October 21, 2009

"We don't want people to panic... But I'm admitting that American medicine has overpromised when it comes to [cancer] screening."

"The advantages to screening have been exaggerated."

The latest from the American Cancer Society. Rush Limbaugh's take:
How in the world can it be exaggerated to go in and get tested?...
Folks, I just find the timing of this amazingly coincidental when Obama's trying to push a health care plan that tries to condition everybody to less and less testing in order to reduce costs.

58 comments:

kentuckyliz said...

They're talking about specific cancer screening tests like mammograms and prostate exams/PSA tests.

My melanoma was obvious--black, shedding, itchy, bleeding.

My thyroid cancer was undetectable and accidentally found by the talented Fingers of Palpation by my ENT, when I was seeing him for another reason entirely.

My breast cancer wasn't detected by mammogram, but by PET CT fusion scan, as a followup to chronic thyroid cancer, just to make sure the ThyCa wasn't setting up camp anywhere. Surprise surprise.

So, PET CT fusion scans for everybody! That would detect almost all cancers.

Freaky moment: I read your blog post just as Rush was saying those exact words on the podcast I'm listening to now. Almost seemed like a screenreader text to speech program.

former law student said...

I've heard this for a while now -- it's the "ignorance is bliss" school of medicine.

blake said...

When they say "We don't want people to panic" that's probably a lie.

Freeman Hunt said...

I saw this on the news. They showed a graph of screenings going up 40%, but deadly cancers "only" going down 10%.

I think the ten percenters are probably happy about the screening.

kentuckyliz said...

The typical cancer treatment regime is heavy handed when it comes to early cancer.

Obama HOPEs you wait until you can feel the CHANGE.

WV lizede !!!

From Inwood said...

"The reports of my death have been exaggerated."

Mark Twain

Ann Althouse said...

There's a death panel in there somewhere, I know.

peter hoh said...

I know a doc who thinks that routine screenings are too widely used, and that they result in more harm than good. His rationale seemed sound, but he acknowledged that there was no good way to persuade people of his perspective.

Cedarford said...

"The advantages to screening have been exaggerated."

The latest from the American Cancer Society. Rush Limbaugh's take:

How in the world can it be exaggerated to go in and get tested?...

Folks, I just find the timing of this amazingly coincidental when Obama's trying to push a health care plan that tries to condition everybody to less and less testing in order to reduce costs.


Limbaugh probably has one of the finest healthcare executive packages out there.
So he doesn't have to deal with the choices and lost opportunity costs both the insured consumer, and the insurer have to deal with about the problem of the cost of defensive medicine tests. And what is now thought are a very dubious range of broad-based "cancer screening tests" that cost tens of billions at miniscule gain.

Chest X-rays that pick up stage 4 lung cancer, but not any at a stage that is curable, with rare exceptions.
Insisting it is a "good thing" to have women in their 20s to get mammograms. The economics of mass PSA tests and ensuing biopsies.

Rush may not care, but employers and the self-insured are seeing healthcare costs that doubled under Dubya and are near or at the limit of affordability. And perhaps well over the limit of what healthcare costs must be for America to regain it's competiveness with European and Asian countries where healthcare is a 40% to a 190% less of an adder-on to cost of goods and services.

Rush has for years touted US healthcare and Big Pharma as "The Best in the World!!!". Unfortunately his inclination is to urge giving the well-off the ability to divert 10-15 thousand a person into "Heath Savings Accounts" tax-free!

It's a great idea for the rich, but that is not where America is headed.

Generally, the problem is America is so broke and so uncompetitive we can no longer pretend that a test that costs 300 dollars and is performed on 20 million people is worth it if the 6 billion spent only saves 250 lives. That 9 billion is lost opportunity cost that could be applied better elsewhere in a no-longer unlimited government, private industry budget.

Of course the knee-jerk response is always "Tell it to the Victim Families of the 250 dead people!!" as a way to justify cutting elsewhere.

Fine.

Saving 25 people at 24 million spent each is a stupid allocation of scarce resources. Spending it on creating 10,000 new jobs rebuilding or widening 110 structurally deficient bridges which saves 80 lives but adds 200 million a year for the next 60 years in new productivity effeciencies is a far wiser use of funds.

Suchita S said...

