April 18, 2012

"Although women tend to love the notion of government control more than men do, it is women who will be told they'll have to cut back."

"On treatments. And years. You know we've been taking more than our share."

That's the end of a post I wrote in 2009, which is quoted chez Instapundit this morning (and sending me traffic). Glenn is linking to something about men not going in for the kind of routine screening tests that women tend to get.  He quips: "It’s all about fairness. When women’s life expectancy is reduced to match men’s that’ll be fair. It’s Buffett-rule logic applied to health care. . . "

Ouch! Anyway, there's also a new article at the NYT pushing us back about screening:
Certainly, the rationale behind screening seems obvious. The earlier cancers are diagnosed, the more often lives will be saved, right? With enough screening, we might even stop cancer.

If only. Finding cancer early isn’t enough. To reduce cancer deaths, treatment must work, yet it doesn’t always. Second, it must work better when started earlier. But for some cancers, later treatment works as well. (That’s why there is no big push for testicular cancer screening — it is usually curable at any stage.)
Usually curable at any stage? I'm just going to move on and assume my guess about why is true.
... So how can we be confident that getting a screening test regularly is a good idea? The only way to be sure is to look at the results of randomized trials comparing cancer deaths in screened and unscreened people. Even when screening “works” in such trials, the size of the benefit observed is surprisingly low: Generally, regular screening reduces fatalities from various cancers between 15 percent and 25 percent.

What does that mean? Think about a “20 percent off” sale at a store. Whether you save a lot or a little depends on the item’s regular price. You’ll get huge savings on a diamond ring, pennies on a pack of gum.
Wait. I'm trying to catch up with your metaphors, NYT. I'm picturing the typical NYT reader assuming: The diamond ring is my breasts. The pack of gum is your testicles.

67 comments:

Greg said...

'Usually curable at any stage? I'm just going to move on and assume my guess about why is true', as per the procedure recommended by Dr. Ivan Cutyanutsov.

Original Mike said...

Isn't it ironic? ObamaCare, and similar plans, are often sold as cost reducers because, the argument goes, catching diseases earlier saves money. But, now that we are saddled with this leviathan, the push is to cut screening, because we can't afford it.

Tim said...

The greater problem will be the Democrats will use government control of health care to redistribute wealth from successful, healthy citizens to unsuccessful, poorer citizens to buy votes; i.e., capping services to control costs will be a secondary, if not tertiary concern next to the future cannibalizing debt it will cost.

One not need look any further than the epic insolvency looming in Medicare.

Yet, when anyone (Rep. Ryan would be the latest example) suggests the mildest possible forms of reform, he is castigated as some latter-day Attila the Hun.

We're fucked.

Carnifex said...

Ask a Brit about cancer survivor rates in the UK, then ask an American liberal. I expect you'll get quite different answers, with only one of them being true for having lived through it.

Original Mike said...

"I'm trying to catch up with your metaphors, NYT. I'm picturing the typical NYT reader assuming: The diamond ring is my breasts. The pack of gum is your testicles."

This is what pisses me off the most about ObamaCare (and that's saying a lot).

"the size of the benefit observed is surprisingly low: Generally, regular screening reduces fatalities from various cancers between 15 percent and 25 percent."

These people are sub-human. I'm picturing them as shower room attendants at Auschwitz.

Pogo said...

"the size of the benefit observed is surprisingly low"

Low is a relative term.
Low compared to what?
And low for whom?

For a lefty, a scientist, and a gubmint official, it's low.

but it is not low to those few who had that savings of months or years of life.

Carol said...

Funny, the timing of all these stories, eh? After so many years of hectoring that we need to get this and that screening. I finally relented on the C-scope only to find out later it wasn't covered by my insurance so I paid out of pocket about 1200.

Oh, and found out later if I had just come up with some *symptom* it would have been covered.

Fen said...

