Comments on: Mammography Debate Rages After USPSTF Recommendation Changes

By: PierceNichols

PierceNichols — Thu, 19 Nov 2009 19:44:48 +0000

Health care is not an economic issue.

Nonsense. Unless rigorous and on-going cost-benefit analyses are part of healthcare policy making, resources will be mis-allocated to the highest profile purposes rather than the most effective.

By: PierceNichols

PierceNichols — Thu, 19 Nov 2009 19:42:12 +0000

Anxiety is a pretty catch-all term. I know from experience that even having reason to believe you may have been exposed to a deadly disease (before testing excludes the possibility) is a thoroughly rattling experience. I can’t imagine how horrible it would be to get an actual false positive diagnosis.

Orac made an excellent point in his analysis of this issue (http://scienceblogs.com/insolence/2009/11/really_rethinking_breast_cancer_screenin.php#more) that the evidence shows that screening of the general population of women in their 40s for breast cancer is not terribly effective — ~1900 women have to be screened (that’s ~19,000 mammograms) in order to save a single life. That’s a cost of millions of dollars in screening mammograms alone, let alone the cost of running down the false positives.

Are you sure there’s no more effective way to spend that money?

By: TalkingStick

TalkingStick — Thu, 19 Nov 2009 00:38:21 +0000

Men can’t interpret scientific data? Women automatically know better? That sounds like you’re politicizing science instead of focusing on the facts.

An aspect of good science is clear definition of terms. When one speaks of harm from false positive results being anxiety in the patient I think women do have more to offer than men in regards to breast cancer. I am also humbly aware that as pertains to prostate cancer, what I as a female might consider significant is likely quite different from what the average male would.

By: ImprobableJoe

ImprobableJoe — Wed, 18 Nov 2009 23:02:30 +0000

Men can’t interpret scientific data? Women automatically know better? That sounds like you’re politicizing science instead of focusing on the facts.

By: Margot

Margot — Wed, 18 Nov 2009 22:56:47 +0000

Health care is not an economic issue. It is a human rights issue.

Amen.

By: TalkingStick

TalkingStick — Wed, 18 Nov 2009 22:43:15 +0000

I am not conversant with all the documenting studies but: I do know that after routine mammography was introduced deaths from breast cancer decreased by 30% A more precipitous drop than by any therapeutic regime. The multiple modality treatments by my personal interpretation have not improved that much in the past 30+ years. In other words the best treatment we have is early diagnosis.

Prostate cancer is a different situation but I do not have the knowledge to comment.

By: zpdm123

zpdm123 — Wed, 18 Nov 2009 22:25:40 +0000

I guess the question is does earlier detection improve one’s health. There is such a thing as “detection bias” where when you look for a disease you can find it earlier and so it looks like a patient is living longer, but if you had not tested they would have lived just as long but they would have been diagnosed later and appeared to have died more quickly from the disease. It boils down to whether the treatments for breast cancer are effective. I don’t know, will say that last I checked there is no treatment for prostate cancer that improves overall survival.

http://healthjournalclub.blogspot.com/

By: TalkingStick

TalkingStick — Wed, 18 Nov 2009 21:53:02 +0000

In all respect to the good thinker pups. I think there is a lot of naivete’ going on here. It is coupled with a limited understanding just how the science works.

This study is not science. It is a statistical exercise that measures only a few short term factors. If the Guttmacher people think the insurance companies or the government as in Medicare pay that much attention to doctors they are naive also.

Among other likely aims, this is a process the right wing and insurance companies have been encouraging for some time under the mantra of choice or consumer driven medical care with the ultimate outcome of pre-paid care calling itself insurance. Meaning the rich can purchase a policy for mammograms or abortion etc. The poor are again left behind.

The even more remarkable long term effect is a cafeteria of medical treatments to select from, which enfeebles the responsibilities of the physicians who are trained to know the science to advocate and operate in the best interest of their patients and the public health.

I have an excellent article from JAMA on consumer driven medical care I can share on a personal basis. talkingstick at windstream.net

Health care is not an economic issue. It is a human rights issue.

By: Twain

Twain — Wed, 18 Nov 2009 21:33:37 +0000

The Science is not being displaced. It is being vigorously debated and questioned – especially by women who know better. It is political because of the current health care mess and I think the insurance companies would like very much to get out of the cost of mammograms.

By: kirk murphy

kirk murphy — Wed, 18 Nov 2009 21:28:25 +0000

David,thanks for this post: I very much hope the Guttmacher’s expert is correct in expecting docs will still have the freedom to order the studies required to evaluate and diagnose breast cancer.

The expert’s basis for his prediction doesn’t inspire much confidence

“It depends on whether doctors will agree with the recommendations, and if they don’t, I can’t imagine that insurance companies would want to upset their doctors and deny coverage to things they find medically necessary.”

If that’s what the Guttmacher’s health care expert believes, they need to find a new “expert”. He’s either confabulating, delusional, or simply lying.

“The Guttmacher Institute in 1968 was founded as the “Center for Family Planning Program Development”, a semi-autonomous division of The Planned Parenthood Federation of America. ”

From looking at the Guttmacher’s parent institution’s history with Lieberman and Stupak, my bet’s on lying.