What Rush doesn't realize is that cancer screening tests are unnecessary if the results won't change much or lead to treatment (eg. mammogram in a 95-year-old with a history of diabetes and coronary artery disease) or if the results aren't predictive for many in the population (particularly the PSA test).

Saying that more testing for everyone is inherently better is like saying that every car should get an 18-point full-service inspection. Just because your insurance company might pay for it doesn't mean you need it.

former law student said...

I know a doc who thinks that routine screenings are too widely used, and that they result in more harm than good.

I'd rather my oncologist say, "We caught it in time," rather than "There's nothing that can be done."

I wish there was a screening test for lung cancer. My sister's only symptom was a cough. A friend's wife, a lifelong non-smoker, got it from radon she thought.

The worst scenario is when it's caught too late for treatment to be effective, but you don't know this for sure, so you pull out the treatment stops anyway.

Bruce Hayden said...

I'd rather my oncologist say, "We caught it in time," rather than "There's nothing that can be done."
...
The worst scenario is when it's caught too late for treatment to be effective, but you don't know this for sure, so you pull out the treatment stops anyway
.

Does this mean that you are now coming out in opposition to ObamaCare and its Death Panels that will determine who gets what tests and treatment based on primarily political lobbying?

(I threw in the Death Panels for Ann's benefit).

bagoh20 said...
This comment has been removed by the author.
bagoh20 said...

Telling me this is like telling a lottery winner that gambling is stupid, except the odds and the winnings are much better in in the screening game. Not to mention, if you don't play, you not only don't win, you lose...everything.

10/22/09 12:40 AM

Ignorance is Bliss said...

former law student said...

I've heard this for a while now -- it's the "ignorance is bliss" school of medicine.

Don't blame it on me!

Slow Joe said...

At this point, Rush could say the sky is blue and liberals would start firing up photoshop and freaking out about it.

Of course you want to get screened. Of course Obama and the people making this statement will get their spouses and selves screened.

But you, the little people, do not need to be screened. We will invent statistics about it. This is just another example of the reason we want medicine to be highly lucrative. New screening methods, treatments, machines will all be bought by profits. If they are all bought by taxpayers, guess what: they are going to suck and stagnate.

I'm not going to accept this misery. I'm not going to let the fucking government tell me what level of happiness I should settle for.

Pogo said...

And this is exactly how medicine becomes politicized.

I used to be puzzled by the finding in US studies that blacks do not become organ donors in part because they "are more likely to believe that health care professionals will not do as much to save their lives if they are designated as organ donors" source.

They often avoid doctors and do not follow their advice for the same reason: they do not trust them to do the right thing.

Now we will enter a phase of mistrust for doctors nationwide, because we will not know if a medical decision is made for our benefit, or for the payor.

Welcome to socialized medicine.

Michael Hasenstab said...

I'd rather my oncologist say, "We caught it in time," rather than "There's nothing that can be done."

That's where I am, right now.

I thought I had a kidney stone, went to my primary care MD for treatment. He suggested that I have a sonogram just to see what's going on in there, and to be sure that the kidney was okay.

Bingo, Stage I kidney cancer, caught before it metastasized.

That little bit of extra cancer screening probably saved my life.

A few year back, Mrs. H had a mastectomy to remove some cancer that was detected early. She's mad it 8 years now without recurrence.

God willing, we're going to live a while longer. That happy news no doubt means nothing to the bureaucrats who are honing the federal gummint into the insurance company from hell, but it means a great deal to me, my wife and our family.

As an aside, isn't remarkable how the federal gummint is gaining public support for its horrible insurance plan by demonizing private insurance companies that offer far better plans and coverage?

Issob Morocco said...

Hmmm, American Cancer Society pooh poohs screening. I wonder if they were told Fed Funds would be scarce if they didn't join Team Obama's mission? Is this more Chicago Style politics at play? Those who live in the Land Of Corruption, would say "Welcome to our world". Rush is correct to question such change in strategy in a group known to strongly push for early detection.

Cheers!

AJ Lynch said...

Has anyone coined a term like "birther" to describe this conspiracy Rush see?

Der Hahn said...

I'd rather my oncologist say, "We caught it in time," rather than "There's nothing that can be done."

The logical problem with that statement is your oncologist doesn't know if the cancer he found 'in time' will actually cause your death if left untreated unless he has access to that crystal ball the Norwegians used to predict Obama would usher in world peace.