The greater problem will be that Democrats will use government control of health care to redistribute wealth from successful, healthy citizens to unsuccessful, poorer citizens to buy votes

Worse than that. You've seen Obama Crony-Capitalism at work? Well, your quality of health care will depend on how politically connected you are:

"Need a waiver? Wait. Aren't you the guy who criticized Obama in that letter to the editor? Well, I'm sorry but we've just run out of waivers...goodbye"

cubanbob said...

The savings are obvious. By delaying tests by the time the tests are performed the patient is terminal and no cure is realistically possible so its best to send them home and offer them palliative relief.

What did anyone seriously think the libs were proposing for everyone (except the well connected of who they take themselves to be)? As Dr. Obama said "take the blue pill".

PatCA said...

"Generally, regular screening reduces fatalities from various cancers between 15 percent and 25 percent." As a collective, pretty small. As a person like me, part of that small statistic, life or death.

But what a coincidence that the study's authors work at a health policy institute! Could their institute be funded by the government, the same government that now all of a sudden tells us Pap screenings, among others, are not really necessary once a year? The same government that plans to take over our health care?

My ObGyn told me the government says the Pap is not necessary every year. I said, well then, I'll have it every year.

Pogo said...

According to the Agency for Health Care Research and Quality, “the USPSTF does not consider economic costs in making recommendations.

In the PSA review, a European trial found that it did reduce the risk, but only by a small amount.

Among men aged 55-to-69, there were seven fewer deaths per 100,000 men in the screening group than in the unscreened group, over the median nine years of follow-up.

Such a reduction might be small in the eyes of some men, but larger in the eyes of others.

cubanbob said...

PatCA said...
"Generally, regular screening reduces fatalities from various cancers between 15 percent and 25 percent." As a collective, pretty small. As a person like me, part of that small statistic, life or death.

But what a coincidence that the study's authors work at a health policy institute! Could their institute be funded by the government, the same government that now all of a sudden tells us Pap screenings, among others, are not really necessary once a year? The same government that plans to take over our health care?

My ObGyn told me the government says the Pap is not necessary every year. I said, well then, I'll have it every year.

4/18/12 10:58 AM


Those who propose the reduction in screening should be made to live by their proposals.

vet66 said...

So, in the interest of fairness, a mastectomy and removal of testicles are considered equal? And the folks who are voting on this for us have a cadillac health plan the rest of us can only dream about? I think we will start paying cash under the table to our doctors.

Seeing Red said...

Cancer is becoming a chronic disease and the NHS didn't want to cover it because it costs too much money.



...Sadly, Kenneth’s story is symptomatic of a dreadful truth. According to shocking new research by Macmillan Cancer Support, every year many thousands of older people are routinely denied life-saving NHS treatments because their doctors write them off as too old to treat....

Roger J. said...

I commented on Dr Helen's post on the other website re prostate screenings. She cited the Preventive Health Task Force recommendations. Here it seems to me is the issue, and I am commenting as an epidemiologist. We deal in population statistics; we can be reasonably sure of being accurate in the population sense. Unfortunately disease is individual in nature, and doctors deal with individual cases. Wont bore you with my experience with prostate cancer, but had I followed the Task Force's recommendations I would be dead.

Here's my meta concern: we will see more of such recommendations from government panels who will, I suspect, be looking at population data. And that may be an issue in controlling health care costs. But disease affects individuals, and is, again IMO, best dealt with by first, informing yourself about your condition, and second, find a a physician you trust, and have discuss your individual case with him or her.
When the government gets involved they will, perforce, look at population data and costs. That is not, IMO again, not a good thing for individuals who may be afflicted with health care issues.

Ron said...

Gum....testicles...blown....popped...

write jokes as you will!

Original Mike said...

I used to view the left as an annoyance. But they are becoming an existential threat.

Geoff Matthews said...

Would your guess on testicular cancer survival involve the removal of the cancerous testical?
Are there drawbacks to having only one testical? I doubt that it would be readily noticeable (to the general public).

Roger J. said...

