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Today, on National Public Radio's Diane Rehm show http://wamu.org/...
the assistant director of the federally sanctioned task force: the U.S. Preventive Service Task Force, which falls under the U.S. Department of Health and Human Services, Dr. Diana Petitti of A.S.U. stated that there were no insurance company representatives on the board but then appeared to contradict herself  as she gave a disclaimer: that there was indeed one member who is the director of "Health Partners"   http://www.healthpartners.com/...   a Minnesota based HMO, that does sit on the task force or was associated with its decision.

http://www.examiner.com/...

Also, Diane Rehm in her show examining a controversial decision on breast cancer exams by a federally sanctioned task force had on three other guests: the second guest was: Dr. Rebecca Zuurbier, director of breast imaging, The Sullivan Center for Breast Health at Sibley Memorial Hospital .  The third guest on Mrs. Rehm's show was: Arthur Caplan, professor of bioethics and philosophy, University of Pennsylvania.  And the fourth guest was: Nancy Dubler, senior associate, Montefiore-Einstein Bioethics Center consultant for ethics, New York City Health and Hospitals Corporation.

For the most part throughout the interview Dr. Diana Petitti  faced skeptical questions from Mrs. Rehm and two of the other three guests. Dr. Kaplan stated that in effect para-phrasing: the task force had decided that even though lives were being saved with breast cancer exams for women over 40 but not yet 50 that not enough lives were being saved to justify the cost of the  breast cancer exams.

The other guest, Dr. Rebecca Zuurbier said that, paraphrasing: a great dis-service was being done by this task force decision and that women would die because they would think that they did not have to be screened for breast cancer since they were not yet 50. Caller response was almost overwhelmingly against the Task Force's decision on breast cancer screening with one caller stating: that she was outraged that they were "trying to cloak in a courageous banner" their decision. One caller believed that the decision illustrated that there was sexism in medicine and Dr. Kaplan agreed.  Dr. Kaplan, believed that even if they had found it to be cheaper to not have mammographies fro women over 40 but below 50 that it would be very hard to try and take this medical benefit away because once something so important and beneficial had been given out it was almost impossible to take it back.

I took from this last remark of Dr. Kaplan that he believed that this task force decision was indeed just a ploy to save money from not giving so many breast exams, even if more women would die because of it.

Finally, Dr. Zurbier made the profound statement that: "That there's nothing morally courageous about saying don't examine your breasts".

In short, Dr. Kaplan and Dr. Zuurbier seemed to be saying that this Task Force decision to limit mammograms was really a cost ratio benefit analysis and not really about saving the lives of those who have or might  get breast cancer.  And of course, the stunning revelation that one of the members of this Task Force who made or helped make this controversial decision on breast cancer screenings is a medical director of "Health Partners" !

Originally posted to thedamnliberal on Thu Nov 19, 2009 at 03:15 PM PST.

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Comment Preferences

  •  if its not of benefit (5+ / 0-)

    to rich white males, its not medicine worth doing.  A lot of overstatement, but too close to truth based on studies that control for sex, income, and ethnicity when they look at outcomes in treatment.

    •  Not true: Prostate screening is getting the same (2+ / 0-)
      Recommended by:
      alizard, jfromga

      Not true: Prostate screening is getting the same treatment.

      They said over-diagnosis due to screening could be as high as 50% and said it was not clear how much overtreatment was happening because of PSA testing.
      Unnecessary treatment carries a risk of side-effects such as impotence and incontinence.
      Men need to be advised that the test cannot tell whether they have a life-threatening cancer and could take them through a "thicket of tests and treatments that they might have better avoided", the report added.

      The basic idea seems to be the same here: silly ignorant patients may be panicked by an adverse test result and force the poor doctors to overtreat them.

      The reality: Frank Zappa died of prostate cancer at the age of 53 because it wasn't detected until it had gone crazy.

      When my doctor told me I didn't need a PSA test because I'm only 49, I said "If I have cancer I want to know about it when it's treatable, not find out when it's a sure thing - and too late."

      So it's not just a women's issue this time. This seems to be about cutting costs.