Using 'survival after treatment' statistics to prove that screening saves lives is inherently biased because you are including people in the survivor group who were not going to die regardless of the treatment choice.

Here's the WSJ take on the same NYT article.

They quote the study -

After 2 1/2 decades of screening for breast and prostate cancer, conclusions are troubling: Overall cancer rates are higher, many more patients are being treated, and the absolute incidence of aggressive or later-stage disease has not been significantly decreased. Screening has had some effect, but it comes at significant cost, including overdiagnosis, overtreatment, and complications of therapy …

In other words, we're finding and treating cancers that likely were never going to be life-threatening, boosting the survival rate stats, but not effectively keeping aggressive cancer from progressing. If screening was helping in that regard, the number of end-stage cancers should be going down, not staying flat.

This is the reason that 'preventative care' will not reduce overall health care costs, and auto service centers advertise 'free safety inspections'. If you go looking for problems, chances are you are going to find something that looks like it needs attention.

There are cases where 'better safe than sorry' is a reasonable choice but it's not any more accurate to say that a radical masectomy to remove a tiny lump saved your life than it is to say you avoided a fatal accident by having brake job.

Henry said...

The American Cancer Society is right. Not only are the advantages to screening greatly exaggerated but they can be dangerous.

A false positive means more screenings and more expense.

An indeterminate result may lead to unnecessary treatment.

Hospitals are not good places to be if you're healthy. Unnecessary treatment can actually kill healthy people.

If you don't like Obama's healthcare salesmanship you might observe that this announcement from the American Cancer Society undercuts one of his favorite daydreams -- the idea that screenings save money.

It doesn't. Screening everyone costs a lot of money. Responding to false positives costs money. Delivering unnecessary treatment costs money and lives.

The more money that goes into futile gestures, the less that is left for necessary care.

Libertarians in this forum might want to remember that they are the ones that don't believe in free lunches.

Pogo said...

"Libertarians in this forum might want to remember that they are the ones that don't believe in free lunches."

True, but the primary issue is choice.

If someone wants to spend money on screening that is unlikely to benefit them, what is it to you?

The problem comes when they are spending other people's money via the state, and all choice is removed by an unelected bureaucrat, as we are drifting toward nationally.

That's not libertarian.

Howard said...

Rush is the perfect example of the pussification of USA. Talk of fears and scary things 18-hour per week is chickenhawk pablum.

Lets not be rational, he says. Rather, lets rely on emotional decision making.

A friend had a prostrate biopsy based on a couple false alarm tests. Nothing quite like the cancer fear stress and pissing blood for a couple weeks.

The doc told him when he got the all clear to get more BJ's from the old lady as a prevention to prostrate inflammation. Unfortunately, he couldn't get him to write a script.

Shanna said...

Generally, the problem is America is so broke and so uncompetitive we can no longer pretend that a test that costs 300 dollars and is performed on 20 million people is worth it if the 6 billion spent only saves 250 lives. That 9 billion is lost opportunity cost that could be applied better elsewhere in a no-longer unlimited government, private industry budget.

This is why WE should not be making these decisions as a collective. WE all have different health insurance plans and some of WE think it’s worth 10 extra bucks a month, or 20 or even 30 to have a plan that covers them just in case we need them, even if they are an imperfect measure.

Furthermore, I don’t understand people who sit around begrudging others some test that costs 300 dollars, if they are paying for it. And I really don’t like the folks who insist that we start paying for everything collectively, and then go about telling us what to do because ‘we’re paying for it’.

traditionalguy said...

Fine with me. The statistical practice of medicine says that the outcomes as a percentage of the whole are not helped by the expenses of tests and early treatments, and are therefore unimportant. But to the man/woman saved by this money waste it is very important. We should also forbid tests for the President,the Congress members,the Supremes, and the Harvard Faculty that dreamed up this approach to public health standards to be enacted by the Unnamed Panel. That will suddenly end this plan to stop testing DEAD in its tracts.

Robt C said...

Rush is wrong on this one. Obama has been talking for months that one way to lower overall health care costs is thru more screening, thus catching things early. So this report refutes Obama's position. (Charles Krauthammer (sp?), who is an MD by training, wrote a column a couple of months ago about the falsehood of Obama's position but I can't find the link.)

wc: "undere" the bus.

