Has the Healthcare Rationing already starting?

[Insurrectionist]

A government panel has come out with the recommendation that woman should wait until 50 before getting mammograms. Also doing self-exams don't do any good so women shouldn't be taught to do them. All this is being brought to you by U.S. Preventive Services Task Force. This government body has influences over your coverage of screening tests by Medicare and many other insurance companies. So now will women have access to a screening process for early detection of cancer before it gets out of control?

I guess they are willing to let some die off.

Your risk of developing breast cancer increases as you get older. About 1 out of 8 invasive breast cancers are found in women younger than 45, while about 2 out of 3 invasive breast cancers are found in women age 55 or older

http://www.cancer.org/docroot/CRI/conte ... ?sitearea=

[Spidey]

Well…you know…it’s all about that “preventative care” that’s gonna save plenty o money on health care costs…

No…wait…

[dissent]

A government panel has come out with the recommendation that woman should wait until 50 before getting mammograms. Also doing self-exams don't do any good so women shouldn't be taught to do them.

I just had a young lady I know (well under age 40) who found a lump during a self exam. Turned out to be benign, but still worth investigating, based on her family history. I can see reducing the exposure to x-rays with a mammogram, but I don't buy the desire to pooh-pooh self exams.

[Lothar]

I don't buy the desire to pooh-pooh self exams.

According to my wife's doctor, systematic BSE's aren't particularly effective. She said that as long as you touch your breasts regularly, you gain all the same benefits. There's no statistical difference between groups that do BSEs and groups that just touch 'em from an early detection standpoint.

[CUDA]

She said that as long as you touch your breasts regularly, you gain all the same benefits.

Thats why I have made it my personal Mission in life to ensure that my Wife does not have Breast Cancer

[woodchip]

And so, under guvment care we will all be reduced to playing statistical roulette.

[Krom]

And so, under guvment care we will all be reduced to playing statistical roulette.

And we don't already? What rock have you been living under for the last 40 years?

[Ferno]

when you see your healthcare bill total twenty dollars instead of thirty grand you might just sit there for a few minutes.

[Krom]

Our current health care system is like a hybrid system. It combines all of the worst parts of socialism with all of the worst parts of capitalism, while simultaneously offering none of the benefits of either system. Truly the finest example of \"worst\" in the entire world.

[Tunnelcat]

Since you're all guys, I don't expect you to understand the logic in their new recommendations. However, as a menopausal woman, I'm QUITE familiar with the subject.

Ever since the Womens Health Initiative research program was ended in 2002, things changed drastically for women. Before that research was done, women blindly followed their doctors and gladly took HRT, synthetic hormone replacement drugs, to combat menopausal symptoms, usually for the rest of their lives! These drugs were synthesized from equine sources (mare's urine) and other unnatural sources and were far more potent and concentrated than needed for a human woman's needs.

This research found out that this was CAUSING increased breast cancer rates in women! Ever since this was discovered, women quit using Prempro and Premarin and doctors quit prescribing it like candy. Wonder of wonders, breast cancer rates DRAMATICALLY dropped since then. So most breast cancers were iatrogenically caused! So if that factor is now eliminated, why keep up the high mammogram recommendation rates?

http://www.whi.org/findings/ht/eplusp_bc2.php

Now also consider that every time a woman has a mammogram, she is getting dosed with ionizing radiation, X-Rays, in a part of the body that has rapid cell division normally. Can you say increased cancer risk just from that test as well?

Frankly, I'm in agreement with most of the new guidelines, EXCEPT for the self-exam part. I'm with dissent on that one. I feel that self-exam is more important than mammograms in finding cancers. Most women don't take HRT for more than 2 to 5 years if they do take it at all and if a woman has NO family history of breast cancer or is NOT overweight (another source of estrogen, body fat), WHY get irradiated every year in a cancer prone part of the body? Most mammograms aren't perfectly clear, generate a lot of false positives, can't see next to the ribcage under the armpits and generate unnecessary and painful biopsies. These tests cost money and cause needless worry and are probably not really needed with the old recommendations for the average woman. Personally, I think it's an overused money maker that's a drain on our already tapped out health care system.

