Rationing Health Care? [Archive]

chuck34

17th November 2009, 14:12

Is this the start of rationing health care?

http://www.cnn.com/2009/HEALTH/11/16/mammography.recommendation.changes/index.html

"Women in their 40s should not get routine mammograms for early detection of breast cancer, according to updated guidelines set forth by the U.S. Preventive Services Task Force."

"The group's previous recommendation was for routine screenings every year or two for women age 40 and older."

"The organization (American Cancer Society) says it looked at virtually the same data as the task force but came to a different conclusion. "Breast cancer is a serious health problem facing adult women, and mammography is part of our solution beginning at age 40 for average-risk women," it says. It recommends annual exams beginning at that age."

"Others fear insurance coverage of mammograms could be dropped based on the new recommendations."

"Certainly mammography does pick up things at [age] 45 that would have been much more serious in five years," said Dr. Anne Wallace, director of the University of California-San Diego Moores Breast Cancer Program."

Just a few selected quotes. But it's fairly interesting. What other factor could there possibly be for this other than cost? To me this is clearly a case of a government run group (U.S. Preventive Services Task Force), looking at the costs of care and making a decision based solely on that. If anyone can find an oncologist that agrees with these findings then I might change my mind. I also heard on the TV report of this story on CNN that there are NO oncologists on this "Task Force". So again what could they possibly be looking at besides cost?

So does anyone still believe that there won't be any rationing under "Universal" health care? What about those profits? They may not be a decision driver under government run health care, but what about costs?

GridGirl

17th November 2009, 19:19

I suppose you have to look at the breast cancer rates for those under the age of 45 and more specifically the costs of the test against the detection of cancer rates of women between the ages of 40 and 45.

I do think there is more awareness of what to look for yourself in terms of self detection. All women should do regular breast examinations themselves. I do and found a lump a few years ago and within two weeks I'd seen a specialist and found that is was nothing.

As a side note men should also regulaly examine themselves too. One of my male friends finally decided to do something about his lump and sadly died two weeks after being diagnosed with testicular cancer even though he'd know it was their for some time. On a more positive note a different friend did do something early and has lived to tell the tale. :) He bought a 4.6l supercharged Jaguar with his life insurance pay out so he wasn't that bothered when we later teased him about it.

Malbec

17th November 2009, 20:43

Just a few selected quotes. But it's fairly interesting. What other factor could there possibly be for this other than cost? To me this is clearly a case of a government run group (U.S. Preventive Services Task Force), looking at the costs of care and making a decision based solely on that. If anyone can find an oncologist that agrees with these findings then I might change my mind. I also heard on the TV report of this story on CNN that there are NO oncologists on this "Task Force". So again what could they possibly be looking at besides cost?

So does anyone still believe that there won't be any rationing under "Universal" health care? What about those profits? They may not be a decision driver under government run health care, but what about costs?

To answer your second question first rationing takes place in all healthcare systems anywhere and everywhere, the US included. It isn't a new thing, its been around since the dawn of medicine.

Secondly regarding mammography there ARE other factors involved, namely that the radiation involved in mammography can induce cancer itself and that the number of false positives increases the younger the patient and the denser the breast tissue. The cost of investigating false positives (I'm not just talking about financial cost but stress, anxiety etc etc as well) in X-raying what is still dense breast tissue is also pretty high. Most countries do not performing screening mammography on women under 50 unless they are in a high risk group because the risk/benefit ratio isn't good enough.

Finally there isn't much reason for an oncologist to be on the 'task force' because screening mammography isn't an oncological speciality, its a radiological one. Now if there isn't a radiologist on the task force then that would be odd.

chuck34

17th November 2009, 20:54

I do think there is more awareness of what to look for yourself in terms of self detection. All women should do regular breast examinations themselves. I do and found a lump a few years ago and within two weeks I'd seen a specialist and found that is was nothing.

Then you may find this bit interesting.

http://www.foxnews.com/politics/2009/11/17/critics-health-care-rationing-new-breast-cancer-screening-recommendations/
"The guidelines also downplay the effectiveness of self-examinations"
"I'm not impressed by mammograms in general," said Braverman, who called manual examinations a "total failure."

However, in that article they are at least supporting an alternative treatment.
"I support the new guidelines because I think it will lead to better testing. [The ultrasound] is a better screening procedure that's safer and easier and picks up things fast," he said, adding that he thinks women should receive ultrasounds as part of their routine medical exams, beginning at an early age."

chuck34

17th November 2009, 21:06

To answer your second question first rationing takes place in all healthcare systems anywhere and everywhere, the US included. It isn't a new thing, its been around since the dawn of medicine.

Yes, but we've been told over and over that there will be NO rationing of care under the government "option". Can you really tell me that is not the case? And if rationing occurs in the private and the public plans, tell me again why I would want the public plan?

Secondly regarding mammography there ARE other factors involved, namely that the radiation involved in mammography can induce cancer itself and that the number of false positives increases the younger the patient and the denser the breast tissue. The cost of investigating false positives (I'm not just talking about financial cost but stress, anxiety etc etc as well) in X-raying what is still dense breast tissue is also pretty high. Most countries do not performing screening mammography on women under 50 unless they are in a high risk group because the risk/benefit ratio isn't good enough.

Everything you've just said there is all about COSTS. Nothing about medical reasons. Aren't we supposed to want the government "option" to get costs out of the system? Isn't that what we've all been told?

Finally there isn't much reason for an oncologist to be on the 'task force' because screening mammography isn't an oncological speciality, its a radiological one. Now if there isn't a radiologist on the task force then that would be odd.

I'm pretty sure that it's an oncologist that reads the scans, not an X-ray tech. I could be wrong but I don't think I am.

Malbec

17th November 2009, 21:12

Yes, but we've been told over and over that there will be NO rationing of care under the government "option". Can you really tell me that is not the case? And if rationing occurs in the private and the public plans, tell me again why I would want the public plan?

Everything you've just said there is all about COSTS. Nothing about medical reasons. Aren't we supposed to want the government "option" to get costs out of the system? Isn't that what we've all been told?

I'm pretty sure that it's an oncologist that reads the scans, not an X-ray tech. I could be wrong but I don't think I am.

Ok I'd better come clean with you, I'm an oncological radiologist. It is I who reads the X-ray, not a tech and not an oncologist.

Read my second paragraph again, I talked about human costs, not financial ones. Breast X-rays causing cancer later is a human cost, not a financial one. As is the stress caused by a false positive. As is the mortality caused by treating a false positive. The financial cost is also high but is not the primary concern.

Your wonderful private health insurance rations your healthcare just as a public health policy does/would. Read the smallprint.

chuck34

17th November 2009, 21:49

Ok I'd better come clean with you, I'm an oncological radiologist. It is I who reads the X-ray, not a tech and not an oncologist.

So when one gets one of these false positives, it's your fault?

Read my second paragraph again, I talked about human costs, not financial ones. Breast X-rays causing cancer later is a human cost, not a financial one. As is the stress caused by a false positive. As is the mortality caused by treating a false positive. The financial cost is also high but is not the primary concern.

Costs are costs. Did I say financial? Who should weigh those costs/bennifits, doctors and patients, or the government?

Your wonderful private health insurance rations your healthcare just as a public health policy does/would. Read the smallprint.

Not my wonderful private health insurance. Mine sucks. But the systems pretty much forces me to use my employer's choice. And they didn't choose something that was good for my personal situation. But that's a bit off topic for this.

And as I said, I realize that private insurance companies ration. But we have been told over and over that there will be NO rationing under the government system. So tell me again why one would want the government run "option"?

Malbec

17th November 2009, 22:08

So when one gets one of these false positives, it's your fault?

Yep. Thats why indemnity insurance for radiologists involved in breast screening is pretty damn expensive. Too many errors and your career is over.

Costs are costs. Did I say financial? Who should weigh those costs/bennifits, doctors and patients, or the government?

You asked for medical reasons, you got them.

Who is best informed to make those decisions? In just about every country in the world doctors and the government decide state screening programs, however if a patient wants to fork out their own money and get screened outside that program then there is nothing stopping them whatsoever, so all three.