      •  Just to clarify: (1+ / 0-)
        Recommended by:
        alizard

        They're talking about borderline cases when the say:

        Men need to be advised that the test cannot tell whether they have a life-threatening cancer

        That's the same issue they're talking about in the mamogram recommendations.

        And it's crap.

        For a hospital or a medical practice, it may be inconvenient to have to weed through all those iffy borderline cases. And some of the them may get treatment when it's not really needed.

        But IF YOU'RE VERY SICK, the case detects it. Without question. And you can go in for treatment immediately.

        What they're saying is, "We're willing to have hundreds or thousands of patients who will die without this, rather than the cost and inconvenience of dealing with all those others."

        But trust me, they'd feel differently if they were one of those who will die because she didn't get a timely mammogram, or because he didn't get a timely PSA test.

        •  Medical testing issues - getting worse fast? (0+ / 0-)

          Is anybody else finding that medical testing seems like its being politicized?

          I have major doubts about some of these firms, Ive seen them make mistakes that didn't have any good explanation.

          Also, if a single test result is not diagnostic for an illness, good luck finding that out from them. You have to find it out yourself.

          For an extreme example of this, look at testing for Lyme disease and other tick borne illness.

          The lesson is yes, that they are really doing this, its an ugly situation.

          You have to do your own research on whatever tests they give you and their potential accuracy or inaccuracy, and what the range of valid results look like.

          If something doesn't smell right, perhaps an HMO or somebody is telling doctors to say something that isnt true? Its happening a lot, clearly, but its very hard to prove, and even if you could prove it, I think that ERISA section 514 could probably exempt them legally!  

          Its your life. Things they say should be looked at as part of the bigger picture. Some HMOs have a very bad reputaion for consistently overworking their staff, to the point where they could not possibly be delivering accuracy.

          Also, do your homework, to test for something, there might be three or four tests that are usually done.

          They ARE done by responsible practices, but in in-network HMO practices, they might not be.

          Hypothetically, they might just do one test and not tell people that that test had a lot of false negatives. Imply that a negative result was the last word.

          Do they do this elsewhere? In other developed countries, no, they don't seem to, at all, like they do here.

          These tests don't need to be so expensive. They often cost a fraction of what they do here, right across the border. But the reason this is done is probably much bigger than simply the cost of the test.

          Sometimes there appears to be a systematic policy of deciding the "quite possibly positive" cases by medical norms are reported as solid negatives by an HMO... often, only a few people are usually going to complain about that.

          The impact can often be very serious.. but REALLY sick people are usually concerned about other things.. like surviving.

          Are tests elsewhere more accurate? Maybe.

          It is VERY clear, though that cost savings are often significant elsewhere.. Maybe it might make sense to fly somewhere else for a weekend, get all the tests you need there, and fly back.

          Save money, get data you might have to fight a huge battle to get here, maybe save your health or your life?

          MRIs cost $98 in Japan, for example. Round trip flights are $600-700 from the two coasts.

          "Public Option" doesn't bend the cost curve. But it gladly breaks families. Its a system designed with a catch 22, pay the extra costs, subsidies vanish

          by Andiamo on Thu Nov 19, 2009 at 05:40:46 PM PST

          [ Parent ]

        •  It isn't crap (0+ / 0-)

          We are subjecting hundreds of thousands of men and women to horrible medical treatments and much of it is unnecessary.

          All my IP addresses have been banned from Redstate.com.

          by charliehall on Thu Nov 19, 2009 at 07:07:28 PM PST

          [ Parent ]

      •  The big, big difference between PSAs and (1+ / 0-)
        Recommended by:
        alizard

        mammograms is that a blood draw won't hurt you, but X-rays can.  And because of that, women will start to think that the risk of a mammogram is not worth the chance of catching the cancer early.

        The fight against PSA screening has been going on for most of the twelve years that my husband has been battling prostate cancer.  You won't find a single survivor that agrees with the recommendation, regardless of the risks of side effects.

