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Message
re: Why did the american cancer society ignore the evidence on early detection?
Posted on 10/25/15 at 9:28 am to AUCE05
Posted on 10/25/15 at 9:28 am to AUCE05
Money.
And they have a new way to lead tits to the basin. BRCA screening. Those screening tests will make up for the mastectomies lost due to decreased mammograms. In addition where are women with a positive BRCA screen sent? Mammogram. Sometimes.
Other times just a double mastectomy done with no evidence of a mass?
I would have a hard time having my nuts removed if there were a TESTCA study. If it were positive but my nuts were fine? But I had a chance? Just a chance of ball cancer you take my balls off.
Follow the money. There's no shortage of mammograms and mastectomies being done.
And they have a new way to lead tits to the basin. BRCA screening. Those screening tests will make up for the mastectomies lost due to decreased mammograms. In addition where are women with a positive BRCA screen sent? Mammogram. Sometimes.
Other times just a double mastectomy done with no evidence of a mass?
I would have a hard time having my nuts removed if there were a TESTCA study. If it were positive but my nuts were fine? But I had a chance? Just a chance of ball cancer you take my balls off.
Follow the money. There's no shortage of mammograms and mastectomies being done.
1
Posted on 10/25/15 at 9:34 am to RedRifle
I don't agree with this at all. Tumors that are detected early can be treated much more effectively than tumors discovered because of their side effects. If you discover a tumor because you're coughing up blood, you're gonna die, and it's gonna be pretty soon. If you discover a tumor during a mammogram, you're much more likely to be able to treat it and live
Yea these tests cost money, and there are false positives, but every tumor detected is a life saved, since most early detection tumors are highly treatable. If you want to ignore that fact, go ahead. Statistically you should be ok, but I'd rather be safe than sorry. It's a life or death issue, and it's far more important than the money you save by not being tested
Yea these tests cost money, and there are false positives, but every tumor detected is a life saved, since most early detection tumors are highly treatable. If you want to ignore that fact, go ahead. Statistically you should be ok, but I'd rather be safe than sorry. It's a life or death issue, and it's far more important than the money you save by not being tested
Posted on 10/25/15 at 9:36 am to RedRifle
Every organization will have their different recommendations for screenings, some of the more specific organizations (American Cancer Society) are driven by special interests. On the phone so I'm not going to be super detailed ,but there is evidence that widespread mass screening is not beneficial in terms of mortality as a whole.
The Uspstf, which looks at all the evidence available and isn't necessarily driven by money, recommends only receiving biennial (every two years) mammograms starting at the age of 50. Not this bs of yearly screening at 40 + monthly self exams.
Hell, women don't need pap smears but every 3-5 years depending on age subset, yet that doesn't stop all the OBs I know from doing one every single year. Over screening is a very real thing that often leads to unnecessary costs and anxiety for those involved.
The Uspstf, which looks at all the evidence available and isn't necessarily driven by money, recommends only receiving biennial (every two years) mammograms starting at the age of 50. Not this bs of yearly screening at 40 + monthly self exams.
Hell, women don't need pap smears but every 3-5 years depending on age subset, yet that doesn't stop all the OBs I know from doing one every single year. Over screening is a very real thing that often leads to unnecessary costs and anxiety for those involved.
Posted on 10/25/15 at 9:43 am to nes2010
quote:
Because they are in bed with the mammography industry. Its about money, not a cure.
You lost me here. The truth is there is no money in mammography. Even the busiest centers are hard pressed to finish in the black. Reimbursement is a pittance and the number of unfunded patients is huge. Operational costs are high for personnel, licensure, MQSA and evolving technology.
The money is being made by Surgeons and Oncologists with pharma getting a hand out too.
In Oncology as a whole there is evolving discussion about screening programs and overdiagnosis. Early detection does give a better chance of successful treatment. There is now an argument that many of these tumors would not have proven life threatening to begin with making any treatment unnecessary or harmful. It's not limited to breast cancer, the literature about prostate cancer screening is very controversial too.
