Healthcare: 38% Favor, 56% Opposed
El Castor
http://www.rasmussenreports.com/public_content/politics/current_events/healthcare/september_2009/health_care_reform
Maybe someone can explain what the 4,000+ pages that the House and
Senate have produced are all about? When this thing started it was all
about insuring the uninsured. That seems to have been forgotten. Now
it's drastic cuts to Medicare, federal bureaucracies up the wazoo,
smoke and mirrors to hide the real cost, 117 taxes on things from knee
replacements to hearing aids, and an almost certain prospect that
those who are insured will see their premiums go up. Right at the
climactic moment, we hear about eliminating mammograms for women in
their 40's -- which I believe many of us see as a shadow of rationing
to come. How many in this group know a woman who was diagnosed with
breast cancer in her 40's? I do.
Josh
Two points.
The recommendation on mammograms in your 40's applies with or without
government-provided insurance. To the extent that it is rationing, the
issue is the same either way. The argument that rationing is caused by
government-run insurance does not hold water.
The recommendation is not rationing. Rationing is when a known helpful
procedure is denied because we ran out of money. This recommendation is
instead based on data which say mortality rates do not improve with
mammograms in your 40's. Yes, plenty of women have cancers detected by
mammograms in their 40's, and yet they don't live longer than those who
don't have mammograms.
Josh Rosenbluth
Olly Mensch
cancer) who was diagnosed in her forties.
Olly
Thumper
Two of my best friends are now deceased who were diagnosed in mid
forties. Who knows if a screening at 40 would have saved them but
both of them were diagnosed in their first screening at around 44.
THumper
El Castor
One point.
I did not claim that the mammogram recommendation was rationing, but
rather a shadow of rationing to come, and that is exactly what it is
-- a shadow of one of an almost infinite number of methods that the
government might use to restrict access to healthcare services, and
thereby reduce the cost of those services.
For example, I get an annual PSA test -- the male equivalent of a
mammogram. The test is paid for by my health insurance provider. Here
is the position of the UK's National Health Service on PSA testing:
"Why isn't there a national screening programme for prostate cancer?
All screening programmes cause some harm. This could include false
alarms, inducing anxiety, and the treatment of early disease which
would not otherwise have become a problem. When considering population
screening programmes the benefits and harms must be carefully
assessed, and the benefits should always outweigh the harms. Until
there is clear evidence to show that a national screening programme
will bring more benefit than harm, the NHS will not be inviting men
who have no symptoms for prostate cancer screening."
http://www.cancerscreening.nhs.uk/prostate/index.html
Do US men benefit from PSA testing? I believe that we do. From a 2007
article in the Telegraph, a British newspaper:
"UK cancer survival rate lowest in Europe"
Male five year cancer survival rates:
USA - 66.3%
England - 44.8%
Scotland - 40.2%
http://www.telegraph.co.uk/news/uknews/1560849/UK-cancer-survival-rate-lowest-in-Europe.html
Curiously, the NHS admits that their prostate cancer screening policy
does in fact cost lives, so why don't they change the policy? Money.
"New evidence from a prostate cancer screening trial in Europe has
shown that screening reduced mortality by 20 per cent. However, this
was associated with a high level of over treatment. To save one life,
48 additional cases of prostate cancer needed to be treated."
http://www.cancerscreening.nhs.uk/prostate/index.html
Josh Rosenbluth
> On Tue, 24 Nov 2009 06:45:59 -0500, Josh <u...@nowhere.com> wrote:
> >El Castor wrote:
> >> 38% support is the lowest ever.
>
> >> Maybe someone can explain what the 4,000+ pages that the House and
> >> Senate have produced are all about? When this thing started it was all
> >> about insuring the uninsured. That seems to have been forgotten. Now
> >> it's drastic cuts to Medicare, federal bureaucracies up the wazoo,
> >> smoke and mirrors to hide the real cost, 117 taxes on things from knee
> >> replacements to hearing aids, and an almost certain prospect that
> >> those who are insured will see their premiums go up. Right at the
> >> climactic moment, we hear about eliminating mammograms for women in
> >> their 40's -- which I believe many of us see as a shadow of rationing
> >> to come. How many in this group know a woman who was diagnosed with
> >> breast cancer in her 40's? I do.
>
> >Two points.
>
> >The recommendation on mammograms in your 40's applies with or without
> >government-provided insurance. To the extent that it is rationing, the
> >issue is the same either way. The argument that rationing is caused by
> >government-run insurance does not hold water.
>
> >The recommendation is not rationing. Rationing is when a known helpful
> >procedure is denied because we ran out of money. This recommendation is
> >instead based on data which say mortality rates do not improve with
> >mammograms in your 40's. Yes, plenty of women have cancers detected by
> >mammograms in their 40's, and yet they don't live longer than those who
> >don't have mammograms.
>
>
>
> I did not claim that the mammogram recommendation was rationing, but
> rather a shadow of rationing to come, and that is exactly what it is
> -- a shadow of one of an almost infinite number of methods that the
> government might use to restrict access to healthcare services, and
> thereby reduce the cost of those services.
>
> For example, I get an annual PSA test -- the male equivalent of a
> mammogram. The test is paid for by my health insurance provider. Here
> is the position of the UK's National Health Service on PSA testing:
>
> "Why isn't there a national screening programme for prostate cancer?
> All screening programmes cause some harm. This could include false
> alarms, inducing anxiety, and the treatment of early disease which
> would not otherwise have become a problem. When considering population
> screening programmes the benefits and harms must be carefully
> assessed, and the benefits should always outweigh the harms. Until
> there is clear evidence to show that a national screening programme
> will bring more benefit than harm, the NHS will not be inviting men
> who have no symptoms for prostate cancer screening."http://www.cancerscreening.nhs.uk/prostate/index.html
>
> Do US men benefit from PSA testing? I believe that we do. From a 2007
> article in the Telegraph, a British newspaper:
>
> "UK cancer survival rate lowest in Europe"
> Male five year cancer survival rates:
> USA - 66.3%
> England - 44.8%
>
> Curiously, the NHS admits that their prostate cancer screening policy
> does in fact cost lives, so why don't they change the policy? Money.
>
> "New evidence from a prostate cancer screening trial in Europe has
> shown that screening reduced mortality by 20 per cent. However, this
> was associated with a high level of over treatment. To save one life,
> 48 additional cases of prostate cancer needed to be treated."http://www.cancerscreening.nhs.uk/prostate/index.html
Just like with mammograms, the data on the PSA test aren't clear.
http://content.nejm.org/cgi/content/full/NEJMe0901166
So no, the mammorgram recommendation isn't a "shadow" of the actual
rationing seen with the PSA test. Neither is an example of rationing.
Josh Rosenbluth
El Castor
We will have to agree to disagree. In any event, in the future, women
with a cancer festering in their breast or men with a cancer festering
in their prostate can console themselves with the knowledge that they
saved the health care system money.
In the meantime, I will continue to get an annual PSA test, even if I
have to pay for it out of pocket. You, on the other hand might wish to
keep an eye out for an unexplained ache in your pelvic region. That is
a sign that it has spread to the bone.
The symptoms of terminal prostate cancer:
http://www.ehow.com/facts_4828555_terminal-prostate-cancer-symptoms.html
Pain
1. One of the most frequent symptoms of terminal prostate cancer
would involve a certain level of pain. This pain would manifest in the
pelvis or upper thighs as well as the ribs and the back.