MadisonMan said...

Rush could say the sky is blue and liberals would start firing up photoshop and freaking out about it.

I'd just say he's wrong. Anyone looking out the window can see that.

But he was right yesterday, for about 5 hours in the afternoon, and it was glorious!

Henry said...

True, but the primary issue is choice.

No, the primary issue in respect to the American Cancer Society is good medicine. From the WSJ (see Der Hahn's link above):

the American Cancer Society is working on explaining to patients that screening for breast and prostate cancer carries the risk of overtreating small cancers while missing other, potentially deadly cancers.

Limbaugh is the one making this political. "Coincidental" he calls it.

That's BS.

As I pointed out before, Obama was the one promoting preventative care -- screening -- as a cost saver.

This report, in that it exposes how complicated health care decision making is, actually can be used as an argument against a further massive Federal intrusion into the healthcare system.

But not in the kneejerk, paranoid way that Limbaugh has chosen.

Triangle Man said...

The point of the article is that the technologies do not work well at all. It is fascinating the extent to which people are willing to buy (and defend) health care technology that does not work. Beyond the costs, they are willing to make profound life-altering decisions based on essentially non-informative test results. A positive PSA test is an indication that cancer may be present, but it says nothing about a man's likelihood of dying from prostate cancer.

Pogo said...

"No, the primary issue in respect to the American Cancer Society is good medicine. "

That statement is unclear.
What did you mean?

Triangle Man said...

But to the man/woman saved by this money waste it is very important.

The waste of money on tests that don't work is one thing, but another problem with overdiagnosis is that people are having very serious treatments (prostatectomy, mastectomy, radiation therapy) unnecessarily.

traditionalguy said...

Triangleman...My read on the ACS release was that the tests were catching too many early cancers that were not the "Deadly" ones. That untested the same amount of Deadly cancers were happening as they bwere when the testing was catching them all.Ergo, the tests were worthless. That pretty much admits that they only know how to cure the less deadly cancers. So why not cure those and keep learning how to do it better?

Bender said...

Limbaugh probably has one of the finest healthcare executive packages out there.

I suppose if you call his own pocket a "healthcare executive package," I suppose wo.

As a self-employed small businessman, Rush does not have a health insurance plan for himself. He pays out-of-pocket.

former law student said...

Men do die of prostate cancer. But "watchful waiting" is often the best medicine.

Methadras said...

So what will happen to the various cancer charities if President BarelyCare enacts his horror show vision for medicine? Afterall, it will be controlled by *gasp* government. Where will that money go and if a cure for any cancer is ever found, then how will it be implemented within the framework of the law. Granted, this is a hypothetical, and I do not expect cancer to ever be cured and I find many of the cancer charities to be distasteful money making operations.

peter hoh said...

Howard wrote: Unfortunately, he couldn't get him to write a script.

I've heard tell of a script similar to that. This was from the late 50s, early 60s. The doc wrote on the patient's chart, "Give him the royal treatment, as described in First Kings, chapter 1."

PatCA said...

For many years, my breast cancer survivor friends and I have been shouting that preventative care does not save money. Testing and treating women for 25 years is much more expensive than the alternative--no screening until we discover a Stage IV lump. We have also been saying that the survival rates are in the realm of "lies, damn lies, and statistics."

For me though early diagnosis was better. I am alive because of it. Yes, we are not a collective, as Shanna said. I am an individual and I want testing. And the ACS and government are preparing the way to reduce screening to reduce costs, costs they already knew were not cost effective (to the collective) and lied to us about--as long as someone else was paying.

former law student said...

PatCA: are you saying that hospice care is cheaper than treatment?

knox said...

The advantages to screening have been exaggerated? Better alert the National Breast Cancer Awareness Month people, who paint the world pink every year around this time.

Furthermore, I don’t understand people who sit around begrudging others some test that costs 300 dollars, if they are paying for it. And I really don’t like the folks who insist that we start paying for everything collectively, and then go about telling us what to do because ‘we’re paying for it’.

Agreed. This is very perplexing, and you hear that resentful attitude all the time. Anyone who hates and resents smokers and fast-food eaters-- i.e. liberals--should not want nationalized healthcare.

Henry said...

Pogo wrote: That statement is unclear.
What did you mean?