Posted on 10/25/15 at 9:46 am to RedRifle
Cancer is big money and advanced cancer is even bigger money.
Posted on 10/25/15 at 9:47 am to LSU alum wannabe
quote:
BRCA screening. Those screening tests will make up for the mastectomies lost due to decreased mammograms.
Completely, totally different ballgame. BRCA testing does not apply to general public at large, and is in no way applicable as a low-risk screening tool. Relatively few women are appropriate candidates for appropriate BRCA screening, and even fewer will test positive. This is a small pool, and is a completely different animal from routine mammography.
And as far as "getting kitties in the basin" prophylactic mastectomy at the right age is an appropriate option if the genetics are there, but again, these are small numbers we are talking about her with regards to BRCA related breast cancers, and risks are real for the women (and occasionally men) who are unfortunate to carry those mutations in their cell lines.
I'm not a breast surgeon and I'm not a radiologist, but I care about how healthcare dollars are allocated, and just because screening recommendations have changed doesn't mean there has been a wholesale conspiracy over time. Good systems continually collect and evaluate data, and change when good data and clinical experience dictates so.
Posted on 10/25/15 at 10:46 am to RedRifle
Are people trying to say late detection is better than early? This is strictly about cost cutting.
Posted on 10/25/15 at 12:15 pm to uway
Biomed research and the integration into medical care is broken and has been for quite some time. About 70 years some flawed experiments and poor inference lead people to believe testosterone caused prostate cancer. Testosterone got blamed for heart disease as well. There has never been evidence that either is true. It's been assumed. It's guided research funding, research ideas, guidelines, treatment, etc. The people that create or accept such dogma are also the ones publishing the most research, guiding funding, writing recommendations. Not hard to see why things go off the rails.
Doctors don't know physiology and they don't know pharmacology and they don't know research methods and statistics. Those are the three main items underpinning all biomed research reports. The volume of research is too immense to get a grasp of. Back in the 90s some math was done on how many articles come out that are relevant to Internal Medicine practitioners. They determined docs would have to read about 120 articles per day, every day of the year, in order to keep up with the literature. That can't be done. Even if docs only read the abstracts, at one minute per abstract that's 2 hours. That doesn't include trying to make sense of it all. There's simply no time for doctors to keep up with everything. They have to rely on summary reports and guidelines.
Another problem is that those doing the research are primarily judged on the number of publications they have and the dollars in grants they receive. Grant funding is very strongly tied being established in your field (meaning you have a lot of publications).
The life of a researcher is essentially: churn out pubs, write grant apps, get funded. Rinse and repeat. Tens or hundreds of millions are essentially wasted every year in cancer research because of this model. When a grant is funded and they will look at tissue samples, they may get funding to buy a freezer to keep the tissue specimens in. Half or less of each specimen is typically used. What happens when the papers are written and the funding expires? They unplug the freezer or sell it, and ignore the specimens remaining. They got their pubs and prep'd for the next grant right? Well, when the next breakthrough in tissue analysis comes out, guess what, they can't repeat tests and such on these samples because they've spoiled. Now stuff has to done from scratch.
Why are grants so important? Because they have direct and indirect costs. Direct covers the research. Indirect is a percentage of the direct, on top of the direct, that goes to the institution. It's income.
The quality of research is far down the priority list. So even when doctors try to keep up, they are often reading bad science. And, not being experts in those three big areas, they don't know they're reading bad science.
Journals are another problem. They want "high impact" publications. They look for spectacular findings, whether they are right or not, and when they have an article that is called out for being subpar they generally fight to prevent from having to retract it. Example, the New England Journal of Medicine has been around since 1812. There are no articles it's published, indexed in MEDLINE / PUBMED, that are retracted. This includes research they published about Vioxx (internet search for that scandal, it's a doozy). NEJM only gave an "expression of concern" about that research article when they found out it would be used in court during litigation about the drug. This behavior does nothing to insure your doctor is getting the best evidence out there.
