Passionate Minorities
| Fri Nov. 20, 2009 9:46 AM PST
Ezra Klein on the new recommendations suggesting women should start getting mammograms at age 50, not age 40:
You could hardly imagine a better example of why cost control is so hard: This was a recommendation from an institution with no actual power that was based entirely on accepted medical evidence. Cost was not a component in the analysis. This is simply the data on whether mammograms make sense for most women between 40 and 50, not whether they're "worth" doing as opposed to other expenditures.
And the political outcry has been deafening.
Beyond the purely scientific aspect of the debate, one of the notable things about the reaction to the new mammography guidelines is the way it highlights how passionate minorities drive so many public debates. The USPSTF recommendation is based on large-scale costs vs. large-scale benefits, but the conversation that followed has been based mostly on personal stories. And you'll never hear any personal stories about the costs. Only the benefits. Virtually all of the personal testimony over the past few days has been from women who either contracted breast cancer in their 40s and were saved by a mammogram, or who have unusual conditions that require unusual monitoring. Obviously, if you fall into one of these categories you're going to feel very, very strongly about the benefits of early mammography.
And the millions of women who (if the USPSTF is to be believed) got mammograms in their 40s and suffered ill effects of one kind of another? For the most part those effects were relatively minor, so nobody feels motivated to write op-eds about them. But they're surprisingly widespread: the report suggests that the cumulative risk of a false positive result is over 50% for women who get annual mammograms between 40-49. That's a lot of false positives, a lot of extra biopsies, and a lot of unnecessary panic.
It's a close call, and annual testing may still be worth it. (The USPSTF continues to recommend it for women with a family history, genetic prediliction, or environmental risks.) That's a largely personal choice. But as with most political arguments, the public debate on this is being driven mostly not by dispassionate science, but by a passionate minority. That's democracy for you.
UPDATE: Via comments, it turns out that women who get false positives are occasionally motivated to write op-eds about the experience after all. Here's one from Andrea Stone.
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Comments
A lot of issues were
Submitted by Anonymous (not verified) on Fri Nov. 20, 2009 10:12 AM PST.
A lot of issues were exposed:
One: Feminists claim to be reality based, but in the past few days, they've been strictly anti-science and calling all of this misogyny.
Two: There will be death panels, that is, organizations whose job it is to promote certain practices, discourage others, based on efficacy and sometimes based on costs. The question is no the existence of death panels, it is will the death panels be existing insurance groups or a quasi governtment organization, or local elected groups. who will be on the death panels, what procedures they follow, who sets their goals, what power they have, how one (scientists, doctor, patient groups) can get their ideas heard by them
Three there is a lot of confusion about what evidence based medicine is. Is it solely studying various medical treatments and practices to see what works best? Is it a program to pay for favored treatments and discourage or not pay for treatments that have fallen out of favor?
Will evidence based medicine have us all eating bran muffins, avoiding eggs, taking hormone replacment therapy, getting annual mammograms, prostate exams, pap smears for ten years and then have us all rush away from eating bran muffins, eating more eggs, skipping the HRT, delaying and then getting biannual mammograms, prostate exams, pap smears....
What will evidence based medicine to regarding the treatments that the doctor I choose, licensed by the state, can use?
I'm all for studying and publishing studies of drug/treatment effectiveness. I'm not sure how that fits in with paying for treatments, or not paying for treatments. I'd like to hear more about that.
For more on this week's mammography issues see Orac or David Gorski or even AmyTuetorMD at open salon
Yep
Submitted by Dave Brown on Fri Nov. 20, 2009 10:19 AM PST.
I don't ever need to read anything Ezra Klein says, I just wait for Kevin to comment on it.
But Ezra is right. This is why cost containment in health care is so hard. And I can Imagine the new guidelines on Pap smears will be nearly as controversial. I imagine the morons on the cable networks are fanning the flames even as I write this.
The bottom line is, if we really want cost containment, we have no choice but to ration some care. But now is not the time to have that debate.
"One: Feminists claim to be
Submitted by MaynardHandley on Fri Nov. 20, 2009 11:52 AM PST.
"One: Feminists claim to be reality based, but in the past few days, they've been strictly anti-science and calling all of this misogyny."
