…is bad for the gander.
So says the U.S. Preventive Services Task Force. The subject matter is PSA tests for routine prostate cancer screening, and here’s the post I wrote about that very same panel’s recommendations on mammograms for women (those geese I refer to in the title above).
One by one, the tests that doctors recommend as valuable tools for early diagnosis, or the gift of relief, are being touted by – dare I say it – Death Panels as unnecessary for the general public. What’s next, I wonder.
All cancers are different, very different in possibility of detection and in their prognosis. Prostate cancer is very frequent condition, almost one in three men above 60 has it, but in most cases it is relatively benign, slowly growing and rarely gives metastases. Average life expectation after diagnosis is 15 years. (And this above 60+.) But PSA test can’t differentiate rare aggressive forms from mostly benign ones. And no other test can’t do it either. So early diagnosis of prostate cancer does not save lives, but can greatly enhance anxiety and produce grave side effects from treatment whose benefits are quite doubtful and in most cases nonexistent.
Sergey, tell that to my HS buddy (48 when detected) whose cancer had spread to his spine by the time it was caught. He’s still alive but luckily so. And tell that to me, 47, just diagnosed through PSA screening (DRE was negative). I had a prostatectomy and am now cancer free. My cancer was aggressive so 3 more years could have proved fatal for me. You are repeating liberal talking points you should keep to yourself.
Sergey is quite wrong. The magnitude of PSA elevation categorically relates to biologic behavior, and thus prognosis. The Geason score on the prostate biopsy does the same. These ‘tools’ exist for a reason: to reasonably assess the danger, or lack thereof, of the cancer to the patient.
And, Sergey, ‘average” survival does not mean all prostate cancers have 15 years from dignosis. You surely are sufficiently mathematically competent to know that.
There will be published next week a refututation by oncologists of this absurd recommendation. The Preventive Services Task Force members are PRIMARY CARE physicians, not cancer experts. If these people were cops, they’d be directing traffic, not investigating homicides.
My father died from prostate cancer. He relied on socialized medicine in New Zealand and it did nothing for him. It also did a crappy job of helping him die in peace. I’m pretty certain he would have lived much longer had he lived in the US and had regular PSA examinations.
Don Carlos has it right.
Sarah Palin’s Death Panel is back.
It’s the great hypocrisy of the bureaucratic class that amazes me. We are constantly told that early detection of fatal disease reduces medical costs (by avoiding later-term more invasive, extreme and costly procedures). Yet, the initial phases of Obamacare routinely seek to reduce diagnostic procedures to cut costs and, by there own logic make later-term, invasive, extreme and costly procedures more necessary. That is unless the plan is to deny THOSE procedures, too.
So then we might sum up Obamacare by saying “Take two aspirin and call me in the morning—if you’re still here.” Now THERE’S affordable health care.
BTW, I am a three-time cancer survivor. In all three instances I survived due to early detection and three great Docs. No question of where I stand on “unnecessary” routine screening.
I would not perform this test even for free. I do not want to know something which I would not know how to react. I prefer to rely on God’s grace. If there were more informative test, this could have changed all risk/benefit/cost calculation. As it stands now, this does not worth trouble.
If your life satisfies you, enjoy it. If it does not, drink cyanide. But desperately struggling for just stay alive does not worth effort. It is too humiliating.
Early detection never reduce costs. It can save lives, but that is all. Economically there is no advantage in extending diagnostics.
Medicine is not a science, never was and never will be. This is an art. Some doctors have it, most do not. I would better consult an astrologist and seek treatment from a homeopath rather from medical doctor. These people know more about art and fate.
Early detection can reduce costs when compared to the cost of fighting a more advanced case of cancer. The removal of a cancerous cyst in breast tissue, for example, is much less expensive and painful than a mastectomy and breast reconstruction, without even considering possible radiation and chemotherapy.