Finally, study game theory and you'll find that when you add massive government involvement into the medical system, it's a recipe for disaster. The interplay between 'rational actors' becomes inefficient and guided by outside influences. Litigation hurts as well, which is why you will sometimes get your doctor wanting to do tests and such that you don't need. Some of them are considered 'standard of care'. Failure to follow them opens up for malpractice even when they do nothing but cost money, take up time, and plug up the labs and give additional worry to patients.
If you write TL;DR as a response, I will hunt you down.
Doctors don't know physiology and they don't know pharmacology and they don't know research methods and statistics. Those are the three main items underpinning all biomed research reports. The volume of research is too immense to get a grasp of. Back in the 90s some math was done on how many articles come out that are relevant to Internal Medicine practitioners. They determined docs would have to read about 120 articles per day, every day of the year, in order to keep up with the literature. That can't be done. Even if docs only read the abstracts, at one minute per abstract that's 2 hours. That doesn't include trying to make sense of it all. There's simply no time for doctors to keep up with everything. They have to rely on summary reports and guidelines.
Another problem is that those doing the research are primarily judged on the number of publications they have and the dollars in grants they receive. Grant funding is very strongly tied being established in your field (meaning you have a lot of publications).
The life of a researcher is essentially: churn out pubs, write grant apps, get funded. Rinse and repeat. Tens or hundreds of millions are essentially wasted every year in cancer research because of this model. When a grant is funded and they will look at tissue samples, they may get funding to buy a freezer to keep the tissue specimens in. Half or less of each specimen is typically used. What happens when the papers are written and the funding expires? They unplug the freezer or sell it, and ignore the specimens remaining. They got their pubs and prep'd for the next grant right? Well, when the next breakthrough in tissue analysis comes out, guess what, they can't repeat tests and such on these samples because they've spoiled. Now stuff has to done from scratch.
Why are grants so important? Because they have direct and indirect costs. Direct covers the research. Indirect is a percentage of the direct, on top of the direct, that goes to the institution. It's income.
The quality of research is far down the priority list. So even when doctors try to keep up, they are often reading bad science. And, not being experts in those three big areas, they don't know they're reading bad science.
Journals are another problem. They want "high impact" publications. They look for spectacular findings, whether they are right or not, and when they have an article that is called out for being subpar they generally fight to prevent from having to retract it. Example, the New England Journal of Medicine has been around since 1812. There are no articles it's published, indexed in MEDLINE / PUBMED, that are retracted. This includes research they published about Vioxx (internet search for that scandal, it's a doozy). NEJM only gave an "expression of concern" about that research article when they found out it would be used in court during litigation about the drug. This behavior does nothing to insure your doctor is getting the best evidence out there.
Finally, study game theory and you'll find that when you add massive government involvement into the medical system, it's a recipe for disaster. The interplay between 'rational actors' becomes inefficient and guided by outside influences. Litigation hurts as well, which is why you will sometimes get your doctor wanting to do tests and such that you don't need. Some of them are considered 'standard of care'. Failure to follow them opens up for malpractice even when they do nothing but cost money, take up time, and plug up the labs and give additional worry to patients.
If you write TL;DR as a response, I will hunt you down.
Posted on 10/25/15 at 12:57 pm to sullivanct19a
quote:
Biomed research and the integration into medical care is broken and has been for quite some time. About 70 years some flawed experiments and poor inference lead people to believe testosterone caused prostate cancer. Testosterone got blamed for heart disease as well. There has never been evidence that either is true. It's been assumed. It's guided research funding, research ideas, guidelines, treatment, etc. The people that create or accept such dogma are also the ones publishing the most research, guiding funding, writing recommendations. Not hard to see why things go off the rails.