Hey, I like a good anti-femist rant as much as anyone, but the exact same situation, pretty much, holds for prostate cancer. Prostate screening is largely worthless, not so much because of false positives but because
(a) there's little that can be done if you discover you have the cancer and
(b) there's little that *should* be done because the cancer is so slow chances are you'll be dead from something else before it affects your life.
And yet we have Bob Dole running around claiming prostate screen saved his life.
Stupidity is a gender-blind condition.
If you visit Firedoglake,
Submitted by Anonymous (not verified) on Fri Nov. 20, 2009 12:03 PM PST.
If you visit Firedoglake, Broadsheet, listened to the Diane Rehm Show, or partook of whatever your usual venue of sources is, there were many many women declaring this recommendation was from panels of men, men who hate women, and this would never take place for something like prostate cancer, though you point out it is similar.
Bob Dole isn't saying that it'e because men hate men, or women hate men, or science hates men.
But many feminists are loving this as further indication that men and science hate women and are trying to kill them in ways that wouldn't happen if the genders were reversed.
Response on treatment of cancer
Submitted by GaryP (not verified) on Sat Nov. 21, 2009 11:59 AM PST.
MaynardHandley's comments on the inability to treat prostate cancer (and perhaps breast cancer if I understood him/her correctly) are completely incorrect and need to be refuted.
I am a Medical Physicist with 20 years experiencein cancer treatment (board certified--diplomate of American Board of Radiology in Therapeutic Physics). I am currently retired due to my own serious cancer.
Prostate and breast cancer are two cancers that are extremely treatable (and even curable) and this treatment saves thousands of lives every year and gives others healthy many healthy years.
There are in some cases (extreme age, other serious health issues, extremely poor quality of life) when not treating patients with prostate or breast cancer may be a reasonable choice for the patient and/or family to make. However, for the majority of patients (with any type of cancer) agressive treatment can give patients years of good quality life.
I live every day with the knowledge that my cancer will eventualy kill me but I am extremely grateful for the agressive treatment that saved my life and allows me to enjoy time with my family and friends (and even occasionally continue to work providing care for other cancer victims).
Cancer for many (certainly not all) patients is becoming a chronic disease that can be managed to allow good quality of life for years. Unfortunately, we cannot predict which patients will benefit from agressive treatment any more than we can predict (without screening tests) who will get cancer at a early stage of the disease when treatment is most effective.
Allowing bureaucrats to set health care "best practices" which will eventually become hard and fast rules under government health care is both stupid (no one knows what constitutes "best practices" for an individual patient) and cruel.
Spreading the message (as MaynardHandley does) that cancer is a death sentence and screening and treatment is pointless is irresponsible, dangerous and a disservice to the victims of cancer.
screening
Submitted by steve duncan on Fri Nov. 20, 2009 10:31 AM PST.
I wonder at the outcry as it relates to the gender involved. Is society "sensitive" to this issue more so than diseases suffered by men and therefore more prone to protest changes in perceived proper screening guidelines? I once heard a prominent radio personality muse why wasn't there a prostate cancer awareness month like there was a month dedicated to breast cancer? If some medical board issued guidelines recommending the delay in getting prostate cancer screening wouldn't most men nationwide collectively shrug their shoulders and say "Yeah, whatever" and get back to whatever the hell it was they were doing? The National Cancer Institute estimates for 2009 there will be approximately 192,000 new cases of breast cancer and 40,000 deaths from same. The same body estimates coincidentally 192,000 cases of prostate cancer and 27,000 deaths. The angst over breast cancer outweighs any shared sorrow over prostate cancer by what, a few thousand percent? Yet the casualties from both are not wildly at odds. I posit the medical establishment, insurance companies and others could jack men around any number of ways regarding prostate cancer and any hue and cry over it would be dwarfed by what we're seeing now over this change in breast cancer screening. Why is that?
The answer is freudian
Submitted by Anonymous (not verified) on Fri Nov. 20, 2009 11:43 AM PST.
people like boobs more than they like buttholes. how many "funny" scenes in tv or movies involve an unpleasant rectal exam? how many such jokes involve the discomfort of a mammogram?
If we lived under a
Submitted by tpx on Fri Nov. 20, 2009 3:32 PM PST.
If we lived under a matriarchy there would be more mammogram jokes.