And as I said, I realize that private insurance companies ration. But we have been told over and over that there will be NO rationing under the government system. So tell me again why one would want the government run "option"?

Sounds like you're the kind of guy who gets upset when they fork out cash for a sports car and finds that the dark clouds don't roll back and the traffic doesn't empty like the brochures said it would. I don't really care what anyone says about the government option, rationing exists everywhere and it will continue to exist whatever form of healthcare you have.

You may find that the government option has other benefits, universal coverage perhaps?

chuck34

17th November 2009, 22:25

Yep. Thats why indemnity insurance for radiologists involved in breast screening is pretty damn expensive. Too many errors and your career is over.

So if you see a lump on the scan, you don't go talk to an oncologist? That seems strange to me.

You asked for medical reasons, you got them.

Who is best informed to make those decisions? In just about every country in the world doctors and the government decide state screening programs, however if a patient wants to fork out their own money and get screened outside that program then there is nothing stopping them whatsoever, so all three.

So the way that every other country does things is the way we should? Different is never better? Why must we be like everyone else? If everyone else jumped off a cliff, would you?

Sounds like you're the kind of guy who gets upset when they fork out cash for a sports car and finds that the dark clouds don't roll back and the traffic doesn't empty like the brochures said it would.

What in the world does that mean? I'm the kind of guy who likes to be informed on his decision. I'm not a guy who blindly buys into brochures, or what the "government" (or anyone else for that matter) tells me. I need to get as much info from as many different sources as I can before I jump into something.

Sounds like you're the kind of guy who will buy anything an authority tells you.

I don't really care what anyone says about the government option, rationing exists everywhere and it will continue to exist whatever form of healthcare you have.

I keep agreeing with you, rationing exists in both systems. So tell me why I would want the government system.

You may find that the government option has other benefits, universal coverage perhaps?

Universal coverage? You're joking right? Even if the current plan is passed (unlikely), there will still be millions without coverage. Don't kid yourself. What other benefits are there? Higher taxes? Reduced coverage? Waiting lists? Decreased innovation? What else?

Rollo

17th November 2009, 22:33

So does anyone still believe that there won't be any rationing under "Universal" health care? What about those profits? They may not be a decision driver under government run health care, but what about costs?

Yes and absolutely. I have personally been inside the universal healthcare systems of two countries (the UK and Australia) and have never been denied anything due to rationing. I can go to a GP whenever I want to and be seen and be admitted to a hospital in full knowledge that I'll be treated.

I truly believe after the discussions previous on this forum, that America a) will never have a Universal Health Care system b) is actually too incompetent and selfish to run one and c) am very thankful that I don't have to live there.

Hondo

17th November 2009, 23:33

Yes and absolutely. I have personally been inside the universal healthcare systems of two countries (the UK and Australia) and have never been denied anything due to rationing. I can go to a GP whenever I want to and be seen and be admitted to a hospital in full knowledge that I'll be treated.

I truly believe after the discussions previous on this forum, that America a) will never have a Universal Health Care system b) is actually too incompetent and selfish to run one and c) am very thankful that I don't have to live there.

I know the feeling. I'm suprised the UK hasn't merely banned breasts thereby eliminating the problem.

chuck34

17th November 2009, 23:35

Yes and absolutely. I have personally been inside the universal healthcare systems of two countries (the UK and Australia) and have never been denied anything due to rationing. I can go to a GP whenever I want to and be seen and be admitted to a hospital in full knowledge that I'll be treated.

Good for you. I'm happy for you. However, there are plenty of other stories that run counter to your claims. Can you honestly tell me that this is not the start of rationing?

I truly believe after the discussions previous on this forum, that America a) will never have a Universal Health Care system b) is actually too incompetent and selfish to run one and c) am very thankful that I don't have to live there.

Such a well though out and well reasoned response that I don't even know how to respond. Keep flaming on, I guess. :-/

GridGirl

17th November 2009, 23:55

chuck34

18th November 2009, 00:29

As stated previously on this and other health care discussions.....all halthcare where ever you are in the world is rationed. Always has been and always will be.

Best be off for my daily diabetes, cancer, cardiology, urinology and idiot tests to name but a few as there maybe something wrong with me today. :p

Again, I realise that there is rationing under the current system. But we have all been told that there would be no rationing under the government plan. And that was supposed to be the reason that we were all gonna sign up for it, to get away from that evil rationing that the insurance companies do. Well here it is, plain and simple rationing. What is the reason for government run healthcare now?

Don't bother with that self breast exam though, the government says you don't need it.

Rollo

18th November 2009, 01:10

anthonyvop

18th November 2009, 02:59

As stated previously on this and other health care discussions.....all halthcare where ever you are in the world is rationed. Always has been and always will be.

No its not.
My health care isn't rationed.

GridGirl

18th November 2009, 08:35

Dave B

18th November 2009, 11:42

chuck34

18th November 2009, 14:15

http://www.sesiahs.health.nsw.gov.au/News_and_Events/2009/20091012_HealthProfessionalsUrge.asp
http://www.hc-sc.gc.ca/hl-vs/iyh-vsv/med/mammog-eng.php
http://www.cancerscreening.nhs.uk/breastscreen/

Under the systems of Health Canada, Britain's NHS, and the Australian Medicare system, screening procedures such as Mammography are free to the end user and aren't "rationed", and without discrimination to who those end users are.

Those costs are borne either through the instrument of a separate levy in the case of Australia, or through the regular budgets of the relevant Depts. of Health in Canada and the UK.

Rationing is the controlled distribution of scarce resources, goods, or services. Unless there is a total chronic shortage of doctors and nurses, then so called "Rationing" doesn't occur. In the real world, your premise simply doesn't hold true.

I'm living in the real world, and this premise does hold true. You aren't connecting the dots here. I don't care what other countries do or don't do. I'm talking about what the US IS doing.

A government board has stated that women under the age of 50 don't need mammograms. It's not too much of a leap to say that if health coverage is controlled by the government that this board will have at least some say in bennefits, if not out right control. Therefore, if all this goes through, women under 50 in the US may not have mammograms payed for under the government run "option". This goes against most doctor's recommendations and certainly agaist the American Cancer Society's recommendation.

But you say "just go out and get yourself private insurance to cover it". Well beyond the fact that I believe one of the true goals of all this is to squeeze private insurers out of business, there is the fact that insurance companies are currently looking into their current policies based on this recommendation.

And it starts with mammograms. What's next? Prostate exams? Colonoscopies? Colesterol screenings?

anthonyvop

18th November 2009, 15:00

Your health care is rationed because unless you actually need it you don't use it. Your healthcare is exactly the same as car insurance. It's a pain in the butt to pay for but you wouldn't be happy if you didn't have it if you had an accident.

If your healthcare was completely unrationed you would be having tests for this that and the other very day of the week just becuase you can and you pay for it. My healthcare is exactly the same. Unless I'm ill I receive no benefit even though I'm paying for it through my taxes every month. When I have needed it I've also had no problems with it but maybe I've been quite lucky there.

If your healthcare isn't rationed vop why don't you go and book yourself in for a mammogram. :p Better to be safe than sorry.
I don't get test every day because I am not a hypochondriac! With my health insurance whenever I feel ill or that something is not right I make an appointment with my physician. I usually see him the same day. no problem. If it is after hours I go to the local urgent care facility and if it is an emergency the emergency room. In all cases i have a $20 copay. No sweat.
I have never had to fight with my insurance company for a test, treatment or prescription. In fact they always ask me for approval for a generic drug.

For my company insurance I am required to get a full physical every year and get poked and prodded in place I rather not dwell on with machines that cost ridiculous amounts of $$$. My Health insurance has never complained.

Of course i have a PRIVATE health insurance provider and pay, what a consider, a fair price. I do know it is cheaper than what I would have to pay in taxes if Socialized medicine is brought to the USA.

anthonyvop

18th November 2009, 15:04

In the UK if you're not satisfied with NHS care you have the option of paying for private treatment. Should I want a private doctor to test me for anything I imagine, I'm free to do so.