        I wish elections had consequences.

        by Susan Grigsby on Thu Nov 19, 2009 at 03:58:57 PM PST

        [ Parent ]

      •  I understand (1+ / 0-)
        Recommended by:
        CuriousBoston

        that the current study addresses more issues.  And I admitted to overstating the case.  But, the studies I mention cover many diseases and treatment outcomes for them, and they have one common denominator, you will live longer with better quality of life if you are a well to do white male.  Even a well to do white female or an equally well to do black  male don't do as well in outcomes.  There are some significant biases in medicine, it matters who you are not just what disease you have.

        And again, in health care, its not fair to tell anyone their life isn't worth a relatively inexpensive test.  It ought to be up to the individual and their doctor how they evaluate the risks.

    •  Sexism, in the Medical Community ! (3+ / 0-)
      Recommended by:
      alizard, jfromga, CuriousBoston

      Thank you, this is what Diane Rheam callers expressed and what Dr. Kaplan expressed: "sexism" in the medical community. Never mind their just women, as observed with the filthy action of the Blue Dogs with Stupak. What the hell has happened to the Democratic party? THeir leadership has sold out, don't you ever wonder why they boycott talking about Michael Moore's movie: "Capitalism A Love Affair ?

      •  And it isn't sexism to subject women (0+ / 0-)

        by the hundreds of thousands to dangerous radiation, disfiguring surgery, potentially deadly chemotherapy, and massive stress when your screening modality has been proven not to save lives?

        All my IP addresses have been banned from Redstate.com.

        by charliehall on Thu Nov 19, 2009 at 07:05:20 PM PST

        [ Parent ]

    •  deny coverage (1+ / 0-)
      Recommended by:
      CuriousBoston

      It gives insurance companies a reason to deny coverage of breast examination from coverage until the age of 50.

      I would look at the connections of the board Task Force with the insurance companies.

  •  I am sick to death of hearing... (7+ / 0-)

    ...America, you're just not worth it...

  •  Someones getting a huge bonus for this! (1+ / 0-)
    Recommended by:
    jeremybloom
    •  Yeah, come live with me on the street ! (0+ / 0-)

      Yeah, come join me and live on the street! I am a veteran and a proud liberal and it's easy for you Limousine Liberals to put us peasants down, they won't even deliver my New G.I. Bill check as promised and you sit there and tell me I'm getting a bonus? Come open up a can of friggin Pork and Beans with me because I would consider that a bonus. Obama, made big promises now all he does is kiss Republican and Blue Dog behind ! You're going to find out that all he cares about is the image of Obama! Give me a democratic leader that will stand up to the fascists and stand up for Socialist ideas not some kow-towing sell out to the Military generals and them Military Industrial Complex. Oh yeah, but I'm not Treasury sec. Geitner, and I'm not a pig banker so I guess I get to live on the street!

  •  So there are like thousands of medical test out (1+ / 0-)
    Recommended by:
    charliehall

    there that if we gave it to everyone, it would save someones's life.  If I did a CT scan every month or a chest xray every year or a prostate u/s every year, i'd probably save a life.  But is it worth the risk, the cost, the false positives, the anxiety.  These are decisions that HAVE to be made in medicine if we ever hope to get a hold on medical care cost.  People need to wake up to these facts.  

    •  Rationing, is just plain wrong in this case when. (2+ / 0-)
      Recommended by:
      alizard, CuriousBoston

      women are going to die as stated by well respected doctors have correctly stated. Under that reasoning we could stop having people see their doctor yearly for check ups because after all we have to save the insurance companies their filthy blood money !

      •  Hope08, consider that they might not care (1+ / 0-)
        Recommended by:
        CuriousBoston

        Some might even not want poor people to live as long as they currently are living.

        MRIs do not use radiation, they use magnetism, so there is NO increased risk of cancer like there is with X-rays or computed tomography. I think that some of the newer CT scanning methods use far less radiation than they used to also. (That would be a good question to ask a radiologist)

        Obviously, barring some reason to be looking for a problem giving people X-ray exposure is irresponsible. For example, they used to have X-ray machines in shoe shops. They gave a lot of people cancer.

        >"So there are like thousands of medical test(s) out there that if we gave it to everyone, it would save someones's life."  

        YES, that is VERY true, and in the case of bloodwork, and some other kinds of tests, if we had a REAL national healthcare plan YES, it would be VERY useful. That is what they do in Taiwan, and it is extremely slick.