The Medical/Industrial
Submitted by Ten Bears (not verified) on Fri Nov. 20, 2009 10:32 AM PST.
The Medical/Industrial complex used my wife for a Laboratory Rodent and I and my then good employment with good health insurance as a Cash Cow. We lost our home, divorced (back together), truck, camper, minivan, most of my logging, mechanical and construction tools, furnishings, prized possessions...
The Medical/Industrial complex used my wife as a Laboratory Rodent...
haves, have nots
Submitted by tpx on Fri Nov. 20, 2009 10:59 AM PST.
Privileges are difficult to give up. Upper middle class persons are used to being first in line for medical tests and treatments and will not readily give up their place in the health care distribution line in order to reduce opportunity costs that prevent others from receiving their fair share of health care. Market economics has created winners and losers in the distribution of health care in America, and the winners are not going to relinquish any advantage they perceive having. Winners are able to create such a fuss because they not only have the wealth to do so, but because they also share elite status with the political class, making the development and implementation of good public policy for all difficult, if not impossible.
Privileges are difficult to
Submitted by Anonymous (not verified) on Sat Nov. 21, 2009 9:32 AM PST.
Privileges are difficult to give up.
Upper middle class persons are used to being first in line for medical tests and treatments and will not readily give up their place in the health care distribution line in order to reduce opportunity costs that prevent others from receiving their fair share of health care
This is what happens when your politics trumps medicine.
Medical treatment is NOT a zero sum game.
My "privelege" of getting the best testing quickly is the result of PAYING into a system that produces the best tech and interpretation. Those that contribute less do not get less - they just wait longer.
How do I know? Because I treat those people with less...Medicaid, ChPs patients line up at my door and get the same treatment across the board AS I DO.
DO THEY WAIT LONGER? YES...
but to change the system to LOWER the acess for the middle class just to make it more fair for those underprivelged is simply a political goal..
See castro...it dont work...and your spoiled ass would be the first to complain.
My biggest whiners are the elitist lefties screaming the 'workers' manifesto but expecting to be treated first because they are the elite.
Fuckin hypocites.
BTW, the mammo study was flawed...it didnt include Ductal carcinona in situ as cancer. (technically correct but ask a patient if shes her DCIS doesnt scare her to death)
The truth ALWAYS rears it ugly head when its YOUR ass on the line.
docgary
If more people just took
Submitted by Art Eclectic on Fri Nov. 20, 2009 11:06 AM PST.
If more people just took Beta Glucan every day, they could relax a bit more on the paranoia. I'd post a bunch of links, but I just don't feel like fighting the captcha this morning.
The recommendation had
Submitted by dcsusie on Fri Nov. 20, 2009 11:25 AM PST.
The recommendation had nothing to do with people getting their 'fair share' of health care. It was abiout whether annual mammograms beginning at age 40 are medically sound practice. It's unfortunate that they included all the crap about 'anxiety', which made it sound paternalistic and dismissive of women, but my understanding is that the underlying statistic is that if all women were screened annually beginning at age 40 you would expect to save one life for every 1900 screenings, and CAUSE one additional case of cancer (from radiation exposure) for every 2000 screenings. That's sure not a basis for recommending annual screening beginning at age 40, which is what just about every country but us concluded, and where we were headed until the 'show us you care by spending money' crowd got Congress to pass a resolution supporting mammos beginning at age 40 (though why we would want to take medical advice from a bunch of guys who can't find thier own _ss_s with both hands is beyond me.
That's actually complete BS.
Submitted by B on Fri Nov. 20, 2009 2:22 PM PST.
That's actually complete BS. The radiation levels associated with a mammogram (70-300 millirems per event) is much much smaller than any exposure rate which has been shown to have a statistical impact on cancer rates. As near as we can tell this dose does absolutely nothing. There is a mechanism for an effect through radiation damage, but it is not observable over the last 50 years of medical research.
I'm not sure how you are misinterpreting the results but you are. They are comparing false positives, stress, biopsies, etc. to the 15-20% (or 30-45 depending on the study you choose) of breast cancer deaths mammograms can prevent in the age 40-50 category
Breast cancer "survivors"
Submitted by Shamhat (not verified) on Fri Nov. 20, 2009 11:37 AM PST.