On the male side, why do you think that circumcision is still being done routinely? They give the lame excuses of penile cancer and increased HIV transmission, most of which is really unfounded, so it boils down to be just an easy money maker for doctors and hospitals.

[Duper]

On the male side, why do you think that circumcision is still being done routinely?

actually, it's not. You have to request it. It's tradition for most Judeo-Christians. There are no health risks if you keep your son clean. And the hospital will tell you that as they push you out the door....

You are correct in that they do charge extra. They funny thing is that the hospital actually does very little. They use a rubber band system these days. I believe only Rabbi use knives anymore.

[Tunnelcat]

My husband has complained that they took too much off when he was done in the 1950's and apparently, they are even tighter now with the Plastibell Method (Google it) that is being used about 50% of the time. It pulls too much skin up from the scrotum and takes away the loose skin nature gave male penises that prevents the painful rubbing during intercourse that woman complain about many times. The foreskin is there for a purpose and parents are having it cut off of their male babies for stupid reasons.

There is still a high rate in the U.S., depending on the area or state.

http://www.circumstitions.com/USA.html

[Insurrectionist]

I know there is a few math people here and math can get out of hand with me.

If there is at the time of birth appox. 107 boys to 100 girls born into this world, with a world population at appox. 6.798 billion, at age 40 a woman has 1.44 percent chance of developing breast cancer before they reach 50, how many women will die because they were refused a mammogram.

http://www.cdc.gov/cancer/breast/statistics/age.htm

http://www.indexmundi.com/world/demogra ... ofile.html

I sure one of the math wizards will be able to give you an appox. number of women who will die.

[fliptw]

This isn't about refusing mammograms for a specific age group, its about not recommending them on a regular basis for said group.

[Lothar]

admin note: I have split an off-topic discussion off of this thread.

[Will Robinson]

(brought back from the split off thread)

...turning the countries healthcare system, one of the worlds best systems, into a mismanaged government run fiasco without really providing or improving care?!?...

I'm sorry, what country are you talking about? Because it simply can't be the US which has one of the worst health care systems among developed nations in the whole world...

I didn't mean to say that our system is awesome goodness. But only meant to say that we have a lot of great health care available in our capitalist system and the democrats legislation that puts themselves in place as administrators of the private enterprise is not going to improve the quality of care as they are trying to tell us they will. It was a comment targeted at Canucks false premise that Americans are rejecting "health care". We have lots of great health care in this country, so good that people from numerous other countries (even those with "free" socialized health care) come here to use our system.
Yes it is too expensive for many of us (my family included) but reduced costs is not what we reject.
If the government was offering real reduced cost we'd be all over it, just look at how we are all over Wal-Mart just to save a buck! We don't reject health care we reject the obvious power play and demagoguery of the democrats in government using health care as a false premise for passing their three headed hydra: pork spending package, power grab, social engineering tool. Remember the stimulus package they said had to pass right away? Well they still haven't spent the money...well except to give a few choice banks a big chunk of it to buy out their competition....the rest they are saving to buy votes with. Just follow the money.

[Dedman]

One thing for all the \"public option\" supporters to keep in mind is that the current system was set up by the federal government.

If you think the insurance companies have too much power to set prices, deny claims, etc..., blame the feds. They set the rules the players are playing by. What make anyone think that a \"public option\" will be run any better. The same guards will be watching the nuthouse.

[Krom]

Insurance should have NEVER been a requirement to get medical care for the middle class. It was when the insurance companies went after the middle class that the price of medical care shot up to beyond what most Americans can afford. Dedman is correct, it is the governments fault that this happened in the first place. And now that it is starting to threaten our economy as a whole, the government is too weak and or corrupted to fight off the special interest lobbyists so instead of any real reform we get further trash legislation that doesn't solve the problem. Either by further government action, or further government inaction the situation will not improve. Bashing one party or the other is fruitless because it is the system that is corrupt, don't bash the player because the rules are cheating.

[Will Robinson]

follow the money...
The only \"shovel ready\" jobs Obama created was for his spokesmen who are shoveling this ★■◆● down our throats!