Weight Loss
2. Another common symptom of terminal prostate cancer would be a
loss of weight. As the cancer advances, it will essentially feed on
more calories than the body would normally, prompting weight loss.
Nausea
3. Many times, a person with terminal prostate cancer will feel
some amount of nausea. This nausea may also bring about vomiting, but
may not be present in each individual.
Loss of Appetite
4. Since a person with terminal prostate cancer will usually feel
nauseous or queasy, he will generally begin to lose his appetite. This
particular symptom tends to exacerbate weight loss.
Urination
5. Typically, a person suffering with terminal prostate cancer will
also experience a grouping of symptoms that involve urination. While
these symptoms are not exclusive to terminal prostate cancer (it can
also be seen in its earlier stages), an individual with this form of
cancer will often experience some trouble urinating, less urine
production and the presence of blood in the urine.
Fatigue
6. Most people with terminal prostate cancer will also begin to
feel fatigue. This is almost a culmination of other symptoms as well
as the cancer itself. Inevitably, it will begin to take a toll on the
individual and spawn exhaustion or fatigue.
... And the ultimate symptom -- Death.
El Castor
>On Tue, 24 Nov 2009 06:08:21 -0800, Rita <Ri...@nowhere.com> wrote:
>
>>On Mon, 23 Nov 2009 22:51:59 -0800, El Castor <No_...@Here.Com> wrote:
>>
>>>Right at the
>>>climactic moment, we hear about eliminating mammograms for women in
>>>their 40's -- which I believe many of us see as a shadow of rationing
>>>to come. How many in this group know a woman who was diagnosed with
>>>breast cancer in her 40's? I do.
>>
>>I have been following this debate and looked particularly for the
>>scientific ratinale behind the change in recommendations."
>>
>>I found this article in the LA Times Science section:
>>
>>latimes.com
>>SCIENCE
>>
>>Cancer screening: What could it hurt? A lot, actually
>>
>>Routine cancer testing saves lives, but it also leads to biopsies,
>>surgeries, radiation, even deaths that otherwise would not have
>>occurred. But experts' reevaluations are met with public angst.
>>
>>
>>By Karen Kaplan
>>
>>November 21, 2009
>>
>> It seemed like a good idea at the time.
>>
>>In 1984, Japan began screening the urine of 6-month-old infants for
>>neuroblastoma, the most common type of solid tumor in young children.
>>The test was simple and could show signs of cancer long before
>>clinical symptoms arose.
>>
>>Hundreds of infants went through the ordeal of diagnosis and
>>treatment, but it didn't reduce the number of tumors, including deadly
>>ones, found later. Almost none of the tumors caught by screening
>>turned out to be dangerous -- and more of the screened children died
>>from complications of surgery and chemotherapy than from the cancer
>>itself.
>>
>>In 2004, health officials ended the program.
>>
>>The United States is grappling with the same type of problem today.
>>After decades of focus on the upside of cancer screening, public
>>health experts are increasingly reevaluating the wisdom of
>>administering routine cancer screening tests to millions of
>>asymptomatic people.
>>
>>Though screening certainly saves lives, recent studies make it clear
>>that it also leads to biopsies, surgeries, chemotherapy and radiation
>>-- even some deaths -- that otherwise would not have occurred.
>>
>>That screening has a downside is not easy to accept, as evidenced by
>>the furor over this week's recommendation from the U.S. Preventive
>>Services Task Force that most women wait until age 50 to start routine
>>mammograms, and then get them only every other year.
>>
>>Though the decision was based on new scientific evidence that many
>>more women are harmed than helped by annual tests starting at age 40,
>>it was swiftly attacked by physicians and policymakers who said they
>>would ignore it.
>>
>>The message that we're over-screening for cancer isn't necessarily a
>>welcome one to the American public either.
>>
>>A whopping 87% of U.S. adults believe that routine screening is
>>"almost always a good idea," and 74% believe early detection saves
>>lives "most or all of the time," according to a 2004 survey in the
>>Journal of the American Medical Assn.
>>
>>Most said they'd continue to get their screening tests even if their
>>doctors advised against it.
>>
>>Indeed, in the days after the task force released its mammogram
>>recommendations, breast cancer survivors railed online against what
>>they saw as the notion that their lives were not worth saving.
>>
>>Part of the outcry stems from the fact that so many people know
>>someone who was diagnosed with breast cancer in her 40s and appeared
>>to respond to early treatment. It's natural to think of those women as
>>the ones who would be hurt by a reduction in screening, psychologists
>>say.
>>
>>We're not as well equipped to weigh the risks and benefits of the
>>population at large.
>>
>>"We think, 'I'm sure glad my sister or my best friend got that done,'
>>" said Julie Downs, director of the Center for Risk Perception and
>>Communication at Carnegie Mellon University in Pittsburgh.
>>
>>Also complicating matters is that it's easy to identify cancer
>>survivors whose tumors were caught by screening, but it's nearly
>>impossible to put a face on the woman or man who is hurt by
>>over-screening.
>>
>>Patients are also reluctant to give up on the idea that they can
>>control their medical destiny through proactive measures, said Nancy
>>Berlinger, a healthcare bioethicist at the Hastings Center, a research
>>institute in Garrison, N.Y.
>>
>>"Anything that suggests that early detection might not save lives is
>>going to be deeply disturbing," she said. "It suggests that we can't
>>do much to help ourselves."
>>
>>The public's attachment to screening also reflects its faith in
>>high-tech medicine, said Dr. Len Lichtenfeld, deputy chief medical
>>officer of the American Cancer Society in Atlanta.
>>
>>"They want to believe that the new technology is the better
>>technology," he said. "Sometimes it is -- sometimes it isn't."
>>
>>The idea that detecting cancers early makes them easier to treat has
>>been around since at least the 1930s, when doctors began advising
>>women to conduct breast self-exams.
>>
>>"That philosophy sounded right, so screenings were implemented," said
>>Dr. Therese Bevers, medical director of the Cancer Prevention Center
>>at the University of Texas M.D. Anderson Cancer Center in Houston.
>>
>>And in many cases, that strategy works. The American Cancer Society
>>credits widespread use of mammograms for a 2% annual decrease in
>>breast cancer deaths since 1990. Pap smears have slashed deaths from
>>cervical cancer by more than 70% since they were introduced in the
>>1940s.
>>
>>But finding cancers that respond to early treatment is only one of the
>>potential outcomes from a screening test. Many tests produce false
>>positives, prompting additional tests that can be invasive, expensive,
>>time-consuming and anxiety-inducing.
>>
>>A study published this spring in Annals of Family Medicine found that
>>60% of men and 49% of women had gotten at least one false positive
>>during three years of routine screenings for ovarian, prostate, lung
>>and colorectal cancer. As a result, 22% of those women and 29% of
>>those men had an invasive diagnostic procedure, the study found.
>>
>>Other screening tests produce false negatives, giving patients and
>>their doctors the incorrect impression that they have nothing to worry
>>about.
>>
>>Some detect aggressive cancers whose outcomes aren't improved by early
>>detection.
>>
>>And some identify small cancers that grow so slowly they'd never
>>compromise a patient's health. Many would even go away on their own.
>>
>>Statisticians and epidemiologists know this for a fact. The problem
>>is, there's no way to tell which of the tumors are dangerous and need
>>to be treated and which are harmless and would be best left alone. So
>>all of them get treated, often aggressively. The medical establishment
>>calls this overdiagnosis.