We now understand that not all identifiable clumps of transformed and immortalized cells eventually develop into life-threatening cancer.
Many of the women who were treated for DCIS identified by mammogram—that is, the biopsy was positive for cancer and they had surgery, chemo, radiation, and lifetime followup—would never have progressed to a palpable lump and metastatic disease. They survived cancer not because it was caught so early and treated so effectively, but because it was never life-threatening in the first place.
This isn't intended to minimize the personal journey of any individual who was forced to contemplate mortality and navigate treatment and recovery, but many of the women protesting loudly, "I was saved by a mammogram before age 50," are in fact the personification of its risks.
I've been hearing about this
Submitted by B on Fri Nov. 20, 2009 11:46 AM PST.
I've been hearing about this from my 70 year old mother. Mammogram recommendations and coverage of annual gynecological exams. She and her friends are worried a bit more about the other end of the scale. When recommendations are to stop doing mammograms and to stop doing exams for women over 80. These recommendations eventually result in lack of coverage through medicare and supplemental insurance.
This kind of stuff definitely feeds the Obamacare narrative -- rationed care and death panels. It has nothing to do with Obama, but they hype is apparently growing (I don't get cable).
I totally understand the science and the statistics -- but shouldn't they just avoid outright one size fits all recommendations. Maybe a healthy 70 year old with 100 year old parents out to be treated a little differently than a cancer or heart attack survivor. Maybe the hard decisions should be shouldered by the doctors. I'm not sure how to do that, as they usually take the easy way out when it's possible.
-------------------
And I'm really not sure how they are able to compare 1) stress and discomfort concerning a false positive and 2) a negative cancer outcome. That's always seemed like a really stupid comparison. Frequency of exams, intrusive exams with actual medical consequences, incredibly expensive exams, . . . I can understand that. But I don't understand stress and discomfort. Stress is highly individualized and all you have to do to relieve it in most people is tell them the false positive rate. Morons.
Mammograms were pushed as a
Submitted by J. Frank Parnell on Fri Nov. 20, 2009 11:44 AM PST.
Mammograms were pushed as a holy grail to defeat breast cancer. If only we screened early and often we could slay the beast. Many people sincerely believed this, and others saw a financial gravy train to jump on. In fact mammograms are an imperfect tool, largely ineffective on younger women, beset by numerous different kinds of false positives, and significantly increasing a woman’s’ life time radiation dose. Mammography is a useful diagnostic tool, just not the silver bullet it was sold as.
Being an imperfect tool and
Submitted by B on Fri Nov. 20, 2009 11:54 AM PST.
Being an imperfect tool and increasing a lifetime radiation dosage are easily quantified, analyzed, and explained phenomena. Maybe women would opt out. As they still increase survivorship other women might choose to go ahead.
Just tell folks exactly what the marginal benefit is. What I don't understand is comparing stress to a negative cancer outcome.
I did see this
Submitted by Anonymous (not verified) on Fri Nov. 20, 2009 11:47 AM PST.
I did see this op-ed/personal experience piece on a false positive. I personally think this kind of experience should be aired more frequently to provide some kind of balance to the coverage of this topic.
http://www.sphere.com/2009/11/17/my-cancer-scare-thanks-to-a-mammogram-n...
Here we go again...
Submitted by rhinoman (not verified) on Fri Nov. 20, 2009 12:48 PM PST.
OK, tell me again how government is going to reduce the cost of health care. Or how these health care bills are "deficit neutral". Seriously?
We're broke, guys. The fact that we haven't maxed out our credit cards yet doesn't mean that we have assets.
So, how are we going to pay for this?
we pay twice as much for less
Submitted by tpx on Fri Nov. 20, 2009 2:23 PM PST.
If we would adopt the French or Canadian health care system we would cut health care costs in half while improving distribution for everyone. It is the passionate wealthy factions who do not want to give up their privileged place in the health care distribution model. Capitalism provides for the lucky few, who prevent the kind of wholesale changes that are required to bring the US up to the standards established by Sweden, France, Japan, etc. American style democracy's deference to wealth allows the lucky few to keep the rest of America from having health care people living in comparable economies have, while paying twice as much for it.
Well, sure, but...
Submitted by rhinoman (not verified) on Fri Nov. 20, 2009 2:50 PM PST.