I mean that the American Cancer Society has science on its side and it is bizarre and embarrassing for Limbaugh to suggest some kind of nefarious opportunism on their part.

Shanna, above, points out that the ACS report cuts against government planning. Robt C points out, as I have, that Rush gets his history wrong on Obama's position vis-a-vis screenings.

Limbaugh looks like a fool here.

Pogo said...

" American Cancer Society has science on its side "

The meaning of those numbers is debatable, and I would argue should result in a personal decision.

Politics becomes involved when the ACS makes that choice for others and it becomes policy. That isn't science at all.

Triangle Man said...

Politics becomes involved when the ACS makes that choice for others and it becomes policy. That isn't science at all.

What does this even mean? The ACS makes recommendations based on the best available medical evidence.

blake said...

Triangle,

It means the ACS' recommendations shouldn't have the force of law. Nor should laws be enacted to supersede individual choice in the matter.

Triangle Man said...

@traditionalguy

The subtle but important difference is that PSA testing leads to the detection of many cancers that would never have caused symptoms much less killed. PSA was developed as a marker for recurrent disease after treatment, and it works very well for that. The *hope* was that PSA as a screening test would detect deadly cancers at an earlier more treatable stage. Instead it detects a lot of indolent cancers that may be better left alone. The point made by ACS is that the advanced cancers seem to occur at about the same rate as they did before screening with PSA was available.

Henry said...
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Henry said...
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Henry said...

blake wrote: It means the ACS' recommendations shouldn't have the force of law.

And ACS isn't claiming it should. The ACS is suggesting that doctors explain to patients the risks associated with early screening.

The fact that scientific research goes on at the same time as the government prepares to do something stupid does not mean that scientific research should stop so the government can't misuse it.

With that logic, the government will make phrenology part of its mandate.

Triangle Man said...

Nor should laws be enacted to supersede individual choice in the matter.

Medicine is already highly regulated. The history of and propensity for charlatans in medicine necessitates this.

Triangle Man said...

With that logic, the government will make phrenology part of its mandate.

I will not support a bill without a public option that includes trepanation coverage.

blake said...

Henry,

I didn't disagree with that any of the three times you wrote it. Though I think it was better without the phrenology reference.

Keep in mind phrenology was medical "science" 100 years ago. I think it's naive to believe that we don't have a whole bunch of similarly goofy ideas now.

That's why this whole area is best left severely alone.

Triangle Man said...

It looks like this thread may be getting old enough to be dead, but I wanted to leave another thought.

The problem with these particular screening tests is not necessarily the cost (as implied by many above), it is the consequences suffered by those who receive false positive results. The question is how many women should have an unncessary mastectomy, or how many men should have an unncessary prostatectomy to save one life?

traditionalguy said...

Triangleman...I understand your point. The "indolent" cancers are not killing us fast enough to need treatment since age itself will gets us first. But knowing you have one lets you change your diet and keep it indolent. Growth hormones in modern meats also spur growth in cancer cells. Sounds like the old age cut off date will need to be the critera, a/k/a a death panel ruling.

Henry said...

blake -- three tries to get my grammer and italics right.

In my mind we should err toward the best science available.

But what works politically, as Palin discovered and Limbaugh knows quite well, is not to accuse the government of mandating too much (which in my mind is the real risk) but of not covering enough.

Triangle Man said...

But knowing you have one lets you change your diet and keep it indolent

For people who do get PSA screening, a reasonable approach to prostate cancer is "active management" or "watchful waiting". That is, monitoring the behavior of the tumor over time to see if it appears aggressive. This might spare many men unnecessary surgery, impotence, and incontinence.

A diagnosis with cancer is a powerful experience, however, and many find that they feel compelled to get the tumor out.

Another reasonable approach, supported by medical evidence, is to forgo PSA screening and to see a doctor only if symptoms develop.

PSA may be saved by limiting its use to high risk groups (men likely to have aggressive or fatal disease). There is research ongoing to identify groups at high risk, and to develop prognostic markers that may refine or replace PSA testing.

blake said...

In my mind we should err toward the best science available.

Fair enough. In my mind we should err toward freedom.

Henry said...

Now we're talking at cross purposes.

PatCA said...

"PatCA: are you saying that hospice care is cheaper than treatment?"

Yes, because treatment and testing for recurrence continues for a lifetime.