So far as I'm aware, nothing in the US plans would take away that option. I've no idea why anbody would have a problem with those plans.
Why?
Maybe I don't want to have to pay for Govt insurance then turn around and have to pay for private insurance?
Maybe I value freedom of choice?
Maybe I don't want to subsidize some slacker's healthcare?

Malbec

18th November 2009, 19:57

So if you see a lump on the scan, you don't go talk to an oncologist? That seems strange to me.

Sure, once a lesion is found then the oncologists get involved. If that happens, we're out of the screening process and into the staging and treatment part. The oncologists don't get involved in the screening process.

So the way that every other country does things is the way we should? Different is never better? Why must we be like everyone else? If everyone else jumped off a cliff, would you?

Because medical evidence is the same the world over allowing for racial differences (which don't affect breast cancer). Therefore most countries often come to a similar conclusion regarding breast screening.

I keep agreeing with you, rationing exists in both systems. So tell me why I would want the government system.

Universal coverage? You're joking right? Even if the current plan is passed (unlikely), there will still be millions without coverage. Don't kid yourself. What other benefits are there? Higher taxes? Reduced coverage? Waiting lists? Decreased innovation? What else?

You seem dedicated to focusing in on a promise of no rationing which appears to me to be a typical case of political spin, just as no politician anywhere will ever admit that they do intend to raise taxes. Are you trying to prove that politicians lie? If so give yourself a round of applause.

Malbec

18th November 2009, 20:04

I don't get test every day because I am not a hypochondriac! With my health insurance whenever I feel ill or that something is not right I make an appointment with my physician. I usually see him the same day. no problem. If it is after hours I go to the local urgent care facility and if it is an emergency the emergency room. In all cases i have a $20 copay. No sweat.
I have never had to fight with my insurance company for a test, treatment or prescription. In fact they always ask me for approval for a generic drug.

For my company insurance I am required to get a full physical every year and get poked and prodded in place I rather not dwell on with machines that cost ridiculous amounts of $$$. My Health insurance has never complained.

Of course i have a PRIVATE health insurance provider and pay, what a consider, a fair price. I do know it is cheaper than what I would have to pay in taxes if Socialized medicine is brought to the USA.

What you've written there is irrelevant to rationing. Whether you get your aspirin when you want isn't a measure of rationing in a modern developed state. The question is, when you get diagnosed with cancer which chemotherapy agents are you covered for and not covered for? Which tertiary referral centres will your policy send you to if you have a complex diagnosis? Will your policy even cover you for tertiary referral in the first place?

Thats the level where rationing truly kicks in. Not at the bread and butter level.

Jag_Warrior

18th November 2009, 20:48

Rationing health care or a red herring? This health care debate always seems to produce its share of fishies, it seems. But I don't know. Let's lookie and see.

This topic isn't one that I know very much about. So I defer to people like Dylan on the technical and medical aspects. But here's what I've read (actually from Fox News ;) ): The U.S. Preventive Service Task Force is an outside independent panel of doctors and scientists who make recommendations. From that, I take it that these recommendations are not binding. So, on we go...

And as I read the report, the recommendations did not apply to all women under 50:
The panel says the recommendations apply to women 40 years or older "who are not at increased risk for breast cancer by virtue of a known underlying genetic mutation or a history of chest radiation."

The task force advises that women aged 50 to 74 receive mammograms every other year and recommends against teaching breast self-examinations. The task force recommended in 2002 that all women over 40 should undergo a mammography every one to two years.

According to Rep. Phillip Gingrey, R-GA, a practicing obstetrician and gynecologist for 26 years, he fears that "insurance companies will seize upon the guidelines to deny coverage to women under 50 who do not have an increased risk for harmful genetic mutations -- like BRCA1 or BRCA2, genes that when mutated have been linked to breast cancer."

Is that what's he's truly worried about? And his plan to prevent that is what??? ;)

Someone correct me if I am wrong, but wouldn't that fear only be valid in an unregulated insurance market, or one with rather lax regulation? Possibly one like Rep. Michelle Bachmann, R-MN, says she supports: less regulation, not more. Ms. Bachmann has suggested that many or most of the current regulations should be rolled back. Sound good to you guys and gals?

There are (at least) two distinct issues here, which are not being separated, as I see it. One: will these recommendations actually be used by the government to "ration" healthcare (actually, "payments" - you can do whatever you choose, if you can pay for it... no one will stop you)? Two: will these recommendations be used by private insurance companies to limit payments for certain procedures?

The first question, I cannot answer. But it would be easy enough to find out, I would think. As the recommendations have been stated since 2002: all women over 40 should undergo a mammography every one to two years. So my question is, do women on Medicaid or a VA program now have their claims denied if they undergo a mammography under the age of 40? If not, then it would seem that these arguments about health care rationing might just be more fear mongering, along the lines of "unpluggin' grandma" this summer. Hmm? :p

On question two, it's my understanding that only because of federal legislation are U.S. health insurance companies now forced to cover cancer screening in women, as well as breast reconstruction. Am I wrong about that? And a followup to that, since we now seem to be concerned with overall health issues... whether any sort of health reform passes or not, what is going to be done to prevent private insurance companies from denying coverage to women in their 20's, 30's, 40's or 50's??? I look forward to Rep. Phillip Gingrey's ideas on that matter. I'm sure it will be forthcoming. :rolleyes:

Last point from me. Please don't anyone tell me that private insurance companies are not actively involved in denying coverage, and thereby leading to a rationing effect. One of my aunts developed cancer in the 80's. At that time, bone marrow transplants were still considered experimental by the insurance industry. So they would not cover a transplant for her. Before my uncle could raise the necessary funds (over $100,000) for the treatment, her condition had greatly worsened and she died. Health care is like anything else here: if you have the money, you can get it. But like I said, I see two distinct issues that are being blended together.

chuck34

18th November 2009, 20:48

Sure, once a lesion is found then the oncologists get involved. If that happens, we're out of the screening process and into the staging and treatment part. The oncologists don't get involved in the screening process.

Hence my original point pursuant to this issue. Why weren't oncologists part of the team that decided against mammograms?

Because medical evidence is the same the world over allowing for racial differences (which don't affect breast cancer). Therefore most countries often come to a similar conclusion regarding breast screening.

But should it be the governments that come up with those conclusions, or the doctors? And again I don't know of any doctor that would recommend against mammograms (except perhaps on an individual basis).

You seem dedicated to focusing in on a promise of no rationing which appears to me to be a typical case of political spin, just as no politician anywhere will ever admit that they do intend to raise taxes. Are you trying to prove that politicians lie? If so give yourself a round of applause.

So you conceed that they've lied about this. What else have they lied about? Cost perhaps? Taxes maybe? What else?

Malbec

18th November 2009, 21:15

Hence my original point pursuant to this issue. Why weren't oncologists part of the team that decided against mammograms?

Because the risk of mammograms is a radiological issue, not an oncological one. And because as I stated earlier mammography is a radiologically delivered service, not an oncological one.

But should it be the governments that come up with those conclusions, or the doctors? And again I don't know of any doctor that would recommend against mammograms (except perhaps on an individual basis).

Its true that American doctors are extremely gung-ho about investigating (because they're paid per case) but the pros of radiating active breast tissue must be weighed up against the risks which are significant in younger women. In most developed countries radiating people without cause is still assault.

Reading your posts you seem to believe that mammograms are purely beneficial, this really isn't the case.

So you conceed that they've lied about this. What else have they lied about? Cost perhaps? Taxes maybe? What else?

Concede? You seem to be taking a polemic position on this which I suggest you alter. Especially so since I don't pretend to support the reforms you appear to be so against.

I suggest you take a step back and look at both arguments equally, including those who argue against the new reforms and treat their arguments with equal scepticism. You'll find there's a lot of rubbish on BOTH sides.

Malbec

18th November 2009, 21:25

And as I read the report, the recommendations did not apply to all women under 50:
The panel says the recommendations apply to women 40 years or older "who are not at increased risk for breast cancer by virtue of a known underlying genetic mutation or a history of chest radiation."

The task force advises that women aged 50 to 74 receive mammograms every other year and recommends against teaching breast self-examinations. The task force recommended in 2002 that all women over 40 should undergo a mammography every one to two years.

