Bill said:
That's not what I recall. But the claim that they are "subpar"
depends on the proposition that the US level of testing represents
some kind of gold standard, which isn't true.
The US over-tests, which is expensive - and given the inevitable
false positives - not just financially but also in terms of damage to
patients.
The vastly better incidence and survival rates speak the truth.
The worst example is the PSA test of prostate cancer, which finds
many too many potential cancers to be worth the trouble. It's nice to
be told - as I was - that my PSA was unusually low, but I'd consented
to the test on the basis that I was going to be very selective in my
reaction to any kind of positive result.
Sure it has false positives. But a friend of mine would be dead now. He
didn't know he had quite serious prostate cancer until a PSA test. There
were several others, with varying degree of severity.
Not to make the point I was making.
Sorry, but then the point is meaningless to judge the effectiveness of a
country's sereening system. That would be like saying "Oh, but on 56th
street between K and L there were four cases out of 70 residents, so ...
You are trying to dodge the point that primary colorectal cancer
rates vary quite a lot from region to region by suggesting that the
only thing going on is a variation in testing coverage - which only
seems to vary between about 50% and 60% - and followup.
This might be true, but seems unlikely. You'd have to muster a lot
more evidence to exclude diet and exercise levels as sources of
variation.
The US and the UK may be different in their gene and population pool
(although probably not very different). But Canada and the US aren't
much different.
[...]
When the primary screening rate doesn't seem to get above 60%, that's
going to happen everywhere. There aren't nearly enough migrants to
fill up that 40% untested catagory.
Sure there are. You probably have not been in the US for decades. AFAIK
even a US citizen does not stay in one location more than 7 years on
average.
While in countries like Germany you typically keep your HMO so there is
consistent track recording, this is not the case in the US. Your new
employer is likely to offer 2-3 health plans to pick from but they are
not from the same HMO. When I moved here, to my surprise, they did not
request my previous health records. The docs relied on the patients to
tell them if some information was needed. That is (or was) one of the
downsides here because there was also a lot of mistrust by patients. It
is one of the few (very few) good points of Obamacare that this mistrust
will diminsh.
[...]
... As the wikipedia article makes clear, it's a relatively
new technique, and there is still some discussion about
exactly how cost-effective it is, but I'm fairly confident it
will be widely adopted - probably even in the UK where they
are already good on mammograms and Paps smears.
New? Colonoscopies and mammograms have been around for decades.
But not faecal occult blood tests, and polyp-snipping.
Sure. I had an occult blood test in Germany in the 80's because of
suspicion. Turned out that was because of some extreme bicycle
riding during that time and the doc said he sees that a lot. Of
course, these tests have improved in sensitivity over the years.
Polypectomy is also around at least since the early 80's. You
probably don't know this because you've always lived in countries
with socialized medicine. They get a lot of this much later, and
for screening often not at all.
I don't know when I learned about polyp-snipping - it was certainly a
few years ago.
Medical sociology is interesting. I remember spelling it out to a
bunch of senior management at EMI Central Research around 1978 -
reprsing something I'd told the managing director when he'd been
practising management by walking about.
Any new technique gets picked up by a particular specialist, who
spends the next five years spouting about it at medical conferences,
along with his three or four acolytes.
After five years, the rest of the profession starts applying it - if
the conference presentations were sufficiently persuasive - and after
another five years it can become SOP. A very rough generalisation.
Ok, but colonoscopy and polyp removal have gone through that phase when
we were in school.
EMI weren't plugged into this because the brain-scanner and body
scanner had produced "obviously useful" text-book anatomy images from
the word go. The brain scanner was a clinical break-through and got
adopted very fast.
The body scanner was much less useful - at the time we used to say
that it's major use was proving that you had inoperable lymphoma -
but it got adopted equally fast. Our ultrasound machines could do
interesting stuff, but they didn't produce such seductive images ...
But the company then croaked ... happens a lot that there are good
technical ideas and in the end it goes nowhere.
[...]
good as ours. But most of them have a lesser arsenal of tools
available. You said it yourself that in AUS you must buy your own
occult blood test kit. Nothing wrong with that but the fact is that
most people won't do it.