>>
>>"Overdiagnosis is the hardest thing to explain to people," said Dr.
>>Stephen Taplin, chief of the Applied Cancer Screening Research Branch
>>at the National Cancer Institute in Washington, D.C. "No individual
>>woman can know if they're overdiagnosed. They know they have cancer,
>>and they're scared to death. It's completely justified.
>>
>>"But if you look at people overall," he added, "there are some people
>>who suffered that scare unnecessarily. If they had never known about
>>that cancer, it wouldn't have affected their life."
>>
>>Such nuances weren't considered when screening tests were implemented.
>>Many were introduced before their effectiveness had been established
>>though clinical trails. At the time, doctors didn't see the need. But
>>experience has prompted them to reconsider.
>>
>>Take the cancer antigen 125, or CA 125, test that has been used to
>>screen for ovarian cancer. Women with the disease often have higher
>>blood levels of this protein, so it seemed to make sense to check for
>>it in asymptomatic women.
>>
>>The test was never widely adopted and is no longer recommended for
>>women at average risk, because other conditions, such as
>>diverticulitis and endometriosis, can also boost CA 125 levels. And
>>some patients with the disease have normal levels of the protein.
>>
>>Many doctors are backing off the prostate-specific antigen test to
>>screen for prostate cancer now that two influential studies published
>>this year found that early detection offered little to no benefit in
>>long-term survival. But the PSA tests did prompt aggressive treatment
>>that sometimes left men impotent or incontinent.
>>
>>Some guidelines, including those for cervical cancer, have been
>>amended to reflect a better understanding of cancer biology. The
>>American College of Obstetricians and Gynecologists this week
>>suggested that most women get Pap tests less frequently because it's
>>known now that cervical cancer progresses slowly, and abnormal cells
>>often resolve on their own, especially in younger women.
>>
>>Despite outcry from patients who equate reduced screening with reduced
>>care, it makes no sense to ignore scientific data that happen to be
>>unpalatable, said Dr. George Sawaya, a researcher at UC San Francisco
>>whose studies helped prompt the change in Pap test guidelines.
>>
>>"It would be much more of a travesty if we didn't change our
>>guidelines in response to new information," he said.
>>
>>karen....@latimes.com
>>
>>You can make of this what you will. But to assume the \purpose of
>>the new recommendations is to ration medical care suggests one
>>is leaping to an unfounded conclusion.
>>
>There is no question that North American Health care has leaned
>heavily in favor of going farther in doing tests than is really
>warranted by the patient's condition.
>
>This is more pronounced in the USA than in Canada because of the more
>widespread use of litligation and expensive settlements.
>
>In Canada, the involvement of the government in paying expenses has
>resulted in heavy review of the necessity of all kinds of tests and
>even procedures.
>
>There are all kinds of things which are now being looked at in askance
>and when one reviews the rationale for these apparently redundant
>test/procedures, it does raise a lot of interesting questions.
>
>Being Canadian, I do not assume that this is a conspiracy by the
>government to manage the demand to fit the supply. Rather I look at
>professional medical journals and newspapers to argue the case in
>front of the public on the basis of merit rather than fear mongering
>and creative manipulation of the news.
>
>It's actually kind of interesting because more and more we are seeing
>treatment being defined in terms of Decision Tables (if this and this
>then do that and that). These Decision Tables are easily turned into
>diagnostic and medical web sites which in turn help us to monitor what
>our own individual treatments from our own medical supports.
>
>This stuff on mammogram and pap smears is really good discussion
>provided people will filter out the creative invention of false
>information and phoney arguments and then consciously err on the side
>of humanity.
>
>Unfortunately honest arguments are often outweighed by the hysterics
>from lobbyists.
>
>Bruce
Hi Bruce,
"The Fraser Institute's annual survey of hospital waiting lists
released recently showed that total wait time in 2009 is still 73 per
cent longer than it was back in 1993, despite the fact that health
spending per person has increased by 41 per cent since then. Simply
put, the public health care system is still failing Canadians. That
Canadians are required to endure a median wait time of 16.1 weeks from
GP referral to treatment by a specialist in the developed world's
second most expensive universal access health care program should be
considered unacceptable. So should the fact that wait times remain
historically high in spite of substantial increases in health spending
across Canada over time."
http://telegraphjournal.canadaeast.com/opinion/article/864637
Now, if you will excuse me, I have to schedule an annual appointment
with my ophthalmologist.
Ah, I'm back!
I have the appointment -- in less than a week. Being Canadian, I know
you find that routine, and I have to confess that unlike making an
appointment with my primary care physician, which I can do on-line, a
specialist requires that I pick up the phone. )-8
Werner
> ...The argument that rationing is caused by
> government-run insurance does not hold water.
>
> The recommendation is not rationing. Rationing is when a known helpful
> procedure is denied because we ran out of money. This recommendation is
> instead based on data which say mortality rates do not improve with
> mammograms in your 40's. Yes, plenty of women have cancers detected by
> mammograms in their 40's, and yet they don't live longer than those who
> don't have mammograms.
>
> Josh Rosenbluth
Whether cause or effect doesn't alter reality.
Canada Health Care
As reported in a December 2003 story by Kerri Houston for the
Frontiers of Freedom Institute titled "Access Denied: Canada's
Healthcare System Turns Patients Into Victims," in some instances,
patients die on the waiting list because they become too sick to
tolerate a procedure.
http://poormedicalstudent.blogspot.com/2004/07/dying-to-see-doctor.html
The federation, which campaigns for tax reform and private enterprise
in healthcare, believes the system is suffering serious financial
challenges. It calculates that by 2035, Ontario will be spending 85
per cent of its budget on healthcare.
The federal government and most
provinces acknowledge there's a
crisis: a lack of physicians and
nurses, state-of-the-art equipment
and funding. In Ontario, more than
10,000 nurses and hospital workers
are facing layoffs over the next
two years unless the provincial
government boosts funding, says the
Ontario Hospital Association,
which represents healthcare providers
in the province.
http://www.expatfocus.com/expatriate-canada-healthcare-medical
http://getinnowhealth.com/
http://www.cmaj.ca/cgi/content/full/174/9/1247
http://www.alternet.org/healthwellness/76032/
The Fraser Institute, a Vancouver, B.C.-based think tank, has done
yeoman work keeping track of Canada'ssocialized health-care system. It
has just come out with its 13th annual waiting-list survey.
...
As reported in a December 2003 article by Kerri Houston for the
Frontiers of Freedom Institute titled "Access denied: Canada's health-
care system turns patients into victims", in some cases, patients die
on the waiting list because they become too sick to tolerate a
procedure.
...
Adding to Canada's medical problems is the exodus of doctors.
According to a March 2003 story in Canada News, about 10,000 doctors
left Canada in the 1990s.
http://www.cato.org/pub_display.php?pub_id=2753
My health-care prejudices crumbled not in the classroom but on the way
to one. On a subzero Winnipeg morning in 1997, I cut across the
hospital emergency room to shave a few minutes off my frigid commute.
Swinging open the door, I stepped into a nightmare: the ER overflowed
with elderly people on stretchers, waiting for admission. Some, it
turned out, had waited five days. The air stank with sweat and urine.