[Tunnelcat]

I know there is a few math people here and math can get out of hand with me.

If there is at the time of birth appox. 107 boys to 100 girls born into this world, with a world population at appox. 6.798 billion, at age 40 a woman has 1.44 percent chance of developing breast cancer before they reach 50, how many women will die because they were refused a mammogram.

http://www.cdc.gov/cancer/breast/statistics/age.htm

http://www.indexmundi.com/world/demogra ... ofile.html

I sure one of the math wizards will be able to give you an appox. number of women who will die.

If you had clicked on the 'trends' button in the cdc.gov page you linked to above, you would have seen the 'deceased incidence' of breast cancer between 1999 and 2005. So far, I haven't found any study that goes up to 2009, but I'm willing to bet that it's still dropping as more and more women refuse hormone replacement therapy.

If mammogram usage eventually does go down, there may also be a corresponding drop from just not having as many X-rays on that part of the body. There was a guest editorial in today's paper from a woman (yes she's a 'gasp' liberal) who also was in agreement with the new guidelines. She also links it to our litigious mentality in this country and our desire to decrease as much risk as possible, especially in the medical community, at any cost. All you tort reformers will salivate. However, that does not address the larger problem of the money-making profit motives the medical system has for forcing all these tests on patients as well.

http://www.creators.com/liberal/lenore- ... ogram.html

[Drakona]

Let's see here. Insurrectionist doesn't link to the policy recommendataions, but a Google search turns up this, which seems to match his description. The actual recommendation states,

The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms.

That strikes me as a pretty reasonable take on the issue, given the state of the science.

I did a bit of googling on the topic of the value of mammograms, and found quite a lot of contradictory stuff on the internet. A lot of sites claimed mammograms caused cancer, but they tended to be sites with names like naturalnews.com that also thought vaccines caused autism and GM foods are a great source of evil, etc. Long on the "intervention and radiation are evil" aspect, short on numbers. That may pass the epistemological filter of some folks; it doesn't pass mine. On the other hand, I found a lot of very official sites that said, "Well, the American Cancer Society recommends . . . " which were also short on numbers.

The most useful article I found on the topic was this meta-study from 2007, in the Annals of Internal Medicine. If you like numbers and care about the topic, it's worth a read. I'll bottom-line some of the findings for you:

The latest meta-analysis demonstrated that screening mammography every 1 to 2 years in women 40 to 49 years of age results in a 15% decrease in breast cancer mortality after 14 years of follow-up . . . It is smaller than the 22% reduction seen among women 50 years of age or older . . .

They discuss their methodology quite a bit, but these are just raw comparisons between the populations of women who do get screened and those who don't. So any effects of mammograms causing harm are factored in; the net effect on mortality due to breast cancer is an improvement, and a fairly sizeable one.

Moreover, it isn't a randomized study. They note that women who are higher risk are more likely to go for the screening. They don't try to account for the effect--just note it as a limitation of the study--but this would make screenings appear less effective at saving lives than they actually are.

The effect tunnelcat talked about -- radiation during screening -- is also addressed.

No studies directly measure the risk for cancer caused by radiation exposure from mammography screening. Any effect of screening radiation on breast cancer incidence is small and is difficult to separate from the effect of screening on breast cancer detection. Estimates of the risk for radiation from mammography are derived from cohort studies of other forms of radiation exposure, including high-dose exposures (over a short or prolonged period of time) and low-dose exposures from other sources (44–68 ). In general, studies of low-dose exposures have been inconclusive, with some demonstrating a small increase in risk and others finding no association (44, 47, 54, 57). However, studies of high-dose exposures have found that women who were exposed to high levels of radiation have a statistically significantly increased risk for breast cancer, with relative risks ranging from 1.33 to 11.39 for exposures of 0.3 to 43.4 Gy (46, 52, 55, 59, 65, 67, 68 ). High-dose exposures that have been studied include radiation treatment, diagnostic radiography, and atomic bombs. The increase in risk seems to be larger with higher doses of exposure, younger age at exposure, and longer follow-up.