According to Rep. Phillip Gingrey, R-GA, a practicing obstetrician and gynecologist for 26 years, he fears that "insurance companies will seize upon the guidelines to deny coverage to women under 50 who do not have an increased risk for harmful genetic mutations -- like BRCA1 or BRCA2, genes that when mutated have been linked to breast cancer."

Is that what's he's truly worried about? And his plan to prevent that is what??? ;)

The recommendations sound pretty sensible to me although given the growth rate of tumours and the risk of radiation a mammogram every other year or three years is a better bet.

Regarding the quote you have there, what coverage is he fearing will be denied? Covering the cost of treating breast cancer? I presume breast screening is a federal or state funded project even if the cost of treating it may not be?

chuck34

18th November 2009, 21:28

Because the risk of mammograms is a radiological issue, not an oncological one.

You know more than I on this issue. But my point is that the oncologists are the ones treating the disease, shouldn't they be consulted in matters of diagnosis?

Its true that American doctors are extremely gung-ho about investigating (because they're paid per case) but the pros of radiating active breast tissue must be weighed up against the risks which are significant in younger women. In most developed countries radiating people without cause is still assault.

Then you may want to allert the authorities in the UK, Canada, and Australia as Rollo pointed out in post #15, as they appear to be assaulting their women.

Reading your posts you seem to believe that mammograms are purely beneficial, this really isn't the case.

Point me to a doctor that would recommend against getting a yearly mammogram.

Concede? You seem to be taking a polemic position on this which I suggest you alter. Especially so since I don't pretend to support the reforms you appear to be so against.

How could I have possibly been so confused?
"You may find that the government option has other benefits, universal coverage perhaps?" --Dylan H

I suggest you take a step back and look at both arguments equally, including those who argue against the new reforms and treat their arguments with equal scepticism. You'll find there's a lot of rubbish on BOTH sides.

Both sides? I think there are plenty more than 2 positions on the health care issue. You seem to be making me out to be someone who thinks we should "do nothing". Far from it.

Malbec

18th November 2009, 21:36

You know more than I on this issue. But my point is that the oncologists are the ones treating the disease, shouldn't they be consulted in matters of diagnosis?

They can be, and there certainly isn't anything wrong with having one there but ultimately mammography is radiologically delivered, it uses radiological resources, not oncological ones. For the oncologists it doesn't matter whether the patient attends because of screening or because they went directly with a lump in their breast.

Then you may want to allert the authorities in the UK, Canada, and Australia as Rollo pointed out in post #15, as they appear to be assaulting their women.

You really don't get the point of screening do you.

Point me to a doctor that would recommend against getting a yearly mammogram.

Me for a start. If anyone recommended an annual one I'd ask "how much are you paid per x-ray". There's little medical evidence out there to say thats beneficial given the sensitivity of mammography and the rate of growth of tumours. Doing them every other year halves the radiation and therefore the risk of causing a tumour later which is of greater benefit. I don't know any radiologists who would argue for an annual examination, and I disagree with the findings of the US 'taskforce' on that matter.

GridGirl

18th November 2009, 21:44

chuck34

18th November 2009, 21:49

They can be, and there certainly isn't anything wrong with having one there but ultimately mammography is radiologically delivered, it uses radiological resources, not oncological ones. For the oncologists it doesn't matter whether the patient attends because of screening or because they went directly with a lump in their breast.

I think you and I are missing each other on this point. The task force that just released the recommendation not to get a mammogram under the age of 50 had NO oncologists on it. That is what I'm talking about. I realise that an oncologist doesn't perform the actual mammogram. Are you the one that would actually treat a patient with cancer? If so then fine, no oncolgist need on the task force. But since I believe that oncologists are the ones that actually treat patients and study cancer issues, I would think they should have been at least consulted.

Are you telling me that if a woman comes in to the doctor because she found a lump (which she's not supposed to do any more btw), that the doctor wouldn't order follow up tests such as a mammogram?

You really don't get the point of screening do you.

Then enlighten me.

Me for a start. If anyone recommended an annual one I'd ask "how much are you paid per x-ray". There's little medical evidence out there to say thats beneficial given the sensitivity of mammography and the rate of growth of tumours. Doing them every other year halves the radiation and therefore the risk of causing a tumour later which is of greater benefit. I don't know any radiologists who would argue for an annual examination, and I disagree with the findings of the US 'taskforce' on that matter.

Then why has it been standard practice to have yearly mammograms for the past how ever many years? It's not just the US either, so it can't be all about cost. The American Cancer Society recommends yearly screenings. If the risk of cancer from the radiation was higher than the bennifit of the screening, why would they recommend the mammogram? They are looking at cancer prevention, not how much they get payed per X-ray.

Your last statement doesn't make sence. You are arguing against a yearly mammogram which this 'taskforce' agrees with you on. But then you say you don't agree with them. Was that a typo, or are we missing eachother again?

Jag_Warrior

18th November 2009, 21:51

Regarding the quote you have there, what coverage is he fearing will be denied? Covering the cost of treating breast cancer? I presume breast screening is a federal or state funded project even if the cost of treating it may not be?

Just an assumption, but I'd say he means that if a woman is self-employed or is otherwise having to buy insurance in the private market (maybe she works for a small company that does not offer health benefits), this could be considered a pre-existing condition, and she either wouldn't be covered at all or cancer would be excluded as a covered disease. If she happened to be covered under an open enrollment, employer based plan, then possibly he means her coverage could be limited, due to it being a pre-existing family/genetic condition? But as the (private) system is now, I believe only very lax regulation would make that possible - or some change to existing law, such as that suggested by Rep. Bachmann. On the last one, I'm actually a bit confused as to what his concern would be.

If he's actually concerned about genetic data being used against patients, perhaps he should author broad legislation to prevent that - not just on the issue of breast cancer. What about other diseases that affect the broader population? But I suspect that's not what his true concern is here ( ;) ). But if I'm wrong, then I will expect to see some legislation on that topic, which he will either author or fully support. Though I'm not holding my breath.

chuck34

18th November 2009, 21:56

Please someone provide Chuck34 a link relating to the life and more importantly to the death of Marie Curie. DylanH, your posts have been great but I don't think your obvious expertise in the subject has any clout on this issue as far as Chuck is concerned. Some crack pot Internet link from an obscure place may however help.

Every doctor I've ever heard has said that women over the age of 40 should have a yearly mammogram. Now all of a sudden, the mammogram is gonna kill you? What the hell happened? Is the American Cancer Society wrong? I guess they aren't crack pot enough for some.

http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Updated_Breast_Cancer_Screening_Guideline s_Released.asp
"For this reason, the basic screening recommendation remains unchanged. Women are still advised to get a mammogram every year, starting at age 40."

I think you could probably get a mammogram every day for a couple of years and not be exposed to as much radiation as Marie Curie, give me a break.

anthonyvop

18th November 2009, 22:38

What you've written there is irrelevant to rationing. Whether you get your aspirin when you want isn't a measure of rationing in a modern developed state. The question is, when you get diagnosed with cancer which chemotherapy agents are you covered for and not covered for? Which tertiary referral centres will your policy send you to if you have a complex diagnosis? Will your policy even cover you for tertiary referral in the first place?

Thats the level where rationing truly kicks in. Not at the bread and butter level.
I know you must hate the fact that I get better health care from the private sector than from any government plan on this planet but facts are facts.

My insurance plan lets me go to any specialist I want to. My doctor and I chose. Not some corporate or government lackey. Ditto with treatments.

As i have stated.

My health care is not rationed.

Dave B

19th November 2009, 10:03

My health care is not rationed.
Obviously, becuase right now plenty of people are making a nice little profit out of you.

If you're ever unfortunate enough to need expensive long-term treatment (god forbid), let's see how accomodating your insurers suddenly become.

chuck34

19th November 2009, 13:31

Obviously, becuase right now plenty of people are making a nice little profit out of you.

3-6%, those evil b@stards!

If you're ever unfortunate enough to need expensive long-term treatment (god forbid), let's see how accomodating your insurers suddenly become.

There are stories of people being dropped in the US, but it's not the norm. There are also horror stories from Canada, the UK, Australia, and elsewhere, are those the norm?

anthonyvop

19th November 2009, 14:40

Obviously, becuase right now plenty of people are making a nice little profit out of you.