Right then, I began to reconsider everything that I thought I knew
about Canadian health care. I soon discovered that the problems went
well beyond overcrowded ERs.
http://www.city-journal.org/html/17_3_canadian_healthcare.html
Failing health-care system
I send this out not looking for sympathy but as the election looms in
the states you will be hearing more and more about universal health
care down there and the advocates will be pointing to Canada. I just
want to make sure that you hear the truth about health care up here
and have some food for thought and informed questions to ask when
broached with this subject.
http://www.officiallyscrewed.com/blog/?p=873
http://www.thetelegram.com/index.cfm?sid=115575&sc=87
the problems in this province's health care system are more severe
than any official was willing to admit.
http://www.ganderbeacon.ca/index.cfm?sid=127765&sc=310
In Canada, we think we’re doing well on the health-care front.
We’re not.
Most measurements, such as those by the OECD, or a recent report by
the Winnipeg Frontier Centre for Public Policy, conclude that Canada
ranks around 30th in accessibility when compared to health-care
programs in other developed countries.
Indeed, the Winnipeg Centre says, “Canada spends more money to achieve
poorer results.”
Nationally, we spend $5,000 a person on health care and in B.C. the
health budget takes around 40 cents of every tax dollar.
That’s a lot of money just to have access to a wait list.
http://www.princegeorgecitizen.com/20080207116948/opinion/columns/snitching-won-39t-help-fix-health-care-problems.html
A Few Lessons
Several lessons can be drawn from the Canadian experience with
socialized medicine.
First of all, socialized medicine, although of poor quality, is very
expensive. Public health expenditures consume close to 7 per cent of
the Canadian gross domestic product, and account for much of the
difference between the levels of public expenditure in Canada (47 per
cent of gross domestic product) and in the U.S. (37 per cent of gross
domestic product). So if you do not want a large public sector, do not
nationalize health.
A second lesson is the danger of political compromise. One social
policy tends to lead to another. Take, for example, the introduction
of hospital insurance in Canada. It encouraged doctors to send their
patients to hospitals because it was cheaper to be treated there. The
political solution was to nationalize the rest of the industry.
Distortions from one government intervention often lead to more
intervention.
A third lesson deals with the impact of egalitarianism. Socialized
medicine is both a consequence and a great contributor to the idea
that economic conditions should be equalized by coercion. If
proponents of public health insurance are not challenged on this
ground, they will win this war and many others. Showing that human
inequality is both unavoidable and, within the context of equal formal
rights, desirable, is a long-run project. But then, as SaintExupery
wrote, "Il est vain, si l'on plante un chene, d'esperer s'abriter
bientot sous son feuillage."6
http://www.theadvocates.org/freeman/8903lemi.html
Emergency Room:
http://www.npr.org/templates/story/story.php?storyId=18106275
http://www.cbc.ca/health/story/2007/01/25/er-waits.html
http://ca.news.yahoo.com/s/cbc/081106/canada/calgary_emergency_room_doctors_1
http://secure.cihi.ca/cihiweb/products/Wait_times_e.pdf
doctor shortage:
19 Canadian-trained doctors migrate to the United States for every
American doctor who comes here.
http://www.homemakers.com/homemakers/client/en/home/DetailNews.asp?idNews=237470
http://www.cbc.ca/health/story/2006/08/28/doctor-shortage.html
++++
Wait times for surgery in Canada at all-time high: study
Last Updated: Monday, October 15, 2007 | 10:33 AM ET
The Canadian Press
A typical Canadian seeking surgical or other therapeutic treatment
had
to wait 18.3 weeks in 2007, an all-time high, according to new
research published Monday by independent research organization the
Fraser Institute.
"Despite government promises and the billions of dollars funnelled
into the Canadian health-care system, the average patient waited more
than 18 weeks in 2007 between seeing their family doctor and
receiving
the surgery or treatment they required," said Nadeem
Esmail, director
of Health System Performance Studies at the Fraser
Institute and
co-author of the 17th annual edition of Waiting Your
Turn: Hospital
Waiting Lists in Canada.
Total waiting times increased in six provinces: Alberta,
Manitoba,
Ontario, Quebec, Nova Scotia and Newfoundland and Labrador.
Total
waiting times increased in six provinces: Alberta, Manitoba,
Ontario,
Quebec, Nova Scotia and Newfoundland and Labrador.
(CBC)
The survey measures median waiting times to document the extent to
which queues for visits to specialists and for diagnostic and
surgical
procedures are used to control health-care expenditures.
"It's becoming clearer that Canada's current health-care system
cannot
meet the needs of Canadians in a timely and efficient manner,
unless
you consider access to a waiting list timely and efficient,"
Esmail
added.
The 2007 survey found the total median waiting time for patients
between referral from a general practitioner and treatment, averaged
across all 12 specialties and 10 provinces surveyed, increased to
18.3
weeks from 17.8 weeks observed in 2006. This was primarily due
to an
increase in the first waiting period, between seeing the
general
practitioner and attending a consultation with a specialist.
Total waiting times increased in six provinces: Alberta, Manitoba,
Ontario, Quebec, Nova Scotia and Newfoundland and Labrador. This
masked the decreased waiting times in British Columbia, Saskatchewan,
New Brunswick and Prince Edward Island.
>http://www.npr.org/templates/story/story.php?storyId=18106275
>http://www.cbc.ca/health/story/2007/01/25/er-waits.html
Study sheds light on ER wait times in Ontario
Visits can range from 1 hour in small cities, to more than 9 in
bigger
ones
Last Updated: Thursday, January 25, 2007 | 3:00 PM ET
CBC News
Ontarians typically waited one to four hours in the province's
emergency rooms over a recent one-year period, although wait times in
some larger cities stretched past nine hours, according to a new
study.
Half of visits to emergency rooms in small hospitals didn't last
longer than 1.1 hours, indicates the study by the Canadian Institute
for Health Information.
Half of visits to large hospitals, typically found in big urban
centres, lasted between 2.8 and 3.6 hours, the study suggests.
In 10 per cent of cases, a visit to a small emergency room stretched
out past 3.2 hours, while 10 per cent of visits to big emergency
rooms
dragged on beyond 9.3 hours.
The institute based its findings on data from April 2005 to April
2006
at nearly every emergency room in Ontario — 167 in total.
"I think one of the values of this report is that it gives people in
Ontario a clear picture of how long people are waiting," researcher
Greg Webster told CBC News Online on Thursday, a day after the
release
of the study.
He said the point of the study is not to judge hospitals or evaluate
how their emergency rooms are doing. Instead, the study strives to
provide a breakdown of numbers.
Here's how long ER visits lasted:
* Large teaching hospitals: Half of ER visits were over in 3.6
hours (10 per cent in 9.3 hours).
* Large community hospitals:
Half over in 2.8 hours (10 per cent
in 7.5 hours).
* Medium
hospitals: Half over in 1.5 hours (10 per cent in 4.2
hours).
*
Small hospitals: Half over in 1.1 hours (10 per cent in 3.2
hours).
>http://ca.news.yahoo.com/s/cbc/081106/canada/calgary_emergency_room_d...
13 HOURS AVERAGE WAIT TIME WITH CANADIAN CARE????
Calgary emergency doctors to assess waiting room patients
Module body
Thu Nov 6, 12:06 PM
0
* What's this
EDMONTON (CBC) - Patients in crowded emergency waiting rooms in
Calgary will soon be examined by a doctor in a nearby curtained area.