Pogo makes my point: in the aggregate (epi data) results are between 7 to 25%; this only is significant if you happen to be the case is the 7 to 25 %. And when it comes to epi data, we are always the case.

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

I have long believed we were living through the Victorian Age again, this time as farce. Like our feminists and prohibitionists, they also had numerous healthy living fanatics,

But people still got old and sick and died, no matter how great their bowel movements were.

So they began blaming people for their own illnesses, and saw old age as a useless time.

In 1905, 55-year-old physician Sir William Osler gave a farewell speech to Johns Hopkins University School of Medicine before leaving for Oxford University in England. In it, he said that men older than 60 should be retired, and that men older than that age be chloroformed.

cubanbob said...

I wonder if the NYT would examine auto-safety rules and environmental rules and AGW with the same scrutiny of benefits versus costs.

Bart Hall (Kansas, USA) said...

The elephant in the room is that women are complainers.

Something's not quite right? Well it's either nyea, nyea, Nyeah, NYEAH at the personal level or run off for some test, some pill, some goop -- preferably paid for by somebody else -- that'll make everything just fine ... until something else comes up, three days later.

Not only do all these women want me to pay for their borderline psycho-somatic health care, the ones who really ARE sick -- the waddling black walruses in downtown KC who can't control their own eating or sexual habits -- want me and my kids to cover decades of diabetes care, blood pressure, and all the rest.

You'd better believe I resent it, especially when their friends in government pander to them by attempting to eliminate my ability to purchase a high-deductible policy because it's all I need or want.

As for prostate screening? The last guy who did a DRE on me (years ago) tore up my rectum so bad it took weeks to heal. I now have my own monitoring system -- whenever I pee outside it goes at least 4 feet -- in my mid-60s -- so there's obviously no obstruction or constriction. And the test doesn't cost me (or anyone else) 170 bucks.

Saint Croix said...

Although women tend to love the notion of government control more than men do

Is it biological, do you think? Is it a sex thing? Women like to be spanked by the government?

Original Mike said...

"I wonder if the NYT would examine auto-safety rules and environmental rules and AGW with the same scrutiny of benefits versus costs."

Of course not. How many times have you heard, "If it saves a single life, ..."

Roger J. said...

Original Mike--it depends on if that single life it saves is yours.

Original Mike said...

Not sure of your point, Roger.

Original Mike said...

In reading your posts here, Roger, I think we are in agreement.

Molly said...

Current health care entails a significant redistribution from men to women (and I expect, from blacks to whites), as the "donors" pay more in lifetime health insurance premiums than they incur in lifetime health costs, and the "recipients" pay less in lifetime health insurance premiums than they incur in lifetime health costs.

"Per capita lifetime expenditure is $316,600, a third higher for females ($361,200) than males ($268,700). Two-fifths of this difference owes to women's longer life expectancy. Nearly one-third of lifetime expenditures is incurred during middle age, and nearly half during the senior years. For survivors to age 85, more than one-third of their lifetime expenditures will accrue in their remaining years."

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361028/

Roger J. said...

Original Mike--sorry to be confusing. I can clarify if you like, but I think you see my point. So will remain silent :)

Original Mike said...

Roger.

(sorry. couldn't help myself.)

Original Mike said...

"Current health care entails a significant redistribution from men to women"

Which is deemed acceptable. Yet, when the issue was insurance companies charging women more, because of their longer life span, that was discrimination.

And yet, they say there is a war on women. The left's motives in this regard are so transparent.

Roger J. said...

Original Mike--thats precisely right--here's the epidemiology of that--women have longer life spans and there are more women than men. Dissolute bastards that men are we have, for insurance purposes, the advantages of dying earlier. And since the major proportion of health care costs are incurred in the last year of life, we save the government a lot of money by dying earlier. (sarcasm off). The upside to this, of course, if you are guy older than 85 there are many more women available for dissolute purposes (ok--sarcasm again)

Bud Norton said...