Yes, if we could adopt the French system, that would be great.
But as Kevin points out again and again, getting Congress to cut costs is pretty much impossible. In fact, I would submit that getting Congress not to inflate costs through the roof is pretty much impossible. We don't adopt the French system because our political system won't allow us to do so.
Our political system won't
Submitted by tpx on Fri Nov. 20, 2009 3:29 PM PST.
Our political system won't allow everyone access to health care because of its domination by wealth. Congress is not dominated by its concern for the public welfare, but by its greed.
There is plenty of evidence
Submitted by Nick S. (not verified) on Sat Nov. 21, 2009 1:59 AM PST.
There is plenty of evidence that the Canadian health care system does not "improve distribution for everyone". I have several friends in Canada I have discussed this with repeatedly- including a nurse. In Ontario at least, most doctors are not accepting new patients- there's a waiting list of weeks or months to get in for any kind of basic check-up with a general practitioner. If you get sick, you're stuck going to an urgent care-type clinic instead of seeing the doctor you don't have- just like here in the U.S.
You're also no longer allowed to see your regular doctor when you get pregnant, too- you'll see whomever the government decides your new OB/GYN should be- even if your GP is qualified.
The wait for an MRI in Canada is measured in weeks, sometimes months- for humans. Cats & dogs can get one next-day. Or I can get one next-day here in the U.S. (I've had several MRIs and a CAT scan on short notice- same- or next-day, and I probably wasn't in danger of dying in the next 24 hours.)
Sure, it's free- when it's available.
By the way, Ontario doesn't cover prescription drugs. People who do get diagnosed and get prescribed medication for their condition sometimes can't afford to pay for it.
p.s. I've read that U.S. wait times are bad as well. A specific example I read was in New York- one of the slowest and most expensive health care regions because of the huge mess of regulations and limitations and the insane rate of medical malpractice suits in the area. We tend to not have that problem out in the Midwest. Doctors who have moved here from N.Y. are shocked that they aren't called into court several times a week.
Instead of the federal government trying to force a state to be a little more rational with its health care regulations (which is completely unconstitutional), they're going to force the entire country to be irrational (which is even more unconstitutional). Quality of care will go up for those that have no access to affordable non-emergency care right now. Quality of care will go down for everyone else, or costs will rise- or both. Somebody has to pay for the new people coming into the system. Taxes will be jacked up for everyone who has insurance or is young enough to not need it.
Um, well, I am a feminist,
Submitted by Anonymous (not verified) on Fri Nov. 20, 2009 12:50 PM PST.
Um, well, I am a feminist, and I appreciate this news. After talking with a friend in her 60s who is dying of breast cancer and is convinced that too-frequent mammograms caused it, I asked my doctor about the radiation. She told me that the radiation from one mammogram was "only as much as 30 chest x-rays." My jaw just about dropped to the floor; I decided to forgo the first one at age 40 and I expect to brandish these recommendations next year.
A chest x-ray is a
Submitted by B on Fri Nov. 20, 2009 2:24 PM PST.
A chest x-ray is a negligible exposure. A mammogram is about equivalent to background exposure levels over a few months to year.
mammogram hell
Submitted by LouC (not verified) on Fri Nov. 20, 2009 1:28 PM PST.
As a woman who has suffered through mammograms all through her 40s, I welcome this news. the X-ray machine used for mammograms could easily be used as a torture devise. Why can't someone invent one that is more comfortable and more tailored to the actual physiology of a woman's breast?
Seriously though, I had to have a second mammogram last year because of "suspicious" shadows on the first. And now another poster tells me I had the equivalent of 60 chest x-rays last year. Great.
Why can't someone invent one
Submitted by Anonymous (not verified) on Sat Nov. 21, 2009 10:06 AM PST.
Why can't someone invent one that is more comfortable and more tailored to the actual physiology of a woman's breast?
__________________________________________
Because the "invention" on new technology and devices costs billions...and those footing the bill take financial risks. Thats right, even the big boys like GE.
The R and D costs time and money...Sure, the rewards are plentiful - but if you take the profit equation out of the formula (ie, have imposed amounts dictated by law and not the market) the number of comers will be reduced.
New devices wil NOT be developed in the numbers we are used to if the end user will be prohibited from paying the fees.