ADVERTISEMENT
The practice has started at the Foothills hospital and will soon
begin
in the Rockyview and Peter Lougheed hospitals.
"We know in Calgary there's been problems, people with miscarriages,
people with appendicitis who've been forced to wait long times in
waiting rooms," said Dr. Grant Innes, the head of emergency medicine
for the Calgary Health Region.
"If we could get a physician out there to see those people much
faster, then we can detect those conditions and treat them more
aggressively."
When hospital beds are full, emergency stretchers fill up and sick
people are left in the waiting room. One advantage of the new system
is it allows doctors to order tests right away, said Innes.
St. Paul's Hospital in Vancouver is using the system.Two-thirds of
patients assessed by doctors in that hospital are sent home right
away, he said.
"That does save a lot of stretchers for patients who really need them
and the patient waiting times in St. Paul's for an average,
moderately
sick patient are about 30 minutes, which is by far the
best in the
country."
David Spalding's wife had to wait five hours at the Foothills
hospital
Wednesday, even though she was rushed to the emergency room
by
ambulance.
"There's lots of people so I understand why it was so long," he said.
"There was people in the hallway, as well about four or five people
came in by ambulance at the same time my wife did."
Spalding said he supports any attempts to cut wait times in emergency
rooms.
"There were a lot of people in a fair amount of distress and I think
a
doctor seeing them right away would probably speed things up a
lot."
A report released a year ago concluded the Calgary Health Region
needed to do a better job co-ordinating emergency services after a
number of patients complained and average wait times jumped to 13
hours.
So Canadian national health care does nothing to reduce
pressure on
emergency rooms it would appear from this thing.
++++
England:
“SICKO”, the latest film from the left-wing American agitpropagandist
Michael Moore, has already drawn a lot of comment for its favourable
comparison of health care in Cuba with that in the United States. But
Mr Moore does not reserve all his praise for the tiny Communist
island. He lavishes admiration on Britain's National Health Service,
presenting a vision of helpful staff and generous treatment.
Britons themselves might doubt details of this assessment.
http://www.economist.com/world/britain/displaystory.cfm?story_id=9230266
Fuelling public discontent, medical staff are astonishingly fed up,
even though they have received a string of big pay increases.
http://www.economist.com/world/britain/displaystory.cfm?story_id=10431749
Given the big sums of extra money that the NHS has received, however,
it would have been extraordinary if the health service had not got
better. The question that matters is whether it has improved enough.
Sir Derek's answer is that the taxpayer has got poor value for money.
The danger in throwing a lot of cash at the NHS was that much of it
would be soaked up in higher costs rather than producing more health
care. That is precisely what has happened. The report finds that 43%
of the extra money given to the NHS since 2002 has gone into higher
pay and prices.
http://www.economist.com/world/britain/displaystory.cfm?story_id=9803938
Germany
"The atmosphere, the feeling on the side of physicians — and perhaps
also patients — that things are getting worse," he replies. "I think
that's the most striking change, really."
http://www.npr.org/templates/story/story.php?storyId=91931036
Josh Rosenbluth
> with a cancer festering in their breast or men with a cancer festering
> in their prostate can console themselves with the knowledge that they
> saved the health care system money.
>
> In the meantime, I will continue to get an annual PSA test, even if I
> have to pay for it out of pocket. You, on the other hand might wish to
> keep an eye out for an unexplained ache in your pelvic region. That is
> a sign that it has spread to the bone.
It looks like we can classify you in the group who are unable to
understand mathematics, or possibly the group who don't engage in fact-
based conclusions.
Josh Rosenbluth
AndyS
The problem isn't whether or not a person will be denied screening,
but
rather who will pay for it.
I have never heard of a procedure being denied a person who agreed
to
pay for it themselves.
Same for any health care. It is available to all, but it must be
paid for,
just like ordering a meal in a restaurant.
Insurance companies make decisions on what is covered and what is
not, and those decisions are available to anyone who wants to buy
insurance. Cheap insurance means less coverage.
Damn shame that everything in life isn't "free", and we sometimes
have
to pay for things ourselves.....
And if a person has NO money, then the government will pay for it
thru Medicaid.....
Rumpelstiltskin
<snip>
>I read that under the proposed Senate health care bill and in all
>previous bills, co-pays and deductibles for preventative care will be
>no more. Insurance companies will be required to pay for
>preventive care.
>
>> Damn shame that everything in life isn't "free", and we sometimes
>>have
>>to pay for things ourselves.....
>>
>> And if a person has NO money, then the government will pay for it
>>thru Medicaid.....
>
>
>>
Just as an aside, it's interesting that you used both "preventive"
and "preventative" in the same sentence. The two words mean
exactly the same thing, though the OED claims that the shorter
is the "preferred formation". It's such an oddity that I actually
made a file to remind me of it. Before I made that file, I could
never remember which word it was that had those two formations.
El Castor
Then can I assume you have never had your PSA tested?
Josh
I have a routine blood test every year. PSA is included. It's all
covered by insurance. But if my insurance ceased to cover it, it would
not bother me at all to stop the screening.
Josh Rosenbluth
Olly Mensch
PSA screening. I must admit, I cannot understand your obvious lack of
logic. It is that "lack' which just might some day endanger your good
health; don't you realize that??
What Jeff argues is so basic, so logical, that it escapes me why you
disagree???
Olly
freeisbest
> 38% support is the lowest ever.http://www.rasmussenreports.com/public_content/politics/current_event...
>
> Maybe someone can explain what the 4,000+ pages that the House and
-------------------------------------------------------------
As usual, the numbers are phony, and the reasoning is faulty. On
TWO national news broadcasts last night, EIGHT IN TEN Americans are in
favor of a public support for health CARE, not health "insurance".
Apparently Repub senators are honest in one small way: after they've
been bought by Big Med, they stay bought.
Just for the sake of curiosity, what is accomplished by whining
about the *number of pages* in HEALTH CARE legislation? I think it's
safe to say that we all expected that you - or someone in the repub
party - can count, so that can't be it. Is the nation supposed to be
humbled because you and rasmussen have lofty contempt for the
silliness of health care for all Americans?
El Castor
Olly, Josh would disagree, but I think I understand. Many of us have a
need to believe in something. Belief is a haven for the frustrated,
and it can give meaning and focus to our lives. This need can manifest
itself in religion, or in a variety of mass movements -- most
especially political movements. Eric Hoffer wrote about this need
fifty years ago in his book, The True Believer. Josh is a true
believer. He should read the book. (-8
Olly Mensch
"denials' and "refusals" (re: tests for prostate cancer)
Perhaps I am not as kind; I consider it being "dumb" - - in the interest
of some principle vs the good common sense to try to maintain reasonably
good health.
= I am currently going through a similar "discussion" (argument?!) with
one of my sons, who, along with his wife, has decided NOT to take the
swine lu vaccine, when and if it becomes available where he lives.
I am reacting like a tpical "jewish Mother" - who just crawled under a
rock to try not to interfere, and respect her kids' judgment; since they
are adults.
But - tell me - please - even though they are very smart "kids" (63
years old) their logic escapes me; their reasoning seems flawed -
childish - ininformed - what's a "jewish" Mother to do?????Any advice,
short of "zip your lips"!!
= = To add to my little private woes - I just heard a report - on T.V. -
from China, that they are discovering a new strain which is a mixture of
swine flu and bird flu - and it is absolutely deadly.