And I have no problem with that at all. I am not a jealous twit who hates people for making money.
BTW the average profit margin for insurance companies in the USA runs about 6%. Hardly the stuff of evil profiteers.

http://news.yahoo.com/s/ap/20091025/ap_on_go_co/us_fact_check_health_insurance

If you're ever unfortunate enough to need expensive long-term treatment (god forbid), let's see how accomodating your insurers suddenly become.
Why can't you accept the fact that there are insurance companies out there who actually provide un-rationed healthcare.

I have been lucky and not needed any long-term care........but....My mother, who I have on my plan, is now on her 4th battle with cancer. This round has been going on for over two years and her prescription meds comes out to over $3000 a month. Our insurance company is paying 100% and haven't heard one complaint. Every test her oncologist orders is done immediately with no questions asked.

She is 82 years old. Which means under Obama-care I would have buried her 2 years ago.

Stop paying attention to the liberal talking points dispensed by the main stream media and actually see for yourself. The Majority of Americans are happy with their Healthcare.

http://www.gallup.com/poll/102934/majority-americans-satisfied-their-own-healthcare.aspx

Now ask yourself why is it that you refuse to accept the fact that I and millions of others do not have rationed healthcare.

Jag_Warrior

19th November 2009, 16:14

She is 82 years old. Which means under Obama-care I would have buried her 2 years ago.

Why is that?

Hondo

19th November 2009, 16:25

Any and all insurance aside, the real problem is the cost of services within the health care industry. If you want to reform something, start there.

anthonyvop

19th November 2009, 21:45

Why is that?

Rationing and death panels.

If you believe that under Obama-care my mother will get the same cutting edge health care than you are a bigger fool that I thought.

driveace

19th November 2009, 22:06

ANY WAY all you guys get a long and have a PSA check as prostate cancer is the "Silent Killer" .I have my PSA check every 6 months !!!

Jag_Warrior

19th November 2009, 23:55

Rationing and death panels.

If you believe that under Obama-care my mother will get the same cutting edge health care than you are a bigger fool that I thought.

Anthony, I just asked you a rather simple question. Now what was it about that question that caused you to resort to a childish insult? I don't recall doing or saying anything rude to you.

So your answer is you believe that there were indeed "death panels", that would have euthanized old people and denied them care. That's fine. That's all I asked you.

anthonyvop

20th November 2009, 06:01

Anthony, I just asked you a rather simple question. Now what was it about that question that caused you to resort to a childish insult? I don't recall doing or saying anything rude to you.

So your answer is you believe that there were indeed "death panels", that would have euthanized old people and denied them care. That's fine. That's all I asked you.

The truth hurts.

Dave B

20th November 2009, 09:05

I'm not sure it's worth my effort trying to hold a rational debate with someone who believes in "death panels". I'd have a more productive day trying to convert the Pope to Islam.

GridGirl

20th November 2009, 09:45

I agree Dave. I think a small number of forumers are putting off a
large number of others from posting. It's just not worth the effort. I don't just mean on this thread either.

chuck34

20th November 2009, 14:48

I agree Dave. I think a small number of forumers are putting off a
large number of others from posting. It's just not worth the effort. I don't just mean on this thread either.

So is it not worth the effort to answer my earlier question about why you wouldn't go by the American Cancer Society's recommendation about getting a mammogram every year, and doing self exams? Why would you believe this "task force"'s recommendation? Sounds like reasonable questions to me.

anthonyvop

20th November 2009, 14:54

I'm not sure it's worth my effort trying to hold a rational debate with someone who believes in "death panels". I'd have a more productive day trying to convert the Pope to Islam.

Prove me wrong!

Any Gov. heathcare plan that has people who decides who gets what treatment is a "death panel."

You may not like it but the name fits.

Malbec

20th November 2009, 16:22

I think you and I are missing each other on this point. The task force that just released the recommendation not to get a mammogram under the age of 50 had NO oncologists on it. That is what I'm talking about. I realise that an oncologist doesn't perform the actual mammogram. Are you the one that would actually treat a patient with cancer? If so then fine, no oncolgist need on the task force. But since I believe that oncologists are the ones that actually treat patients and study cancer issues, I would think they should have been at least consulted.

I've had a look at your link and the quotes. Looks like your taskforce isn't a mammography specific organisation but is one that looks at all aspects of public health. It is the US equivalent of the UK National Institute of Clinical Excellence albeit with a less cringeworthy name.

It doesn't have radiologists or oncologists on it but then it doesn't need to, it has epidemiologists and public health specialists on. They don't need to know the ins and outs of when to give particular treatments, they need to know things like survival rates of different stages of breast cancer at different ages, radiation risk, statistical stuff like that which is what epidemiologists specialise in anyway. I'd say the make up of the panel is absolutely fine. I'm sure they had radiological and oncological advisers where necessary.

Then enlighten me.

No you can look it up yourself, wikipedia might be a good start. Screening radiography where the evidence shows that its effective is NOT radiation without cause. I thought that would be self evident.

Then why has it been standard practice to have yearly mammograms for the past how ever many years? It's not just the US either, so it can't be all about cost. The American Cancer Society recommends yearly screenings. If the risk of cancer from the radiation was higher than the bennifit of the screening, why would they recommend the mammogram? They are looking at cancer prevention, not how much they get payed per X-ray.

Over here in the UK the old American system of X-raying every year after 40 looked like a massive litigation accident waiting to happen. The evidence simply doesn't support radiating breasts from such an early age so regularly unless the woman is in a high risk group. It wouldn't have taken long till a patient with breast cancer started looking into the radiation risks from her X-rays and got together with a good lawyer. Why was the system put in place? I have no idea (could be that it was put in before we knew why certain women were high risk) but thats the point of reviewing protocol on a regular basis, to improve things based on new information.

BTW the American Cancer Society isn't involved in regulating and governing breast imaging, staging and treatment, its the National Cancer Institute with the American College of Radiology and other bodies. When it comes to mammography service regulation is lead by the ACR, again in conjunction with other bodies but not the American Cancer Society.

Your last statement doesn't make sence. You are arguing against a yearly mammogram which this 'taskforce' agrees with you on. But then you say you don't agree with them. Was that a typo, or are we missing eachother again?

No you're right, I got confused between the American cancer society recommendations and the old system and the new proposed system. My mistake.

Malbec

20th November 2009, 16:24

I think you could probably get a mammogram every day for a couple of years and not be exposed to as much radiation as Marie Curie, give me a break.

Pre-menopausal breast tissue is extremely radiosensitive. You may be rather flippant about the risks, the fact is that they are significant and with a system that seeks to cover every female in the US you're talking about potentially 1000s of extra cases of breast cancer caused by the radiation.

Malbec

20th November 2009, 16:31

I have been lucky and not needed any long-term care........but....My mother, who I have on my plan, is now on her 4th battle with cancer. This round has been going on for over two years and her prescription meds comes out to over $3000 a month. Our insurance company is paying 100% and haven't heard one complaint. Every test her oncologist orders is done immediately with no questions asked.

She is 82 years old. Which means under Obama-care I would have buried her 2 years ago.

Now ask yourself why is it that you refuse to accept the fact that I and millions of others do not have rationed healthcare.

I'm sorry to hear about your mother, and its good to hear that she's been lucky enough to survive four bouts of cancer.

That said, I think you know that no insurance policy of any sort gives unlimited cover or refuses to stipulate which organisations you have to go to get treatment. Whilst your mother has been lucky enough to get the specific treatments that she's required so far, if her prescription meds bill only comes to $3000 a month I'd say she's a long way off the territory where rationing comes into effect in the UK. I don't think its a secret that many American insurance policies do not cover the newer chemotherapy agents like Herceptin which would set you back about $8k a month alone. Thats rationing for you.

Malbec

20th November 2009, 16:33

I agree Dave. I think a small number of forumers are putting off a
large number of others from posting. It's just not worth the effort. I don't just mean on this thread either.