And make no mistake, The health care bill will be designed to limit the costs for all tests regardless of the patients INTENTIONS.
See page 203 of the house bill....An individual that is willing to pay an amount to a say, imaging company that is over the govts prescribed amount can be charged with A CRIME.
hell is right
Submitted by KathyF (not verified) on Fri Nov. 20, 2009 2:26 PM PST.
I for one will never get another mammogram until the technology is improved. The one time I did I suffered nightmares--I'd wake up clutching my chest in terror--for months after.
So I welcome the news, feminism be damned.
I'd call this pretty passionate, wouldn't you?
I worked for a medical
Submitted by J. Frank Parnell on Fri Nov. 20, 2009 3:18 PM PST.
I worked for a medical device company that made a product that worked with mamography machines. The basic problem is that to get a uniform X-ray image where tumors will show up one needs to take a breast and squeeze it into a pancake of uniform thickness. This is made more difficult (and more painful) by the need to image tissue up near the shoulder. Digital image processing and alternative probes such as ultrasound have been touted for years, but there is little sign the conventional mamography machine will be displaced in the near future.
The false positive issue is complicated, as you have benign growths and precancerous growths. The health risk/benifit from removing these is not always clear. In typical biopsies, both surgical and needle, physicians tend to take a lot of extra samples to make sure they are in fact capturing tissue from the suspected tumor, as the hemispherical breast they are working with has a very different geometry from the pancake represented in the mammogram. This results in additional pain, trauma and risk for the patient.
It often not appreciated how little the efficacy of even common medical procedures has been researched. The radical mastectomy became standard treatment with very little research into its efficacy. A single surgeon, working on the principle that more is better, tried out a radical plus procedure. He saw no increase in survivability, and speculated that even a normal radical took more tissue than was usually necessary. This led to the far less traumatic modified mastectomy becoming common.
Wow, you mean different
Submitted by coyote (not verified) on Fri Nov. 20, 2009 3:54 PM PST.
Wow, you mean different individuals actually have different preferences and value procedures in different ways? Weird! Who would have ever thought that everyone would not be silently satisfied at whatever one-size-fits-all solution is crafted by Congress and other people who apparently "know best."
What garbage
Submitted by g. powell on Sat Nov. 21, 2009 8:12 AM PST.
Congress is setting up exchanges to allow people to shop for policies, liberals want to include a public option add yet more choice, Weyden will include a provision that would allow employees to opt out of employer-provided plans and shop on exhanges -- yet you continue with the conservative clap-trap that it's a "one-size-fits-all solution."
You really have no understanding of the issues beyond GOP talking points. No surprise.
...one of the notable things
Submitted by Luther on Fri Nov. 20, 2009 5:51 PM PST.
...one of the notable things about the reaction to the new mammography guidelines is the way it highlights how passionate minorities drive so many public debates.
Only Nixon, one of our wisest presidents, understood the principle of the silent majority.
OK, I'm the one who posted
Submitted by Anonymous (not verified) on Fri Nov. 20, 2009 10:50 PM PST.
OK, I'm the one who posted about mammogram radiation levels, and I am not comforted by B's suggestion that women getting yearly mammograms are merely doubling their yearly background radiation exposure for thirty years of their lives.
But I have to draw the line at the new guidelines for Pap smears. The guideline is telling young women to have sex for, oh I don't know, 6 years (I'm assuming sexual activity at 15 is about the average these days?) before ever seeing a gynecologist.
Not trying to comfort or
Submitted by B on Sat Nov. 21, 2009 12:33 AM PST.
Not trying to comfort or scare. Just wishing simple information is out there. If someone is disturbed by analytical x-rays most doctors or dentists are willing to find another way.
Radiation exposure from mammograms is now mostly around 70 millirems (old instruments were as high as 300). Average annual radiation in the US is around 360, but it's as high as 1000 in places like Denver with granite based soils that generate radon gas.
Under a no threshold assumption any increase in radiation exposure could cause an increase in mutations and susceptibility to cancer. However, as a practical matter a low exposure group and a group with 1000 millirem exposure / year (i.e. Denver) can not be distinguished.
Privileges are difficult to
Submitted by Anonymous (not verified) on Sat Nov. 21, 2009 9:47 AM PST.