Olly
Olly Mensch
"true believer"- You referred to Eric Hoffer's book, also. I could not
agee more with your reasoning for what makes a true believer, or,
rather, what is the need of a true believer which makes him one?!
Along those lines - and not to be facetious - reminds me of Htler - and
how the German population followed and believed his warped "credo'-
which eventually led them to their downfall. It s hard to shake such a
need for an iron-clad belief - though,I feel that the attempt should be
made,when and if such belief undermines the very foundation of a good
life - a secure life - a healthy life - and a rewarding life. But, as
your post perhaps suggested, it is difficult to argue with such ardent
needs; but then - which is the more ethical path to take - namely, to
respect their belief system - knowing it can undermine their very
existence - or to "bud out' and respect their convictions and hope that
it is WE who might be wrong??
Olly
Josh
> On Wed, 25 Nov 2009 10:59:06 -0500, liese...@webtv.net (Olly
> Mensch) wrote:
>
>> Josh - -I have been following your discussion with El Castor, regading
>> PSA screening. I must admit, I cannot understand your obvious lack of
>> logic. It is that "lack' which just might some day endanger your good
>> health; don't you realize that??
>> What Jeff argues is so basic, so logical, that it escapes me why you
>> disagree???
>> Olly
>
> Olly, Josh would disagree, but I think I understand. Many of us have a
> need to believe in something.
My belief is grounded in science, math and logic.
http://content.nejm.org/cgi/content/full/NEJMe0901166
http://www.bmj.com/cgi/content/full/339/sep24_1/b3537
What exactly is Jeff's supposedly unassailable "basic" logic? How does
it address the arguments raised in my links?
Josh Rosenbluth
Glenn
"Josh" <us...@nowhere.com> wrote in message
news:hekkrq$324$1...@josh.motzarella.org...
Hang in there Josh, you need to add game theory (a descendent of
operational analysis) and reasoning. What Olly and Jeff are getting
at is found in game theory.
--
Glenn
Josh
>
> "Josh" <us...@nowhere.com> wrote in message
> news:hekkrq$324$1...@josh.motzarella.org...
>> El Castor wrote:
>>> On Wed, 25 Nov 2009 10:59:06 -0500, liese...@webtv.net (Olly
>>> Mensch) wrote:
>>>
>>>> Josh - -I have been following your discussion with El Castor, regading
>>>> PSA screening. I must admit, I cannot understand your obvious lack of
>>>> logic. It is that "lack' which just might some day endanger your good
>>>> health; don't you realize that??
>>>> What Jeff argues is so basic, so logical, that it escapes me why you
>>>> disagree???
>>>> Olly
>>>
>>> Olly, Josh would disagree, but I think I understand. Many of us have a
>>> need to believe in something.
>>
>> My belief is grounded in science, math and logic.
>>
>> http://content.nejm.org/cgi/content/full/NEJMe0901166
>> http://www.bmj.com/cgi/content/full/339/sep24_1/b3537
>>
>> What exactly is Jeff's supposedly unassailable "basic" logic? How
>> does it address the arguments raised in my links?
>>
>
>
> operational analysis) and reasoning. What Olly and Jeff are getting at
> is found in game theory.
I don't think so, but by all means detail where I am wrong.
Josh Rosenbluth
Glenn
Sorry Josh but I'm not a teacher, there are many books available on
game theory at your local Barns and Noble. It's about making
decisions, I'm sure you will enjoy reading about it, after-all it
was operational analysis that was decisive in our victory in ww2.
--
Glenn
Josh
> theory at your local Barns and Noble. It's about making decisions, I'm
> sure you will enjoy reading about it, after-all it was operational
> analysis that was decisive in our victory in ww2.
Let me get this straight. You claim there is a flaw in my logic
explained by game theory, but that flaw can only be understood if I read
some Barnes and Noble books about game theory (**). How can you
possibly know all that if you haven't read those books? But if you have
read them and know the flaw, how come you won't explain it?
Josh Rosenbluth
(**) I have a BS/MS in Operations Research and 25+ years at Bell
Laboratories. I've done a bit more than just read a few Barnes and
Noble books about game theory.
Glenn
I claim no logical flaw as you have made no logical statements, you
are being deceptive and I won't go along with your childishness.
You have no standing to criticize Jeff and Olly. In plain English,
you are a fraud.
--
Glenn
El Castor
Olly, I think the best argument is that more than 20 million Americans
have gotten the H1N1 vaccine without any serious side effects. When
the CDC says the vaccine is safe, I believe them. But I should add
that from what I have heard, healthy people aged 63 probably won't
have an opportunity to be vaccinated for H1N1 until this flu season is
over. By next year the H1N1 vaccine will be combined with the regular
seasonal flu vaccine. Personally, I always get a flu shot as early in
the season as I can and I never get the flu. (-8
"CDC: Swine flu vaccine safe; no big problems seen
By MIKE STOBBE , 11.25.09, 04:32 PM EST
ATLANTA -- There's no evidence that the swine flu vaccine is causing
any serious side effects, U.S. health officials said Wednesday, in
their first report on the safety of the new vaccine. Since
vaccinations began in early October, the government has been tracking
the safety of the swine flu vaccine. By mid-November, about 22 million
Americans had gotten the vaccine and there were about 3,200 reports of
possible side effects, the vast majority for minor things like
soreness or swelling from the shot." more ...
http://www.forbes.com/feeds/ap/2009/11/25/health-us-med-swine-flu-vaccine_7159973.html
El Castor
Hoffer saw little difference between fanatics, aka true believers.
They all share one thing in common, an unshakable reliance on their
belief system, without regard to facts and reality. But, there is a
practical difference between fanatical Nazis, Muslims, and Skinheads
on the one hand, and fanatical Presbyterians, Jews and Buddhists, on
the other. Fanatical Presbyterians, Jews, and Buddhists don't
gratuitously kill themselves and others.
As far as who is wrong is concerned, you're right, it could be us. But
I'm not too worried about being in the true believer camp. I could
always find issues to disagree with Bush, and just about anyone else.
If I have a belief system, it's in a mass movement of one -- myself,
and I don't have a problem disagreeing with myself and changing my
mind. If you can say the same, then I think you're alright. (-8
Josh
Since it looks like you missed it, here is my logic (the supporting data
are contained in the above links):
1) PSA screenings either only barely improve mortality rates or do not
improve them at all.
2) It is true that the higher your PSA readings, the higher chance you
will get prostate cancer.
3) The reason #1 and #2 are both true is:
A) Most people who have PSA levels above the threshold of 4 ng/ml
never get prostate cancer.
B) Most of the people who do get prostate cancer would not have
died from that cancer even if they never had a PSA test (very slow
growing cancers).
C) Some of the people in A and B will die as a result of the
unnecessary diagnostic and treatment actions taken in response to a PSA
test.
D) Other people who do get prostate cancer will die from it with or
without a PSA test (very fast growing cancers)
E) Yet other people will be saved by PSA tests.
4) The empirical data suggest the effects of C, D and E counter-balance,
resulting in no overall improvement in mortality.
Conclusion: PSA screenings are not presently useful as a tool to guide
further actions.
Josh Rosenbluth
Glenn
Strange you should present this, as the doctor first uses the
person's age to determine if treatment, operation, is advisable. If
one is aware, one is asked for permission to continue with
treatment. If one is old, usually one declines, if one is young,
odds favor the operation. Regardless, the patient is presented with
the odds and makes the choice when it is about to become a matter of
life or death, not ahead of time to make sure the decision conforms
to your above logic. Without the test, no choice would be offered
and and I don't find that that any more acceptable than someone
doing what they think is best for me without asking.