        We are nuts to do things the way we do them here.

        It would save so much money.. I suspect that the blood draw is a significant part of the cost..

        If we had a standard package of say, 100 tests and we made it a practice of giving all those 100 tests to people every time they got a medical test that involved drawing blood. Not only would it save lots of lives, by catching problems that might not otherwise be caught, THE DATA THAT WOULD BE GATHERED WOULD BE EXTREMELY USEFUL.

        "If I did a CT scan every month or a chest xray every year or a prostate u/s every year, i'd probably save a life."

        >"But is it worth the risk, the cost, the false positives, the anxiety."

        If you are sick and you need to get better, it should be obvious that to cure you, your doctor needs to know what it is that is making you sick.

        "These are decisions that HAVE to be made in medicine if we ever hope to get a hold on medical care cost.  People need to wake up to these facts."

        Look, DOCTORS should make the decisions, not HMO doctors or bean counters- YOUR doctors should, and they should not be capitated so that they have to pay for each test..

        ESPECIALLY, POLITICIANS SHOULD NEVER BE DECIDING WHO GETS HELP BASED ON BUDGET LINE ITEMS - BECAUSE THAT IS A RECIPE FOR DISASTER.

        POLITICIANS SHOULD STAY THE HELL OUT OF IT.

        "Public Option" doesn't bend the cost curve. But it gladly breaks families. Its a system designed with a catch 22, pay the extra costs, subsidies vanish

        by Andiamo on Thu Nov 19, 2009 at 06:08:06 PM PST

        [ Parent ]

      •  It depends on the reasoning (1+ / 0-)
        Recommended by:
        charliehall

        women are going to die as stated by well respected doctors have correctly stated. Under that reasoning we could stop having people see their doctor yearly for check ups because after all we have to save the insurance companies their filthy blood money !

        If rationing leads to the money directed to preventing other diseases, then it may be more effective to ration.  Breast cancer is number 7 on the causes of mortality in women.  Given limited resources, taking a dollar and allocating it to treating/preventing cardiovascular disease in women would be better even if the research in cardiovascular disease is 1/8th as effective.

      •  But mammography screening the general population (0+ / 0-)

        has been proven not to save lives:

        http://www.dailykos.com/...

        All my IP addresses have been banned from Redstate.com.

        by charliehall on Thu Nov 19, 2009 at 07:02:37 PM PST

        [ Parent ]

    •  anxiety is a red herring (0+ / 0-)

      a person can get over anxiety, once she has further testing and a negative result.

      •  Maybe not (0+ / 0-)

        a person can get over anxiety, once she has further testing and a negative result.

        Further testing and procedures aren't risk free.  A false negative may result in biopsies or a lumpectomy both of which entails risks such as infections, loss of quality of life, etc. The question is of course whether the benefits outweigh the risks.  

        •  of course stress is stressful (0+ / 0-)

          but the test anxiety goes away after the test!!

          And yes, procedures can and do have mistakes and side effects.

          I was "talked out" of further tests to explain my cancer symptoms. I had no idea that my doctor couldn't detect ovarian cancer unless it was screaming out loud. If she had pursued further tests, instead of relying on my uninformed patient's point of view, I might well have been spared years of chemo therapy and I might have been cured of my cancer. Instead, another 2 years went by before my cancer was found, when I was age 42, and I have less than a 1% chance of being cured.

          I could have lived with anxiety over tests, and its patronizing to assume a woman can't. Yes, women have real anxiety, but in my opinion its because they don't understand that the test isn't the problem, cancer is the problem. It may be stressful, but it is quite useful to spend a week out of every year thinking about mortality. And perhaps, buying some disability insurance, or developing support systems.

          One of the things that bothers me about the studies mentioned by the panel, is they only talk about the number of deaths prevented. There is a huge difference in quality of life between having a few years remission vs. no remission, even if the eventual outcome is death. So if some of those cancers were found earlier, and some of those women had more years of better life due to mammograms, I don't care if some other woman has one week's anxiety until her biopsy results come back.

      •  Psychosocial stress is a major impacter on health (0+ / 0-)

        Continued for any length of time, it destroys your brain!