I don't understand the "although" in the quote ("Although women tend to love the notion of government control more than men do, it is women who will be told they'll have to cut back"). Shouldn't it be "women tend to love the notion of government control more than men do, so it's they who will be getting the government control they say they love so much"? It's only right and fitting that they should get a taste of their own medicine (almost literally in this case). You can break out the "although" if after a few years of Obamacare it's still the case that women like government control so dang much.

Freder Frederson said...

the push is to cut screening, because we can't afford it.

How do you and instapundit come to this conclusion? His contention that doctors' groups are recommending that some screening be curtailed because they are afraid of finding something expensive is completely dishonest.

I assume Instapundit is being deliberately dishonest. He always makes shit up to fit his world view.

Freder Frederson said...

the push is to cut screening, because we can't afford it.

How do you and instapundit come to this conclusion? His contention that doctors' groups are recommending that some screening be curtailed because they are afraid of finding something expensive is completely dishonest.

I assume Instapundit is being deliberately dishonest. He always makes shit up to fit his world view.

Original Mike said...

"it is women who will be told they'll have to cut back."

I wouldn't bet on that.

Freder Frederson said...

Ask a Brit about cancer survivor rates in the UK, then ask an American liberal. I expect you'll get quite different answers, with only one of them being true for having lived through it.

Can I ask my Dad? He was diagnosed with bladder cancer three years ago under the NHS and is now (at 82) is cancer free. You probably wouldn

The NHS is far from perfect, but most of the horror stories are bullshit.

The British press is full of stories about Brits saddled with hundreds of thousands of dollars medical bills after becoming ill or injured in the states. The rallying cry to stop Conservative changes to the NHS was "we don't want American style healthcare."

Original Mike said...

"I assume Instapundit is being deliberately dishonest. He always makes shit up to fit his world view."

Thanks for the laugh, man.

Roger J. said...

Freder--you are making my point about the difference in population statistics and individual cases--I am elated that your dad is doing well. But ultimately the appropriate epidemiology test is survival rates after medical intervention. Using that metric the US health care system, for all its faults, is pretty damn good.

Seeing Red said...

--I assume Instapundit is being deliberately dishonest. He always makes shit up to fit his world view.---


Don't we all?

Seeing Red said...

Didn't HillaryCare bump up mammograms to age 50?

Freder Frederson said...

Freder--you are making my point about the difference in population statistics and individual cases--I am elated that your dad is doing well.

No, I was responding to Carnifex's uninformed opinion that she would "expect to quite different answers from a Brit and American liberal" about cancer survival rates in the UK because only one had lived through cancer treatment under the NHS.

She is full of shit and doesn't know what she is talking about.

Crimso said...

Your guess would be wrong, at least as far as the "at any stage" part is concerned. Removal of the testicle (with no other treatment) wouldn't do much good if the disease is metastatic. Platinum-based drugs combined with etoposide probably make the biggest difference in those cases (though they do still remove the testicle; the chemotherapy can only do so much).

Peter said...

"Usually curable at any stage? I'm just going to move on and assume my guess about why is true."

It's because chemo and ionizing radiation are unusually effective against the most common type of testicle cancer, seminoma (a germ cell tumor).

BUT, what they mean is, 5-year survival goes from 98% for early-stage cancers to 80% for late-stage.

Which might not sound like much of a difference, but it's the difference between a 1-in-fifty chance of death and 1-in-five.

And since these are almost always a young man's cancer, you're losing more potential years of life than is typical for cancer.

http://tcrc.acor.org/tcprimer.html

edutcher said...

The NHS is a nightmare, made worse by PC, and anyone who thinks it wouldn't be reproduced here also forgets how ZeroCare was supposed to cut costs.

And, when you look at how things like Zeke Emanuel's Complete Lives will be the demographic model, you know this is going to make the SS look warm and fuzzy.

traditionalguy said...

The war on women using medical care is pure Obama.

Freeman Hunt said...