Sergey, if you want to consult an astrologist when you are ill, please feel free to do so, although I would guess that good ones are harder to find than good doctors. For myself, my family, and I hope, my friends, we will seek out the doctors who continue to help humanity by refuting and defying fate.
Sergey’s thinking is pretty addled. His postings above are convincing testimony.
I am reminded of some of his past postings, in which he intimated a scientific background. Now he trusts in God, although a different cost-benefit from screening would change his view, so he doesn’t trust God very much either.
Hey, Sergey, the life expectancy of the white American male (I am one) has gone up almost 20 years since Social Security was instituted….Go ahead with your cyanide; the rest of us will struggle on, one step at a time. That is listening to God’s will for us.
And pay attention to your grammar. Or were you under the influence?
If I recall correctly, I was in total agreement with the assessment handed down about the PSA, and the other topic. Too many false positives, and even many of the positives are not necessarily ever going to end up with a serious problem. I don’t know about prostate cancer, but from what I read up to 60% of breast cancer would not become a problem in the lifetime of the woman with it.
Still, considering that the government is set to take over US medical, depending on what happens to Obamacare, I have to suspect this isn’t medical, but financial in effect. It is the first shots from the “kill panel”. Sometimes though bad decisions end up being the right ones, if for all the wrong reasons. All good here.
@2:41 Sergey wrote: “Early detection never reduce costs.”
My point above (@ 1:44 AM) is that we are contstantly TOLD that early detection reduces costs by the same people who work to limit or eliminate early detection techniques.
Susannamantha you restate my point succinctly. Thank you.
The U.S. Preventive Services Task Force
What a name. Unbelievable really. Orwellian.
Doom:
What is an acceptable rate of false positives for you?
Kindly remember that PSA is a screening test, not a diagnostic test.
Two words: watchful waiting.
Don,
That 60% isn’t false positives, though that is rather high too. I can’t recall exactly, but I thought that had been in the 25% range. Now, you can’t just add 60% of cancers not becoming dangerous plus 25% of false positives that are wrongly treated in the first place, but it adds up to a LOT of unnecessary anguish. In my book, that means most treatment is bad. If they could get the percentages down into the 10%, or even 15%, then I’d bite.
Just add up how many women are being unnecessarily treated and what it does to their lives, their husband’s and children’s lives, their careers, their income, plus the costs, and as is, it’s not worth the screening. Heck, I would bet at those numbers more women die from the “cure” than die from the stinking disease!
Die unnecessarily, that is.
1. USPSTF is funded by the government.
2. The government is trying to cut costs for healthcare that they pay for.
3. Marching orders: Downgrade recommendations for screening tests, which might lead to expensive diagnostic studies.
4. Mission accomplished.
The reality? Many (most?) medical practitioners regard the Task Force recommendations as unrealistic, and have value only as the Weatherman for which way the government wind is driving healthcare.
Reminder: False positives suck, false negatives are heartbreaking, true positives are the worst, but also the best if a screening discovers a problem early enough for long-term remission or cure.
Steve,
I agree with these last too comments from you. It is just that doctors have their own agenda, and to some unknown but significant degree that comes down to making money. Procedures, needed or not, make money. There are both sides to that coin and I think doctors are just as guilty of stretch as the government. Since many procedures are already government paid, one could argue that the debate is an internal government one, so no side is necessarily choosing for the patient, rightly, or on some moral high ground, but each speaks for their own interests.
And, your final post? Absolutely. But unless they make true positives accurate enough, and can filter out the unneeded (60%), then they really don’t know what they are doing, literally. What is the first rule of medicine? Do no harm, put very simply. They fail here.
“Do no harm” has its roots some 2000 years ago, and is today only applicable by therapeutic nihilists. For example, if an antibiotic is highly effective at curing a bacterial infection with a 20% (untreated) mortality rate but causes a fatal anaphylactic reaction once in 20,000 cases, does the “First, do no harm” doctrine apply?
Doom: you have not responded to my query of 23 May. Chicken?