--
Glenn
Josh
> age to determine if treatment, operation, is advisable. If one is
> aware, one is asked for permission to continue with treatment. If one
> is old, usually one declines, if one is young, odds favor the
> operation. Regardless, the patient is presented with the odds and makes
> the choice when it is about to become a matter of life or death, not
> ahead of time to make sure the decision conforms to your above logic.
> Without the test, no choice would be offered and and I don't find that
> that any more acceptable than someone doing what they think is best for
> me without asking.
Firstly, can you provide a link that gives the odds (both for the
treatment will save you, and the treatment will kill you) as a function
of age?
Secondly, I have no objection to you having the test. I do question the
public policy that says all should have the test based on the data I
have seen. Maybe you can persuade me otherwise for a particular age
group based on the data requested above.
Josh Rosenbluth
Glenn
I got the information from old people that have been diagnosed with
this cancer, some live with it, some had the operation. They get
their information from the nurses and doctors. I'm sure there is a
better reference, you can search if you care to, I don't have a
need. I didn't mention what the odds are, again I don't care. If
there's information available about me, I want to know. I know of
no doctor that will force an old person to have any test, but most
want to know. I had a relative that died in his forties from
diabetes complications. He refused to treat it. It take all kinds,
but he and you are part of a small minority (some people refuse
fluoride toothpaste but there's only one non-fluoride toothpaste
available at Wal-Mart).
--
Glenn
Josh
> cancer, some live with it, some had the operation. They get their
> information from the nurses and doctors. I'm sure there is a better
> reference, you can search if you care to, I don't have a need. I didn't
> mention what the odds are, again I don't care.
Since I'm attempting to arrive at a fact-based conclusion, I do. I have
searched. I have found nothing that suggests the age effect you talk about.
> If there's information
> available about me, I want to know. I know of no doctor that will force
> an old person to have any test, but most want to know. I had a relative
> that died in his forties from diabetes complications. He refused to
> treat it. It take all kinds, but he and you are part of a small
> minority (some people refuse fluoride toothpaste but there's only one
> non-fluoride toothpaste available at Wal-Mart).
I'm with you when it comes to diabetes treatments and fluoride because
the data support them.
Josh Rosenbluth
El Castor
Interesting discussion. As someone who suffers from BPH, I have PSA
scores persistently above 4, so it's a subject that interests me.
First, with regard to the European study, here is a synopsis of the
results from the March 26, 2009 New England Journal of Medicine:
"PSA-based screening reduced the rate of death from prostate cancer by
20% but was associated with a high risk of overdiagnosis."
http://content.nejm.org/cgi/content/full/NEJMoa0810084
But, is the 20% number really accurate? "In the screening group, 82%
of men accepted at least one offer of screening". The study lasted
nine years, and to be a valid member of the screened group only one
test was required, and a second test was not given until four years
later. This is not comparable to annual testing, particularly in view
of the fact that aggressive cancers with a high Gleason score will
metastasize very quickly.
Here is a comment on the study from a US News article, also from March
of this year:
"The European results show that picking up cancers before they produce
symptoms brings a 20 percent improvement in mortality, and if the
analysis is done including only those people who actually got screened
(some signed on but did not get tested), the benefit was 28 percent.
Based on bone scans, the screened group was 40 percent less likely to
have cancer that spread to bone, the favored site for prostate cancer
metastasis."
http://health.usnews.com/blogs/heart-to-heart/2009/03/23/what-to-make-of-the-prostate-cancer-screening-studies.html
In the wake of this discussion I am more aware than ever that PSA
screening is controversial. In my case, when my PSA scores went from
2.X to 4.X, I had a negative biopsy. My scores remain in the 4.X
region, and I have not had another biopsy, nor do I want one. On the
other hand, if next year I am tested and it goes to 10, I am sure my
urologist would recommend a biopsy, and I would concur.
So, Josh, I intend to continue with annual testing. You, on the other
hand, should request that your doctor omit the PSA screening from your
annual blood test. Will you do that?
Josh
I am glad to see your discussion is much more measured than your earlier
posts, and seems reasonable to me.
Some additional thoughts:
1) A threshold of 10 maybe useful for proceeding to biopsy (haven't
seen mortality rates at that level), but isn't worth much as a policy
measure because too few test that high, and many will develop prostate
cancer who test below that figure.
2) As you probably can guess, I don't think biopsies are called for at
a threshold of 4, but at least the data say you are doing no harm
(probabilistically speaking).
3) My level has always been below 1. I ought not get tested anymore,
but my insurance pays for it and they are going to draw blood anyway for
other purposes. So, I can't see not doing it. But once the insurance
rules change, then yes I am done with it.
Josh Rosenbluth
3) Fortunately
El Castor
El Castor
Oops on that last post.
>1) A threshold of 10 maybe useful for proceeding to biopsy (haven't
>seen mortality rates at that level), but isn't worth much as a policy
>measure because too few test that high, and many will develop prostate
>cancer who test below that figure.
I've heard of 125. Not nice. Since I've already got a prostate that my
urologist referred to as a "whopper", and it's only producing 4.5, I
suspect 10 would be a bad sign -- almost certainly the result of
cancer or an infection.
>2) As you probably can guess, I don't think biopsies are called for at
>a threshold of 4, but at least the data say you are doing no harm
>(probabilistically speaking).
Don't think they are called for? If in a period of a year you go from
1.X to 4+, and don't have an infection, I feel quite certain that your
mind will be open to change on that score. But don't worry, you won't
feel a thing. (-8
>3) My level has always been below 1. I ought not get tested anymore,
>but my insurance pays for it and they are going to draw blood anyway for
>other purposes. So, I can't see not doing it. But once the insurance
>rules change, then yes I am done with it.
Why wait. Save Medicare some money. Stop now. One thing though, if you
do, regardless of what you say here, you will always wonder if it's
still under 1. One of the problems with the US test is that many of
the men in the 'no test' control group had been recently tested prior
to the beginning of the study, and even after the study had begun,
paid to have their PSA tested outside the study. It costs very little
and is a peace of mind thing.
>Josh Rosenbluth
>
>3) Fortunately
BTW, since you have a very low PSA (assuming you are over 60), here's
something you might want to know:
"�For men with low PSA levels (between 1 and 3), any increase is
alarming,� warns Carter. In a study presented this year at the
American Urological Association, Carter found that increases as small
as 0.2 ng/ml a year were a predictor of death from prostate cancer."
http://urology.jhu.edu/newsletter/prostate_cancer820.php
freeisbest
-snip-
>
> >1) A threshold of 10 maybe useful for proceeding to biopsy (haven't
> >seen mortality rates at that level), but isn't worth much as a policy
> >measure because too few test that high, and many will develop prostate
> >cancer who test below that figure.
>
> I've heard of 125. Not nice. Since I've already got a prostate that my
> urologist referred to as a "whopper", and it's only producing 4.5, I
Josh
>
> BTW, since you have a very low PSA (assuming you are over 60), here's
> something you might want to know:
>
> alarming,� warns Carter. In a study presented this year at the
> American Urological Association, Carter found that increases as small
> as 0.2 ng/ml a year were a predictor of death from prostate cancer."