So if 1,000 people usually die, 150-250 extra people would live? And that's supposed to be small potatoes?

Original Mike said...
This comment has been removed by the author.
Original Mike said...

Yes, Freeman. Apparently so.

I think these people are bastards.

sydney said...

Roger J,
You are spot on about medicine evolving to take the population approach rather than the individual approach to medical care. Twenty years ago when I was in residency this argument was going on explicitly. The population-approach adherents won.The stimulus package of 2009 even contained rules for Medicare payments that reward physicians for taking a population based approach to patient care and punish them for taking an individual approach. That's one reason I opted out of it in 2011.

Roger J. said...

sydney: thank you for your kind comment--the population based approach works if you are concerned about health care expenditures--it fails miserably when you are the case the doesnt fall withing the population study.

I will defer, Sydney to your insights on how modern practitioners view the distinction--I generally query my docs as to their views before involving them in my care. I always remember that I am the case and not the population. An important distinction IMO.

Freder Frederson said...

Yes, Freeman. Apparently so.

You and Freeman didn't bother to actually read the article, did you.

Because that is not what "reduces fatalities from various cancers between 15 percent and 25 percent" means at all.

I will leave it to you to learn what the statement really means.

Freder Frederson said...

So if 1,000 people usually die, 150-250 extra people would live? And that's supposed to be small potatoes?

You're only off by two orders of magnitude (the actual number is 1.5-2.5 per 1000).

Micha Elyi said...

"In 1905, 55-year-old physician Sir William Osler gave a farewell speech to Johns Hopkins University School of Medicine (in which he said) men older than that age be chloroformed."-Pogo

In pursuit of the Osler agenda, Obama and other progressives seek to drive Catholics and their hospitals underground.

Unknown said...

Statistical studies are helpful in establishing treatment guidelines, or tracking overall cost/benefit over a large group, but not really helpful at all when it comes to treating individual patients. For that, you need the skill and yes, art that is the professional judgement of a real live doctor.

Example: Medicare has determined that the average hospital stay for pneumonia with a good outcome is approximately 3 days. So they have decided that they will pay for 3 days, no more. Because the study says that's adequate, right? I mean, it's science.

Well, no. Because to get an average, you include a lot of people who were well enough to go home in 24 hours, and some who were still very sick after a week. That's how averages work. For the individual doctor treating an individual patient, that study means absolutely nothing. It should have no bearing whatsoever on how long this person needs to stay in the hospital. But of course, Medicare says it does.

The average person can hold their breath underwater for approximately one minute. One doesn't hold 85 year old granny's head under water for a full minute, regardless of how she thrashes, because one insists that the average MUST apply to an individual.

Ridiculous example? Perhaps. But that is the kind of silliness you run into when you try to apply a statistical study across large populations to the treatment of an individual patient. It simply doesn't work that way.

sydney said...

Roger J,
Most physicians I know prefer the individual approach. However, we are under pressure by third party payers to adhere to the population approach, as Unknown cited above. That Medicare example above may seem ludicrous, but it is reality. I received a letter last month from my department chair at the hospital scolding me for having an average length of stay for my patients of 4.4 days instead of 3 and under as mandated by the new hospital rules (inspired by Medicare.) The nuance of each individual case means nothing to them. Even worse, Medicare has also decreed that no patient should ever have to be admitted within 30 days of a prior hospitalization. It is just not ever necessary and so they will not pay for it under any circumstances. It's crazy. Most of feel as if our world is being turned upside down. (Or the lunatics are running the asylum)

Unknown said...

sydney,

The second rule change was the predictable outgrowth of the first. Once Medicare decided to limit hospital stays, that pressured docs to hustle patients out of the hospital early, even if they felt an extra day might be beneficial. The result was that many of these patients went home, got sicker, and had to be re-admitted. So now Medicare has responded to that very predictable uptick in readmissions, which they caused in the first place, by saying they won't pay for the readmission either.