I do wonder why some of them feel the need to take such an argumentative posture too, they seem to feel extremely defensive for some reason.

chuck34

20th November 2009, 17:09

I've had a look at your link and the quotes. Looks like your taskforce isn't a mammography specific organisation but is one that looks at all aspects of public health. It is the US equivalent of the UK National Institute of Clinical Excellence albeit with a less cringeworthy name.

It doesn't have radiologists or oncologists on it but then it doesn't need to, it has epidemiologists and public health specialists on. They don't need to know the ins and outs of when to give particular treatments, they need to know things like survival rates of different stages of breast cancer at different ages, radiation risk, statistical stuff like that which is what epidemiologists specialise in anyway. I'd say the make up of the panel is absolutely fine. I'm sure they had radiological and oncological advisers where necessary.

In other words, this taskforce was made up of pencil pushers and beurocrats. I think I'll take my medical advice from a doctor. I'll respect your opinion that you wouldn't get a mammogram every year, but I believe you are in the minority on that.

No you can look it up yourself, wikipedia might be a good start. Screening radiography where the evidence shows that its effective is NOT radiation without cause. I thought that would be self evident.

There are too many stories of cancers being caught before becoming a problem for me to think that mammograms are "radiation without cause". I know it's anecdotal, but it still seems like the right thing to do.

Over here in the UK the old American system of X-raying every year after 40 looked like a massive litigation accident waiting to happen. The evidence simply doesn't support radiating breasts from such an early age so regularly unless the woman is in a high risk group. It wouldn't have taken long till a patient with breast cancer started looking into the radiation risks from her X-rays and got together with a good lawyer. Why was the system put in place? I have no idea (could be that it was put in before we knew why certain women were high risk) but thats the point of reviewing protocol on a regular basis, to improve things based on new information.

I am not aware of any such cases being brought up. I'm sure that in our litigious (sp?) day and age that someone would have already made that link. But I do agree with reviewing protocol on a regular basis. Maybe that was what was done here, but it has not been presented that way.

BTW the American Cancer Society isn't involved in regulating and governing breast imaging, staging and treatment, its the National Cancer Institute with the American College of Radiology and other bodies. When it comes to mammography service regulation is lead by the ACR, again in conjunction with other bodies but not the American Cancer Society.

I know that the American Cancer Society isn't involved in regulating and governing breast imaging. However, they are out to increase awareness of ALL cancers, promote screenings/early detection, reduce risk factors etc. They study EVERY aspect cancer from causes to cures. If they saw that there was a higher risk of getting cancer from the screening than there was bennefit from getting the screeing, they wouldn't recommend the screening.

I realise that there is a risk involved with X-Rays, mammograms, radiation in general, but come on there's a risk in everything. It's been pretty well established for quite some time that the rewards outweigh the risks in this particular case. And now for some beurocratic "taskforce" to come in and reverse that stance ... well it sets people on edge to say the least.

I don't want to seem too "flippant", but perhaps, you being a radiologist and all, perhaps you can't see the forest for the trees? What I mean is, perhaps you are too focused on the risks of your specific field. If there is a group of oncologists (who deal with causes, cures, and prevention of cancer) that agrees the risks of mammograms are higher than the bennifits, then maybe I can see your point. But so far I have not seen that story anywhere, quite the opposite in fact.

chuck34

20th November 2009, 17:11

Pre-menopausal breast tissue is extremely radiosensitive. You may be rather flippant about the risks, the fact is that they are significant and with a system that seeks to cover every female in the US you're talking about potentially 1000s of extra cases of breast cancer caused by the radiation.

Are there medical studies out there that show these 1000s of extra cases caused by the radiation? And if so why weren't they cited by the "taskforce"?

chuck34

20th November 2009, 17:13

I do wonder why some of them feel the need to take such an argumentative posture too, they seem to feel extremely defensive for some reason.

I'm sorry that I get defensive about my health (even if this particular issue doesn't directly effect me). I guess I should just not worry about it and do whatever "they" tell me, right?

Jag_Warrior

20th November 2009, 17:37

I'm not sure it's worth my effort trying to hold a rational debate with someone who believes in "death panels". I'd have a more productive day trying to convert the Pope to Islam.

It's really not - just a waste of time. At the point that someone begins angrily claiming that their fantasy world is reality, you should just accept that you're dealing with a loon or some sort of marginally functioning paranoid schizophrenic.

We don't refer to that type of person as a wingnut for nothing, ya know?

http://www.tz-uk.com/pics/tinfoilhat.jpg

Malbec

20th November 2009, 17:55

In other words, this taskforce was made up of pencil pushers and beurocrats. I think I'll take my medical advice from a doctor. I'll respect your opinion that you wouldn't get a mammogram every year, but I believe you are in the minority on that.

Epidemiologists and public health doctors ARE doctors not bureaucrats. Honestly if you thought they were mere penpushers shouldn't you be reconsidering whether you're capable of understanding the complexities of the issue?

In the medical field I'm in the majority. I'm aware that in the layperson's field your opinion may be the majority. I guess medical knowledge is the difference here.

I know it's anecdotal, but it still seems like the right thing to do.

Gut feelings should not guide healthcare decisions.

I realise that there is a risk involved with X-Rays, mammograms, radiation in general, but come on there's a risk in everything. It's been pretty well established for quite some time that the rewards outweigh the risks in this particular case. And now for some beurocratic "taskforce" to come in and reverse that stance ... well it sets people on edge to say the least.

I don't want to seem too "flippant", but perhaps, you being a radiologist and all, perhaps you can't see the forest for the trees? What I mean is, perhaps you are too focused on the risks of your specific field. If there is a group of oncologists (who deal with causes, cures, and prevention of cancer) that agrees the risks of mammograms are higher than the bennifits, then maybe I can see your point. But so far I have not seen that story anywhere, quite the opposite in fact.

The taskforce is not bureaucratic, its a medical one staffed by doctors.

The benefits of x-raying normal women below 50 on an annual basis is outweighed by the risk. Above that age the benefit outweighs the risk if the examinations are done every other year. This has been clearly stated and the medical evidence is overwhelmingly in support of this.

I'm afraid this is going to be my last point on this matter, as jagwarrior has pointed out 'debating' this issue with you appears pointless. If you asked me to explain how an internal combustion engine works I am not going to say it runs on perfume and rosewater to suit your view of the world.

chuck34

20th November 2009, 18:47

Epidemiologists and public health doctors ARE doctors not bureaucrats. Honestly if you thought they were mere penpushers shouldn't you be reconsidering whether you're capable of understanding the complexities of the issue?

In the medical field I'm in the majority. I'm aware that in the layperson's field your opinion may be the majority. I guess medical knowledge is the difference here.

Gut feelings should not guide healthcare decisions.

The taskforce is not bureaucratic, its a medical one staffed by doctors.

The benefits of x-raying normal women below 50 on an annual basis is outweighed by the risk. Above that age the benefit outweighs the risk if the examinations are done every other year. This has been clearly stated and the medical evidence is overwhelmingly in support of this.

I'm afraid this is going to be my last point on this matter, as jagwarrior has pointed out 'debating' this issue with you appears pointless. If you asked me to explain how an internal combustion engine works I am not going to say it runs on perfume and rosewater to suit your view of the world.

What the hell? I'm not some sort of tin foil hat guy. Where do you get that from? I'm taking the American Cancer Society's view on this, not some conspiracy crap. You have not given me anything other than your personal opinion on the matter, which I respect, but it's just your opinion. Other opinions you might be interested in.

http://www.womenshealth.gov/FAQ/mammograms.cfm#e
http://familydoctor.org/online/famdocen/home/women/reproductive/breast/018.html#ArticleParsysMiddleColumn0008
http://cancer.about.com/od/breastcancer/f/mammogramfaq.htm
http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Regularly_Scheduled_Mammograms_Save_More_ Lives.asp

But I'm sure those are just crackpot, tin foil hat wearing, nut cases, right? Or maybe they're just in it for the money?

GridGirl

20th November 2009, 18:58

So is it not worth the effort to answer my earlier question about why you wouldn't go by the American Cancer Society's recommendation about getting a mammogram every year, and doing self exams? Why would you believe this "task force"'s recommendation? Sounds like reasonable questions to me.