That's not what I said. What I said was that I could buy such a kit
at my local chemist. One of the reasons I didn't do it was that I'm
pretty certain that I can get my doctor to write me a prescription
for one - an hypothesis that I'm going to test tomorrow.
Your preconceptions about "socialised medicine" are shaping the way
you remember what I wrote.
No, you just said it: You need to get a prescription from you doctor to
get the kit for free (or for a modest co-pay). And you haven't got one.
That means it is not standard practice in AUS to screen for colon
cancer. And this is wrong, considering how cheap yet sensitive this kind
of test is. So that part of your medical system is clearly worse than in
the US.
Yes, I am sure the doc will write you a prescription. Especially if you
would tell him about a concerning family history or maybe he does it
just to appease you. But the fact is, _you_ must take action to get the
test done. Your health system doesn't. This is not screening because it
misses all the people who are more passive in the medical sense and I
fully confess that I also belong to that group. They don't go to the doc
until something hurts badly. So I am glad that the US system pushes me
to do those tests and that the HMO really bugs me if the test isn't back
in what they consider due time.
Unlikely. The down-side of over-testing is the financial expense and
the damage done by the more invasive tests needed to rule out false
positives. The PSA test for prostate cancer is the poster-child for
that kind of over-testing. My cancer specialist friend once famously
said - on television, that he'd sue if someone ran a PSA test on his
blood without his permission.
As I said, the PSA test has greatly benefited friends of mine. My HMO
iis large and has its own clicnics, so they have tons of data:
http://www.eurekalert.org/pub_releases/2013-01/kp-kps011013.php
A single PSA test may get it wrong and is of questionable value. But if
you watch the PSA trend in your body over the years an aggressive
prostate cancer has a higher chance of being detected. This is why they
say, quote "Kaiser Permanente guidelines include a recommendation that
men age 40 and older should discuss the PSA test and rectal exam with
their physician".
screening, but if it looks cost effective, it does it - it certainly
does mammograms and Pap smears and has for many years. And I got my
cholestrol level checked there by my GP in 1990.
It isn't. The US system goes in for "churning" it's patients. ...
No. It saves lifes and clinical evidence clearly shows that.
... Each
test costs money ,and a portion of that money turns into a profit for
the people running the system. Tests that produce loads of false
positives earn even more money on the more extensive, expensive and
dangerous tests that prove that it was a false positive.
Obamacare does mean that some 50 million more Americans can get the
mammograms at 50+ which pick up enough breat cancers to be worth the
expense - bearing in mind that each mammogram pushes enough X-rays
into teh breat tissue to marginally raise the risk of breat cancer in
later life ...
Wait for the numbers. Most of the uninsured will remain ... uninsured.
There is a reason why they keep sign-up numbers under wraps.
Meanwhile contraceptives are cheap, and barrier contraceptives pay
off in lower rates of sexually transmitted diseases. Sex change
operations are expensive, but they are also very rare. They won't
bankrupt your system. You may find them morally offensive, but your
morals aren't shared by the rest of society, no matter how much you'd
like them to be.
I find it morally offensive when elective surgery is covered while
life-saving screening is curtailed.
[...]
No, experience. The docs told them and docs generally know.
The bureaucrats know a lot about this stuff. I talked with a few of
them when I was working at EMI. Their contempt for emotionally-driven
medical opinion was well-concealed, but detectable.
I don't care about their opinions, they are still just bureaucrats who
lack the understanding of true practitioners. Just like the RoHS guys.
That doesn't make the evidence available all that helpful, and
medical training isn't aimed at getting economically useful
information out of medical records.
At this HMO it is. They have to run a business which solely consists of
insurance premiums and co-pays as the revenue stream and delivering
medical services at the other end. That's all they do. It is a
non-profit company without government funding so they must at least
break even.
[...]
I'm afraid that it's your head that's buried in the sand. You've
posted obviously unreliable data, and refuse to recognise that
posting "2013" data before the end of 2013 has to be evidence of some
kind of fraud.
Sorry, but you seem to have no clue of how to arrive a statistics and
predictions. It's like not trusting SPICE.
[...]
And my cancer specialist friend has a real Ph.D. as well as a medical
degree. Such people are rare, and their output doesn't exactly
dominate the medical literature (though their citation rates are
better than average.
But it does tend to dominate many clinical studies.