The latest boondoggle is that in an effort to make sure these discharged-too-early and can't-be-readmitted patients got care, docs started ordering lots of home health. Not so fast, doctors! Now Medicare is going crazy coming after docs for ordering "unnecessary" home health services.

Kick them out soon, don't let them back in, and if you try to compensate by ordering more home health we'll investigate you for Medicare fraud after the fact. That's the new policy.

Medical care in this country is being destroyed. Death panels? What a laugh. There's no real need for them! Because doctors and hospitals are going to have to either do the government's dirty work for them, or choose to provide care without being paid. That is the position they have put physicians in. My husband is getting out just as soon as he can - likely 3 to 5 years.

(I apologize for remaining "Unknown", but I don't have an account that's useful here.)

Freeman Hunt said...

You're only off by two orders of magnitude (the actual number is 1.5-2.5 per 1000).

Explain.

Freder Frederson said...

Explain.

If you're too lazy to read the article that is the subject of this thread, I am too lazy to explain it to you.

ed said...

"I'm picturing the typical NYT reader assuming: The diamond ring is my breasts. The pack of gum is your testicles." - Althouse

Hey as long as you pony up the $1,000 a year that Sandra Fluke demands for contraception who cares about your cancer?

mike said...

Hey everyone. Interesting idea for a blog. I have been checking out a lot of blogs and forums recently. salt lake house cleaning

Freeman Hunt said...

From the article:

Generally, regular screening reduces fatalities from various cancers between 15 percent and 25 percent.

Say we have 1000 people who are going to die of cancer without regular screenings, and regular screenings reduce this by 15-25 percent.

1000*.15=150
1000*.25=250

So 150-250 fewer people would die.

Please explain to me the error in my math.

SDN said...

"I used to view the left as an annoyance. But they are becoming an existential threat."

Original Mike, now you see why I've been saying for years that there's only one solution for the Left trying to enslave the country.

You will not convince them to stop trying by reasoning, or by debate, or by compromise; their innate dishonesty and lust for power prevents that. Therefore the only solution is a Second Revolution, followed by a second "exile of the Tories": Leave, or die.

Based on what it took for the first Revolution, that should take about 15% of the population getting angry enough to take our country back. My political choices this cycle are going to be predicated on what will get that 15% critical mass, and that's why voting for Obama over his paler doppelganger is a serious choice.

"Give me Liberty, or give me Death!"

Jay said...

Freder Frederson said...
She is full of shit and doesn't know what she is talking about.


Nice projection.

Freder Frederson said...


I assume Instapundit is being deliberately dishonest. He always makes shit up to fit his world view.



As opposed to you, big teller of truth and facts and stuff!

Freder Frederson said...

The NHS is far from perfect, but most of the horror stories are bullshit.


Tell that to the people who have died that it is all "bullshit"

But of course watching you screech, spittle, and call names reveals you're quite unhappy with actual facts on these matters.

SGT Ted said...

I have long believed we were living through the Victorian Age again, this time as farce. Like our feminists and prohibitionists, they also had numerous healthy living fanatics,

But people still got old and sick and died, no matter how great their bowel movements were.

So they began blaming people for their own illnesses, and saw old age as a useless time.

In 1905, 55-year-old physician Sir William Osler gave a farewell speech to Johns Hopkins University School of Medicine before leaving for Oxford University in England. In it, he said that men older than 60 should be retired, and that men older than that age be chloroformed.


Those are Progressive notions they pretty much still believe in. They just claim "compassion" as the excuse.

Freder Frederson said...

Say we have 1000 people who are going to die of cancer without regular screenings

If you had bothered to finish reading the article it explains it.

It is not a 15--25% aggregate risk reduction, but a 15-25% reduction in the individual risk of dying from cancer. You have to factor in the risk of getting cancer. Since you only have a 1% or so chance of dying of cancer, a 15-25% reduction in that risks means only 1.5--2.5 excess deaths per 1000.