Privileges are difficult to give up.
Upper middle class persons are used to being first in line for medical tests and treatments and will not readily give up their place in the health care distribution line in order to reduce opportunity costs that prevent others from receiving their fair share of health care
This is what happens when your politics trumps medicine.
Medical treatment is NOT a zero sum game.
My "privelege" of getting the best testing quickly is the result of PAYING into a system that produces the best tech and interpretation. Those that contribute less do not get less - they just wait longer.
How do I know? Because I treat those people with less...Medicaid, ChPs patients line up at my door and get the same treatment across the board AS I DO.
DO THEY WAIT LONGER? YES...
but to change the system to LOWER the acess for the middle class just to make it more fair for those underprivelged is simply a political goal..
See castro...it dont work...and your spoiled ass would be the first to complain.
My biggest whiners are the elitist lefties screaming the 'workers' manifesto but expecting to be treated first because they are the elite.
Fuckin hypocites.
BTW, the mammo study was flawed...it didnt include Ductal carcinona in situ (technically correct but ask a patient if shes her DCIS doesnt scare her to death)
The truth ALWAYS rears it ugly head when its YOUR ass on the line.
docgary
improve health care distribution
Submitted by tpx on Sun Nov. 22, 2009 8:31 PM PST.
Fucking hypocrites go to public universities, receive public assistance for their educations, earn a portion of their income from social welfare transfers and think they generate all of the value added to medical goods and services when they are employed in health care services distribution. Medical provider entrepreneurs are the biggest whiners in America, and changing the political economy to take away their elite status will greatly improve health care distribution.
Lets play a mind
Submitted by Anonymous (not verified) on Sat Nov. 21, 2009 9:51 AM PST.
Lets play a mind game..
Picture this scaled back mammo recommendation announced in, say, 2006.
President Bush announced the formation of a panel for the re-evaluation
of screening tests WITH THE RECOMMENDATIONS AS WE SEE TODAY.
The honest few of you would agree that the majority of those posting here would be hanging bush for trying to KILL THE POOR, WOMEN AND BLACKS.
NOT ONE OF YOU WOULD BE MAINTAINING THE POSITIONS POSTED HERE.
PLEASE RAISE YOUR HANDS IF IM WRONG...
EVERYTHING IS POLITICAL.....
DOCGARY
You are wrong and should
Submitted by tpx on Mon Nov. 23, 2009 8:29 AM PST.
You are wrong and should have your medical license revoked.
Mammograms are the #1 cause of breast cancer...
Submitted by Anonymous (not verified) on Sat Nov. 21, 2009 1:59 PM PST.
Up until 2005 the #1 cause of breast cancer was "therapeutic" hormones.....the #2 mammography. With international moratoriums on the use of hormones, incidence of "therapeutically" induced breast cancers has dropped like a rock and mammograms are now the #1 cause of breast cancers. Decades of meta-analysis continues to demonstrate that routine mammograms discover barely 3% of all breast cancers....most are discovered by the patient...
The 40/50 arguement is an excuse or a smoke screen deflecting attention away from a deadly diagnostic practice that is well documented in its causal relationship to breast cancer.
You are wrong... Submitted
Submitted by Anonymous (not verified) on Tue Nov. 24, 2009 4:08 PM PST.
You are wrong...
Submitted by tpx on November 23, 2009 - 8:29am.
You are wrong and should have your medical license revoked.
_____________________________________________________
So you disagree with my opinion and want my licensed revoked?
What a shmuck you are!
You, singlehandedly, prove that liberalism is a mental disorder!
I repeat...
If the raising of the age for mammos occurred during Bush's years,
you would be the first to scream:
"Bush is killing women and people of color so the insurance companies can increase their profits"
You are wrong ... Submitted
Submitted by Anonymous (not verified) on Tue Nov. 24, 2009 4:10 PM PST.
You are wrong ...
Submitted by tpx on November 23, 2009 - 8:29am.
You are wrong and should have your medical license revoked.
So you disagree with my opinion and want my licensed revoked?
What a shmuck you are!
You, singlehandedly, prove the liberalism is a mental disorder!
I repeat...
If the raising of the age for mammos occurred during Bush's years,
you would be the first to scream:
"Bush is killing women and people of color so the insurance companies can increase their profits"
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