costs. The insurance market has proven itself to be pretty powerless to reduce costs, and I'm not entirely certain yet another addition to the market will be particularly helpful.

Evidence based medicine taken by proxy? Your not talking about a group of oncologists who noticed a trend and did a study. Your talking about flawed logic based on even further flawed studies some over 30 years old, not designed to even address the questions we are trying to answer.

Some of those same studies were used to inform the 2002 guidelines, as well. But apparently it's not an issue unless you dislike the conclusion.

Also, you don't actually have to be an oncologist to perform a literature review about cancer. Or are oncologists the only ones qualified to perform what amounts to epidemiological research? It's evidence-based medicine because... wait for it... they looked at the evidence, and presented their recommendations based thereon.

Its obvious you haven't read the links to the articles I posted.

Of course I did.

Right, because providers make the decisions on how patients afford procedures. 🙄 The insurance companies (which are being increased with a fed insurance company) certainly have no affect on patient care watsoever. 🙄

I admit I'm scratching my head right now. We're either talking about the recommendations and evidence-based medicine, or we're talking about health care reform. You seem to be conflating the two, which is a move I can't say I really understand.

Providers do determine standard of care. Not sure what it is about that you fail to understand.

Yeah so, wrong again, on both accounts.

Wait, so 2009 isn't recent enough?

http://www.annals.org/content/151/10/738.abstract

Appears in the same issue of Annals of Internal Medicine, and was one of the studies used in the new recommendations.

I forgot that to ask for opinions meant I couldn't post again in the entire thread, or share my opinions, or discuss already posted opinions. 🙄

If only you did that, 7star. You tend to ask for opinions or input and then get unnecessarily abrasive in your responses. The new recommendations just aren't as political as you seem to be trying to make them, so you'll have to forgive me if I don't agree with you that this represents the opening volley in cost-containment for government-run health care.

It's the recommendation of an independent task force after reviewing the literature on the benefit of screening. It's really, really, really nothing more. What is more, it's a starting point for discussion, not the endgame.

 

[7starmantis]

Dood, this will probably be my last post in here, its getting thick and I'm tired. Let me respond to a few things and then I'm out.

I've stated before that when to start screening really boils down to a value judgment. There is a point where risk outweighs benefit, but there isn't really an objective way to identify that point. It's entirely subjective. The USPSTF simply identified the threshold of 50 as that point, rather than the previous threshold identified in the 2002 recommendations.

So if its "entirely subjective" why would we offer guidelines at all, or change those that were already laid out? I dont really follow.

This is exactly my reason for opposing a government run health insurance program. You say there is no objective way to identify the point, but then a public option" is going to do just that. You can call me names, say I'm dense, even call me Glen Beck, but no one to date has touched the issue of a governmentally run insurance program and their un/willingness to pay for screenings that are "so obviously" (/sarcasm) harmful or at least unnecessary. Its important to address before we make these things (bills) laws. If it wont interfere, why not put that in writing in the bill itself? Sound so terrible?

Essentially, they concede that the real benefit is found in screening between the ages of 60-69, and that the increase in benefit drops precipitously when you extend it to younger populations. Again, they simply identified the 50-year threshold as the acceptable balance of risk v. benefit.

But I thought it was "entirely subjective"?

Some of those same studies were used to inform the 2002 guidelines, as well. But apparently it's not an issue unless you dislike the conclusion.

Why apparently? Do you know my opinions on the 2002 guidelines as well? Thats simply not the point of this thread, start another one if you want to discuss that.

Also, you don't actually have to be an oncologist to perform a literature review about cancer. Or are oncologists the only ones qualified to perform what amounts to epidemiological research? It's evidence-based medicine because... wait for it... they looked at the evidence, and presented their recommendations based thereon.

It's the recommendation of an independent task force after reviewing the literature on the benefit of screening. It's really, really, really nothing more. What is more, it's a starting point for discussion, not the endgame.

I'm glad you taught me that, I thought only oncologist could use the term "cancer". Dont be a dolt, I guess evidence based has gotten a much broader and looser meaning since medicine has become so political.

I'm not saying its anything else, stop trying put words in my mouth, I'm saying its a glimpse into how the "public option" will make cost containment decisions. Thats all.

 

[redsquareblack]

I'm saying its a glimpse into how the "public option" will make cost containment decisions. Thats all.

🙄

Was. Not. About. Cost. Containment.

Was. About. Risk. Versus. Benefit.

Which you'd know if you'd read it.

 

[RogueUnicorn]

🙄

Was. Not. About. Cost. Containment.

Was. About. Risk. Versus. Benefit.

Which you'd know if you'd read it.

just stop. this bonehead is not worth the time.

 

[Dentalogist]

🙄

Was. Not. About. Cost. Containment.

Was. About. Risk. Versus. Benefit.

Which you'd know if you'd read it.

i agree some people can be ignorant

 

[Catalystik]

i agree some people can be ignorant

You are bumping up a 6-year old thread because . . . .?