I haven't quite hit 30 yet and have no history of breast cancer in my family. Due to a combination of my age and family history for me personally I feel no great desire to have a mammogram every year. A regular self examination is sufficient for me. As a side note the American Cancer Society's guideline are different from those and the policies adopted in the UK anyway. There is nothing wrong with the opinions and policies that are adopted by either country even though they are different.

Mammograms are also slightly painful. I have no great desire to put myself through unnecessary pain for a relatively small piece of comfort on a annual
basis. If I get cancer fine, I'll deal with it. I'm not going to spend my days worrying about other illnesses I may potentially get untill I show some symtoms of being unwell.

Dave B

20th November 2009, 19:04

^ It's worth repeating though, that should GridGirl wish to have a check every year - or every month or every fortnight - there's nothing to stop her paying to have it done privately. That option would still exist under Obama's plans: it's not as if Americans will only be allowed state-funded care. I still fail to see why that seems so confusing for some of them.

Jag_Warrior

20th November 2009, 19:22

I'm afraid this is going to be my last point on this matter, as jagwarrior has pointed out 'debating' this issue with you appears pointless. If you asked me to explain how an internal combustion engine works I am not going to say it runs on perfume and rosewater to suit your view of the world.

Just to be clear, I was actually referring to anthonyvop. I may not agree with Chuck on a good many issues, but he at least tries to understand where others are coming from. At the end, there still may be disagreement, but you can have an interesting discussion with him.

Whereas with anthonyvop, though I didn't realize it until yesterday, you can try to be reasonable with him. But because his beliefs are so illogical, irrational, nonsensical and devoid of any actual facts or data, he's unable to state them without trying to just shout you down or using childish insults (even for the simplest of questions), to cover up his intellectual flaws and shortcomings.

Malbec

20th November 2009, 19:42

Just to be clear, I was actually referring to anthonyvop. I may not agree with Chuck on a good many issues, but he at least tries to understand where others are coming from. At the end, there still may be disagreement, but you can have an interesting discussion with him.

Like your epiphany with anthonyvop yesterday, I thought the same about Chuck being relatively reasonable until today. However I've found him obtuse and uninterested in trying to understand the rationale behind anything that doesn't agree with his point of view.

I don't mind people questioning the evidence behind their medical treatment, in fact more people should be doing so. Yet I find it impossible to discuss anything with someone who can dismiss general medical opinion (claiming its merely my own) whilst clinging on to a few quotes from lay websites. There is no desire to understand, merely a desire to reinforce his own preconceptions.

Am I being unreasonable on this thread?

chuck34

20th November 2009, 20:15

Like your epiphany with anthonyvop yesterday, I thought the same about Chuck being relatively reasonable until today. However I've found him obtuse and uninterested in trying to understand the rationale behind anything that doesn't agree with his point of view.

I don't mind people questioning the evidence behind their medical treatment, in fact more people should be doing so. Yet I find it impossible to discuss anything with someone who can dismiss general medical opinion (claiming its merely my own) whilst clinging on to a few quotes from lay websites. There is no desire to understand, merely a desire to reinforce his own preconceptions.

Am I being unreasonable on this thread?

How is it general medical opinion NOT to get a mammogram? I don't understand this. Perhaps its a difference between the UK and the US? My mother, mother-in-law, grand mothers, aunts, friends, all have been told by their doctors to have mammograms yearly from the time they are 40. I put up recommendations from highly respected sources, and you brush them off as "lay" without putting up any evidence of your own. I'm sorry that I don't just take your word for it that "it's general medical opinion" that somehow mammograms are not worth it, but I have too much other evidence saying that isn't the case. All I'm asking is for a link or a paper or a study that points to the risks outwieghing the rewards.

I would love to see that evidence. The study from this taskforce is not very compelling to me, and doesn't seem to have had much effect on respected sources such as the American Cancer Society. If I'm wrong convince me. Just merely saying your right, or some magic handwaving about how Marie Curie and the dangers of radiation, doesn't go very far with me. Sorry that's the nature of an internet forum. There are plenty of "experts" out here.

So just as you don't believe me, why should I believe you? At least I have tried to provide some evidence to back up my claims. It's up to you wether you believe them or not. But don't tell me I have no desire to understand.

I wouldn't say that you are being unreasonable, just uncompelling.

Malbec

20th November 2009, 21:06

How is it general medical opinion NOT to get a mammogram? I don't understand this. Perhaps its a difference between the UK and the US? My mother, mother-in-law, grand mothers, aunts, friends, all have been told by their doctors to have mammograms yearly from the time they are 40. I put up recommendations from highly respected sources, and you brush them off as "lay" without putting up any evidence of your own. I'm sorry that I don't just take your word for it that "it's general medical opinion" that somehow mammograms are not worth it, but I have too much other evidence saying that isn't the case. All I'm asking is for a link or a paper or a study that points to the risks outwieghing the rewards.

I would love to see that evidence. The study from this taskforce is not very compelling to me, and doesn't seem to have had much effect on respected sources such as the American Cancer Society. If I'm wrong convince me. Just merely saying your right, or some magic handwaving about how Marie Curie and the dangers of radiation, doesn't go very far with me. Sorry that's the nature of an internet forum. There are plenty of "experts" out here.

So just as you don't believe me, why should I believe you? At least I have tried to provide some evidence to back up my claims. It's up to you wether you believe them or not. But don't tell me I have no desire to understand.

I wouldn't say that you are being unreasonable, just uncompelling.

Ok, here are links. These are summaries of medical papers aimed at doctors so you may find the jargon difficult but try.

But before that, you appear to believe I don't agree with mammography screening at all which I find utterly astonishing. I do agree with it, just every other year above the age of 50 unless the patient is high risk.

The risks of mammography are best summarised in this paper discussing the fact that women are not often informed of the risks of mammography. The statistics given regarding what happens for every 2000 women x-rayed ought to make you think.

http://www.bmj.com/cgi/content/full/338/jan27_2/b86

There are others

http://content.nejm.org/cgi/content/abstract/338/16/1089?ijKey=c93132014e0f2d6dafa197ac875f6a0f1d7af34 9&keytype2=tf_ipsecsha

http://www.ncbi.nlm.nih.gov/pubmed/15378474?dopt=Abstract

http://www.bmj.com/cgi/content/abstract/339/jul09_1/b2587

The WHO (yes I know its the UN and therefore anti-American)

http://www.who.int/cancer/detection/breastcancer/en/index3.html

Breast cancer mortality is reduced by around 20% in the over 50s with screening. The same figure for 40-49 year olds is about 7% and the confidence interval is about 7% as well indicating that there may be no difference to mortality at all. And those figures do not include mortality caused from the treatment of false positive patients.

With the following paper I know you'll take it at face value and claim that its evidence that mammography should be performed in the 40-49 year old age group. However if you look at the statistics that they (American college of physicians) use, none of it is statistically significant by their own admission. I find it astonishing that they can make such recommendations on non-significant statistics.

http://www.annals.org/content/146/7/511.full.pdf

I note the summary is very carefully worded though.

chuck34

20th November 2009, 21:20

Ok, here are links. These are summaries of medical papers aimed at doctors so you may find the jargon difficult but try.

But before that, you appear to believe I don't agree with mammography screening at all which I find utterly astonishing. I do agree with it, just every other year above the age of 50 unless the patient is high risk.

The risks of mammography are best summarised in this paper discussing the fact that women are not often informed of the risks of mammography. The statistics given regarding what happens for every 2000 women x-rayed ought to make you think.

http://www.bmj.com/cgi/content/full/338/jan27_2/b86

There are others

http://content.nejm.org/cgi/content/abstract/338/16/1089?ijKey=c93132014e0f2d6dafa197ac875f6a0f1d7af34 9&keytype2=tf_ipsecsha

http://www.ncbi.nlm.nih.gov/pubmed/15378474?dopt=Abstract

http://www.bmj.com/cgi/content/abstract/339/jul09_1/b2587

The WHO (yes I know its the UN and therefore anti-American)

http://www.who.int/cancer/detection/breastcancer/en/index3.html

Breast cancer mortality is reduced by around 20% in the over 50s with screening. The same figure for 40-49 year olds is about 7% and the confidence interval is about 7% as well indicating that there may be no difference to mortality at all. And those figures do not include mortality caused from the treatment of false positive patients.