> http://urology.jhu.edu/newsletter/prostate_cancer820.php
Maybe there is something to relative PSA levels, but the study didn't
report relative mortality rates with and without the screening. That
is, it is not sufficient that deaths from prostate cancer increase (they
also do for the current, absolute PSA screening).
We should go wherever the data takes us.
Josh Rosenbluth
El Castor
>> "�For men with low PSA levels (between 1 and 3), any increase is
>> alarming,� warns Carter. In a study presented this year at the
>> American Urological Association, Carter found that increases as small
>> as 0.2 ng/ml a year were a predictor of death from prostate cancer."
>> http://urology.jhu.edu/newsletter/prostate_cancer820.php
>
>Maybe there is something to relative PSA levels, but the study didn't
>report relative mortality rates with and without the screening. That
>is, it is not sufficient that deaths from prostate cancer increase (they
>also do for the current, absolute PSA screening).
>
>We should go wherever the data takes us.
The man who made that statement, H. Ballantine Carter, MD, and
Professor of Urology and Oncology at Johns Hopkins, "one of the
world�s top experts in the study and understanding of PSA", may know
more about the subject than either you or I. (-8
>Josh Rosenbluth
Josh
>>> alarming,� warns Carter. In a study presented this year at the
>>> American Urological Association, Carter found that increases as small
>>> as 0.2 ng/ml a year were a predictor of death from prostate cancer."
>>> http://urology.jhu.edu/newsletter/prostate_cancer820.php
>> Maybe there is something to relative PSA levels, but the study didn't
>> report relative mortality rates with and without the screening. That
>> is, it is not sufficient that deaths from prostate cancer increase (they
>> also do for the current, absolute PSA screening).
>>
>> We should go wherever the data takes us.
>
> The man who made that statement, H. Ballantine Carter, MD, and
> Professor of Urology and Oncology at Johns Hopkins, "one of the
> more about the subject than either you or I. (-8
Many experts disagree with him, and given the data so far, I find their
reasoning persuasive (as explained previously).
http://www.medscape.com/viewarticle/709798
Josh Rosenbluth
Glenn
This site requires cookies, I have no free cookies. Mayo, no
cookies required, provides a number of references if you have the
time. Search the Mayo.org site for PSA. No one recommends testing
after age 75 (even if you get it, you will probably die of something
else), one recommended a baseline check at 40 (for changes in
velocity of the psa number).
--
Glenn
El Castor
>>>>> "�For men with low PSA levels (between 1 and 3), any increase
>>>>> is
>>>>> alarming,� warns Carter. In a study presented this year at the
>>>>> American Urological Association, Carter found that increases as
>>>>> small
>>>>> as 0.2 ng/ml a year were a predictor of death from prostate
>>>>> cancer."
>>>>> http://urology.jhu.edu/newsletter/prostate_cancer820.php
>>>> Maybe there is something to relative PSA levels, but the study
>>>> didn't report relative mortality rates with and without the
>>>> screening. That is, it is not sufficient that deaths from
>>>> prostate cancer increase (they also do for the current, absolute
>>>> PSA screening).
>>>>
>>>> We should go wherever the data takes us.
>>>
>>> The man who made that statement, H. Ballantine Carter, MD, and
>>> Professor of Urology and Oncology at Johns Hopkins, "one of the
>>> world�s top experts in the study and understanding of PSA", may
>>> know
>>> more about the subject than either you or I. (-8
>>
>> Many experts disagree with him, and given the data so far, I find
>> their reasoning persuasive (as explained previously).
>>
>> http://www.medscape.com/viewarticle/709798
>>
>> Josh Rosenbluth
>
>
>This site requires cookies, I have no free cookies. Mayo, no
>cookies required, provides a number of references if you have the
>time. Search the Mayo.org site for PSA. No one recommends testing
>after age 75 (even if you get it, you will probably die of something
>else), one recommended a baseline check at 40 (for changes in
>velocity of the psa number).
I've even seen speculation that a baseline at 25 or 30 would be a good
idea. God forbid I should get Josh all excited, but several years ago
I read about a study of gang bangers killed in action on the streets
of Chicago. They were pretty much all Black, under the age of 30, and
not exactly typical prostate cancer victims. They removed their
prostates during the autopsy and subjected them to a very thorough
microscopic exam. I don't remember the exact number, but it was huge.
Something like 25% had cancer.
Josh Rosenbluth
> On Fri, 27 Nov 2009 15:52:06 -0600, "Glenn" <mino...@gmail.com> wrote:
> >"Josh" <u...@nowhere.com> wrote in message
> >news:hepbm8$bfd$1...@josh.motzarella.org...
> >> El Castor wrote:
> >>> wrote:
>
> >>>> El Castor wrote:
> >>>>> On Thu, 26 Nov 2009 20:19:38 -0500, Josh <u...@nowhere.com>
> >>>>> wrote:
>
> >>>>>> El Castor wrote:
> >>>>>>> On Thu, 26 Nov 2009 10:35:52 -0500, Josh <u...@nowhere.com>
> >>>>>>> wrote:
>
> >>>>>>>> Glenn wrote:
> >>>>>>>>> "Josh" <u...@nowhere.com> wrote in message
> >>>>>>>>>news:hem5sq$gb8$1...@josh.motzarella.org...
> >>>>>>>>>> Glenn wrote:
> >>>>>>>>>>> "Josh" <u...@nowhere.com> wrote in message
> >>>>>>>>>>>news:helua4$52i$1...@josh.motzarella.org...
> >>>>>>>>>>>> Glenn wrote:
> >>>>>>>>>>>>> "Josh" <u...@nowhere.com> wrote in message
> >>>>>>>>>>>>>news:heku0r$tm4$1...@josh.motzarella.org...
> >>>>>>>>>>>>>> Glenn wrote:
> >>>>>>>>>>>>>>> "Josh" <u...@nowhere.com> wrote in message
> >>>>>>>>>>>>>>>news:hekrl1$fu1$2...@josh.motzarella.org...
> >>>>>>>>>>>>>>>> Glenn wrote:
> >>>>>>>>>>>>>>>>> "Josh" <u...@nowhere.com> wrote in message
> >>>>>>>>>>>>>>>>>news:hekkrq$324$1...@josh.motzarella.org...
> >>>>>>>>>>>>>>>>>> El Castor wrote:
> >>>>>>>>>>>>>>>>>>> On Wed, 25 Nov 2009 10:59:06 -0500,
> >cookies required, provides a number of references if you have the
> >time. Search the Mayo.org site for PSA. No one recommends testing
> >after age 75 (even if you get it, you will probably die of something
> >else), one recommended a baseline check at 40 (for changes in
> >velocity of the psa number).
>
> I've even seen speculation that a baseline at 25 or 30 would be a good
> idea. God forbid I should get Josh all excited, but several years ago
> I read about a study of gang bangers killed in action on the streets
> of Chicago. They were pretty much all Black, under the age of 30, and
> not exactly typical prostate cancer victims. They removed their
> prostates during the autopsy and subjected them to a very thorough
> microscopic exam. I don't remember the exact number, but it was huge.
> Something like 25% had cancer.
But, would baseline screening have improved their mortality (assuming
they weren't ganag members)? There is no data to support it.
You can get to my link by searching for "PSA baseline screening" in
google. It basically summarizes the same level of discor that the
Mayo clinic does.
Josh Rosenbluth