An appropriate reaction to a URL that was propaganda designed to
scare fee-paying patients into consulting rooms.
Wrong. Preventative care is usually free. So far we have not paid one
dime for that. The reason is simple: The HMO assumes you stay with them
for a while. They do not want you to become seriously sick and they know
what can prevent that. Because if you do develop cancer due to lack of
screening it's all going to come out of their pocket.
Then you have to figure in the susceptibility to magical thinking,
which does vary with year of birth.
You'd be surprised. Even atheists find great relief in this one a major
medical blow such as cancer has hit them.
"Scores" isn't a huge additional cost. And since the current US
system is already half-again more expensive than anybody else's, you
are objecting to the mote in socialised medicine''s eye while
ignoring the beam in US medicine's eye.
Obamacare did absolutely nothing about malpractice, for obvious reasons,
and that's a large part of the beam you are talking about.
The US system is half again more expensive than anybody else's.
Changing it - while not upsetting the insurance companies who are
making lots of money out of the existing system, is tricky, and it's
not all that surprising that it isn't going well.
It has the potential to turn into a disaster.
Canadian academic opinions about why the US system is so expensive
vote for over-priced administration, and it's no great surprise that
Obamacare's administration is turning out to be expensive too - their
local role model isn't exactly cheese-apring.
.... while Canadians are dying on waiting lists.
Not the first software debacle in US history. And similar disasters
happen outside of government. The Tea Party has rather selective
vision. They frequently have been proven to be far-right. Their
opinions line up with reality from time to time, just as a stopped
clock is right twice a day.
They are realists. There are lots of similar web portals that work. But
they were designed ... <oh horror> ... by private enterprises instead of
some bureaucrat committees. We could have had a working web portal for
well under $100M. But no, now we have p....d away almost 10x that amount
and it still doesn't work. Typical big government inefficiency.
It has. The real inflation numbers are simply not acknowledged by the
governent, so only people who live here know. Real inflation has
surpassed 5% long since. One glance at utility bills speaks volumes. CPI
leaves out many costs "because they are too volatile". Yeah, right.
Printing money causes inflation if the economy isn't in
recession. If the economy is in recession, the extra money gets spent
on under-utilised resources. They weren't being sold before, so this
doesn't raise their price.
This is all Keynesianism 101. The Tea Party is too dim to understand
it, or - as in James Arthur's case - has been brainwashed into not
being able to take it seriously.
Keynes didn't have much clue about this and you apparently don't.
That's what I call a successful leader of a country.
And what do you think she did? ...
A lot. For example, she kept taxes and other burdens on businesses in
check. That alone saved much of the bacon for Germany. It came with some
austerity pains but was necessary and the voters obviously were smart
enough to recognize that. Else they would not have re-elected "mama"
again, as she is often called over there.
... Europe includes basket cases like
Greece and Portugal, and places like Spain and Ireland that caught a
bad cold as soon as the sub-prime mortgage crisis pulled the rug out
from their over-leveraged but previously successful economies.
Germany had got it's economy into fine shape before the sub-prime
mortgage crisis hit, and did a whole lot better than anybody else in
Europe in recovering from the crisis.
http://www.diw.de/documents/publikationen/73/diw_01.c.415240.de/diw_econ_bull_2013-02-3.pdf
Interesting that (finally!) someone else than me has the guts to say
Krugman had it wrong
I'll forgive you. Engineers don't need to know much about economics.
They know more about it than others. I don't want to sound arrogant but
it's a fact: Why is it that I predicted the real estate bubble and even
the fed chairman and almost all others did not? Alan Greenspan said so
himself. I still remember how a real estate guru laughed in my face.
Then that very family lost their home in the wake of what I told them
would happen.
[...]
He's a politician. Nobody should have trusted him in the first place.
You elect politicians who can work out compromises that more or less
work for everybody involved. This usually involves breaking promises
that should never have been made in the first place.
Just like with other people, I prefer politicians who always speak the
truth.
Another winner of a Darwin award. Think of it as improving the breed.
Your landlady won't have seen it that way, but that's how evolution
is working on the human genome at the moment.
No, that's failed drug policies in the Netherlands. As a society we
can't expect teenagers to be as smart as we are. They still learn.
[...]