Doctors don't know physiology and they don't know pharmacology and they don't know research methods and statistics. Those are the three main items underpinning all biomed research reports. The volume of research is too immense to get a grasp of. Back in the 90s some math was done on how many articles come out that are relevant to Internal Medicine practitioners. They determined docs would have to read about 120 articles per day, every day of the year, in order to keep up with the literature. That can't be done. Even if docs only read the abstracts, at one minute per abstract that's 2 hours. That doesn't include trying to make sense of it all. There's simply no time for doctors to keep up with everything. They have to rely on summary reports and guidelines.
Another problem is that those doing the research are primarily judged on the number of publications they have and the dollars in grants they receive. Grant funding is very strongly tied being established in your field (meaning you have a lot of publications).
The life of a researcher is essentially: churn out pubs, write grant apps, get funded. Rinse and repeat. Tens or hundreds of millions are essentially wasted every year in cancer research because of this model. When a grant is funded and they will look at tissue samples, they may get funding to buy a freezer to keep the tissue specimens in. Half or less of each specimen is typically used. What happens when the papers are written and the funding expires? They unplug the freezer or sell it, and ignore the specimens remaining. They got their pubs and prep'd for the next grant right? Well, when the next breakthrough in tissue analysis comes out, guess what, they can't repeat tests and such on these samples because they've spoiled. Now stuff has to done from scratch.
Why are grants so important? Because they have direct and indirect costs. Direct covers the research. Indirect is a percentage of the direct, on top of the direct, that goes to the institution. It's income.
The quality of research is far down the priority list. So even when doctors try to keep up, they are often reading bad science. And, not being experts in those three big areas, they don't know they're reading bad science.
Journals are another problem. They want "high impact" publications. They look for spectacular findings, whether they are right or not, and when they have an article that is called out for being subpar they generally fight to prevent from having to retract it. Example, the New England Journal of Medicine has been around since 1812. There are no articles it's published, indexed in MEDLINE / PUBMED, that are retracted. This includes research they published about Vioxx (internet search for that scandal, it's a doozy). NEJM only gave an "expression of concern" about that research article when they found out it would be used in court during litigation about the drug. This behavior does nothing to insure your doctor is getting the best evidence out there.
Finally, study game theory and you'll find that when you add massive government involvement into the medical system, it's a recipe for disaster. The interplay between 'rational actors' becomes inefficient and guided by outside influences. Litigation hurts as well, which is why you will sometimes get your doctor wanting to do tests and such that you don't need. Some of them are considered 'standard of care'. Failure to follow them opens up for malpractice even when they do nothing but cost money, take up time, and plug up the labs and give additional worry to patients.
Valid points
There is a presumption (mainly from patients) that more testing is better for patients. Often times unnecessary testing leads to unnecessary followup testing (with escalating levels of invasiveness) in part due to factors you have outlined very well.
In the well selected patient, less testing/screening is appropriate. There are high risk folks that testing does benefit.
Like anything in life it is risk assessment on an individual/case by case basis.
Personally, I am a big fan of primary prevention via diet, exercise and lifestyle design.
This post was edited on 10/25/15 at 12:58 pm
Posted on 10/25/15 at 1:06 pm to ThinePreparedAni
quote:
Personally, I am a big fan of primary prevention via diet, exercise and lifestyle design.
Agree.
Also, another example of biomed research being broken. We have very little understanding, relative to other topics, regarding these fundamental items.
Posted on 10/25/15 at 1:45 pm to uway
quote:
Are people trying to say late detection is better than early? This is strictly about cost cutting.
It is my understanding that the basic problem is we have been using the same philosophy for cancer treatment since the early 1900s, which is if the cells looks like cancer get rid of or kill them by whatever means necessary. Using that as a guideline would mean finding them as early as possible would give the best treatment outcome, but it is now known that not all cancers are not created equal, some will grow, some will remain dormant, some will go into remission, the problem is identifying which is which. Because of this questions are now being raised if it is wise to subject a person to screenings that have their own risks and side effects, to find a cancer that may not become an issue in a persons average lifetime. Again this is just my simplistic understanding of the issue.
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