        Thats why people will believe almost anything to have "hope".

        Even if its false hope, especially so, it will be hard to counter because people don't like retaining any viewpoint or knowledge that forces them to change long held misconceptions. Its human nature. We all do it.

        Even if objective evidence is very strongly against a viewpoint that reduces (what's called) cognitive dissonance, many people will cling to that viewpoint especially if knowledge demands some kind of change or action on their part.

        Propagandists, politicians, etc, take advantage of what we have learned from cognitive dissonance theory in pursuasion quite a bit, obviously.

        ALso, make no mistake about it, stress is a killer.

        Thats why many other countries will probably pull way ahead of us on far more than healthcare if tolerance of all this stress over medical bills doesn't force real change...soon.

        "Public Option" doesn't bend the cost curve. But it gladly breaks families. Its a system designed with a catch 22, pay the extra costs, subsidies vanish

        by Andiamo on Thu Nov 19, 2009 at 06:34:24 PM PST

        [ Parent ]

        •  Yes Comrade, they must be right :) (0+ / 0-)

          A large amount of medical doctors (Oncologists included) have stated that women will die because of this lame brained, money saving decision !
          Now, that is pscyhological stress! Hope you enjoy your D.L.L.C. and Insurance Company checks!

    •  no, there aren't thousands of medical tests. . . (0+ / 0-)

      and they aren't given out willy nilly.
      these decisions do need to be made, but they need to be made with great deliberation and with fair input from all parties concerned. And I think medical insurers do  not have any right to a say in these things. (of cocurse, I don't think they have a right to profit form illness either. . . )

  •  How Much Is A 40 Year Old Women's Life Worth? (2+ / 0-)
    Recommended by:
    alizard, CuriousBoston

    Well, I guess this lame brained task force has found that amount so they can save their cronies in the Insurance Industry and the governement their precious blood money!

    •  It depends on her salary and productive capacity (0+ / 0-)

      I have the formula they use written down somewhere.

      Basically, these cost-benefit analysis are done for the benefit of industry, so they consider things differently than we would.

      All the investments that people have made in their own lives, their education, their ability to care give others and their children, spouses, its all disregarded completely.

      They just look at remaining years of working ability and what you deliver to your employer there versus if you weren't there.

      Thats how they decide how much to spend on people or how to compensate people who have lost health or ability in lawsuits.

      Its really very sobering to realize how little human lives are worth in court financially.

      "Public Option" doesn't bend the cost curve. But it gladly breaks families. Its a system designed with a catch 22, pay the extra costs, subsidies vanish

      by Andiamo on Thu Nov 19, 2009 at 06:14:06 PM PST

      [ Parent ]

      •  People are actually "worth" QUITE A BIT as spare (0+ / 0-)

        parts.. $200,000 or more..

        Thats why morticians are getting busted all the time for selling people's body parts to medical firms.

        "Public Option" doesn't bend the cost curve. But it gladly breaks families. Its a system designed with a catch 22, pay the extra costs, subsidies vanish

        by Andiamo on Thu Nov 19, 2009 at 06:16:56 PM PST

        [ Parent ]

  •  How did the insurance industry (1+ / 0-)
    Recommended by:
    charliehall

    manage to get those same guidelines into place in Canada and most of Western Europe?

    There is nothing so practical as a good theory—Kurt Lewin

    by ebohlman on Thu Nov 19, 2009 at 06:18:20 PM PST

  •  Dr. Kaplan and Dr. Zuurbier are wrong (0+ / 0-)

    I posted some data that proves them wrong:

    http://www.dailykos.com/...

    That someone with ties to the insurance industry accepted the data is irrelevant. You are promoting junk science here.

    All my IP addresses have been banned from Redstate.com.

    by charliehall on Thu Nov 19, 2009 at 06:59:23 PM PST

    •  Wow! We'll just take your insurance company.. (0+ / 0-)

      word for it.  Meanwhile, I hope your thirteen pieces of silver suffice to let you live with your self. SO, now since you're going to deny almost a majority of the medical community's analysis, on this issue, maybe your next argument is prove that global warming doesn't exist either because after all other scientist (a drop in the bucket and funded by oil companies)say its not really happening.

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