With the following paper I know you'll take it at face value and claim that its evidence that mammography should be performed in the 40-49 year old age group. However if you look at the statistics that they (American college of physicians) use, none of it is statistically significant by their own admission. I find it astonishing that they can make such recommendations on non-significant statistics.

http://www.annals.org/content/146/7/511.full.pdf

I note the summary is very carefully worded though.

Thanks for the links. I'll take a look. If the validity of these screenings are really that low, why does everyone seem to recommend them? I would find that astonishing as well.

And was that really that hard? Perhaps things are different in the UK, but for years here all anyone has ever said was get a mammogram every year after 40. And we just came out of "breast cancer awareness month" where there were PSA's all over the place telling women over 40 to get their yearly mammogram. So as someone once said, "It takes extrodinary evidence to back up extrodinary claims". Can you see that this type of info might be much better recieved than, "Mammograms are bad, um-kay"? :-)

Mark in Oshawa

21st November 2009, 03:58

Rationing of Healthcare? Ya...it happens. I think Americans are just getting their heads wrapped around the idea now because they may face it under a public system. That said, I agree with many on here that private insurerers do it all the time. That Denying of coverage thing isn't a myth, and let it be said I am a proponent of private healthcare options for those who can afford it. That said, the whole point of health insurance should be helping you for those illnesses you cannot afford to finance your way back to health from. This denying of coverage crap from HMO's and Insurance companies in the US is a rationing, and the consumer has to really educate oneself.

Now...I am in Canada, and I am not faced with the choice. I have none. Other than Cuba and North Korea, no other nation has national healthcare where the private option is outside the country only. Hence the Canadians flying and driving south...go figure, us in there with the wacky Castro's and Crazy Kim.

We pay through the NOSE for our socialized one size fits all healthcare. Yet we have rationing. Not as much as people would notice if they stay healthy, but the concern for me is the idea that some panel somewhere should decide who gets treatment based on age and the like. It hasn't been as cut and dried up here. We Canadians try to do go broke being fair to everyone so everyone gets the same, shortages in doctors, knee replacement waiting lists, and waiting lists for some cancer treatments. THAT too is rationing, but it is rationing based on at least the theory we are all equal. Funny....our former PM tho has a private clinic he as somehow found legal in Quebec tho..but he wouldn't allow us all to go there......

chuck34

22nd November 2009, 22:56

Ok, here are links. These are summaries of medical papers aimed at doctors so you may find the jargon difficult but try.

But before that, you appear to believe I don't agree with mammography screening at all which I find utterly astonishing. I do agree with it, just every other year above the age of 50 unless the patient is high risk.

The risks of mammography are best summarised in this paper discussing the fact that women are not often informed of the risks of mammography. The statistics given regarding what happens for every 2000 women x-rayed ought to make you think.

http://www.bmj.com/cgi/content/full/338/jan27_2/b86

There are others

http://content.nejm.org/cgi/content/abstract/338/16/1089?ijKey=c93132014e0f2d6dafa197ac875f6a0f1d7af34 9&keytype2=tf_ipsecsha

http://www.ncbi.nlm.nih.gov/pubmed/15378474?dopt=Abstract

http://www.bmj.com/cgi/content/abstract/339/jul09_1/b2587

The WHO (yes I know its the UN and therefore anti-American)

http://www.who.int/cancer/detection/breastcancer/en/index3.html

Breast cancer mortality is reduced by around 20% in the over 50s with screening. The same figure for 40-49 year olds is about 7% and the confidence interval is about 7% as well indicating that there may be no difference to mortality at all. And those figures do not include mortality caused from the treatment of false positive patients.

With the following paper I know you'll take it at face value and claim that its evidence that mammography should be performed in the 40-49 year old age group. However if you look at the statistics that they (American college of physicians) use, none of it is statistically significant by their own admission. I find it astonishing that they can make such recommendations on non-significant statistics.

http://www.annals.org/content/146/7/511.full.pdf

I note the summary is very carefully worded though.

Ok, Dylan I have read through your links. They all seem to be talking about the risks of false positives. This is of course a concern with any screening procedure. That I won't deny. More education to the women receiving mammograms about the risks of a false positive are clearly indicated by these studies. I will not deny that either.

However, you must correct me if I am wrong on this point. You seem to be arguing that the mammograms are actually somehow causing the cancers. Again, if I am wrong please correct me. Your last link there from annals says. "No direct evidence links cancer risk with radiation
exposure from mammography." There was some pain and discomfort. But I really don't think that there is much there to sway one from the screening.

If there are false positives from a particular screening, which there are in this case, then the medical community must either come up with a better test, or do more/better secondary screenings. If a women goes from one positive mammogram to chemo. or a mastectomy then that is a problem. And if that is happening then I would condemn that procedure. However, that does not, on it's own, mean that mammograms are "no good".

chuck34

22nd November 2009, 23:02

chuck34

22nd November 2009, 23:08

Also bringing this back to the government ratioing issue.

Sorry I don't have a link but this morning on "This Week" on ABC, they had a healthcare debate. Aparently in the healthcare bill that was pased by the House, the "taskforce" we've been discussing would become the controlling authority for preventative screenings. As such they will rate screenings as A, B, C, or I. A and B shall be covered by the government plan. Interestingly mammograms were rated as "C", and therefore would NOT covered. But that's not rationing, right? Sure, sure you can go out and get your private coverage for now, but how long will that last?

Mark in Oshawa

27th November 2009, 20:47

I found this very interesting about denials.

http://healthcare-economist.com/2008/06/30/medicare-more-likely-to-deny-claims-than-commerical-health-insurers/

“Medicare was the most likely to deny any part of a claim, with a 6.9 percent rate. Aetna was a close second at 6.8 percent while the others ranged from 2.7 percent to 4.6 percent."

So apparently one is better off not being denied by their "evil" private insurers than the government. So again, why do I want the government "option"?

Was in Chicago a week or so ago, and heard on one of the various local talk stations about a woman who is using the VA for her healthcare, and she had a lump discovered on a mammogram, and is now WAITING for a biopsy and will likely wait for the treatment since she knew of a another woman in the same boat. WAITING when you may or may not have a lump isn't a good thing. Whether it is a false positive or not, it should be looked into right away and treated if it isn't a false alarm. The VA is of course government healthcare and here is a case of rationing with a possible breast cancer. Ancedotal? yup...Cant say everything I heard was the truth 100% but why would anyone advocate that a system that is already taxed and stressed like Medicare and the VA be expanded, yet claim no additional money will come out of the pockets of the country? 3 Card monty with billions is what they should call this deal.

The US HAS public healthcare options, and they all are expensive to operate and have some rationing, just like the opponents say they are.

There is a place for a public system in any developed nation, but in the case of the US, it is pretty clear that this movement here is a political hammer and the Democrats are making hay while the sunshines and they control the Congress. I suspect they know in 2010, a lot less of them will be around to see their jobs.....and hence the rush. Rushing makes bad policy at the best of times.....

chuck34

3rd December 2009, 15:30

http://www.foxnews.com/politics/2009/12/02/task-force-apologizes-controversy-mammography-recommendations/?test=latestnews

"The task force, made up of doctors and scientists, acknowledged the way in which the recommendations were released wasn't done very smoothly"

"They also said some cases of breast cancer won't be caught early because women aren't sure what they're supposed to be doing."

Rollo

7th December 2009, 02:39

If there are false positives from a particular screening, which there are in this case, then the medical community must either come up with a better test, or do more/better secondary screenings. If a women goes from one positive mammogram to chemo. or a mastectomy then that is a problem. And if that is happening then I would condemn that procedure. However, that does not, on it's own, mean that mammograms are "no good".

A false positive is better than a false negative. If a test comes back negative, but the answer is wrong, then what? The patient dies because something wasn't detected?

Any positive would usually result in further testing to confirm the evidence. Surgery to this degree would never be taken lightly, and especially when dealing with a cancer, where it might cause it to enter the bloodstream and spread somewhere else.