The mean glandular dose from 2-view mammography is approximately 4 to 5 mGy. A recent analysis of radiation dose in the United Kingdom trial of mammography screening in women 40 to 48 years of age found a mean glandular dose of 2.5 mGy for an oblique film and 2.0 mGy for a craniocaudal film (69). However, dosage varies among facilities and increases with breast density. If women 40 to 49 years of age are screened every year and an estimated 20% experience a false-positive test result requiring additional radiographies, the average cumulative exposure from screening during the decade will be around 60 mGy.

The upshot of this is, the radiation received from a mammogram is really not very much. They estimate 60 mGy over a decade; the lowest measurable increase in risk they can find is for .3 Gy -- 5 times as much. So while radiation does cause cancer, there isn't conclusive evidence that the amount involved even in a decade worth of mammography is enough to cause cancer at all. And even if it does, how much it causes would be factored into the general studies on breast cancer mortality rates: given that women who are screened have lower mortality rates, the mammograms must be usefully finding significantly more cancers than they cause.

Sort of like wearing your seatbelt, I suppose. For every accident where it hurts you, there are a hundred (or a thousand or whatever it is) where it saves your life. The radiation does in a single mammogram is tiny. And even if the radiation involved in several decades of screenings might be enough to start pushing up against the statistical margins, the cost is outweighed by the benefits. You're much more likely to find and prevent cancer than you are to cause it.

The cost vs. benefit debate comes up for women in their 40s given that individual risk factors affect how useful mammograms are. Basically, if you don't have significant risk factors, they're a lot less likely to find something before you turn 50:

Women with a history of breast cancer in a first-degree relative are more likely to have screen-detected cancer than are women without a family history of breast cancer (139–141). For women 40 to 49 years of age, 4.7 cases are detected per 1000 examinations among women with a family history compared with 2.7 cases per 1000 examinations among women without a family history. For women 50 to 59 years of age, the rates are 6.6 and 4.6 cases per 1000 examinations, respectively (140, 141). In general, the rate of cancer detection among women with a family history of breast cancer matches that among women without a family history who are a decade older. The incidence of false-positive and false-negative mammograms seems to be slightly higher among women with a family history of breast cancer than among women without a family history of breast cancer (139–141).

It depends on the person. Is the discomfort, cost, and risk of a false positive (carrying with it biopsies and worry and so forth) worth a 0.27% chance they'll find something? Does that change if it's 0.47%? 0.66%? That's a pretty personal question, but given that there's a statistical falloff in effectiveness of mammography for healthy women in their 40s, they conclude:

Current evidence indicates that women 40 to 49 years of age who undergo routine mammography screening will decrease their risk for death due to breast cancer but will increase their risks for undergoing unnecessary procedures, breast cancer–related anxiety, discomfort at the time of screening, and exposure to low-dose radiation. Because the incidence of breast cancer and the effectiveness of mammography are lower among women in their 40s than among women 50 years of age or older, mammography screening results in less absolute benefit and greater absolute risk for women 40 to 49 years of age than for women 50 years of age or older. The proportion of women 50 years of age or older whose risks for mammography outweigh the benefits is widely accepted to be clinically insignificant. However, the evidence suggests that this proportion is higher and may be clinically significant for women 40 to 49 years of age. Given this difference, a woman 40 to 49 years of age who had a lower-than-average risk for breast cancer and higher-than-average concerns about false-positive results might reasonably delay screening. Measuring risks and benefits accurately enough to identify these women remains a challenge.

Given that, the USPTF recommendation of . . .

The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms.

. . . seems completely sensible to me.

I can't imagine how that could be perceived as rationing. It's a recommendation, and it even specifically leaves open the option of screenings for those in their 40s who want them. It just recommends against employing them for everyone.

I can only imagine that what set off the original post was something along these lines:

Leaders of the Republican National Committee say revised recommendations issued by a government-funded panel that say women only need to be screened for breast cancer after the age of 50 could be the beginning of health care rationing by the government.

RNC Chairman Michael Steele and co-chair Jan Larimer wrote a letter to President Obama Thursday, obtained by the Washington Times, that calls the new recommendations a "thinly veiled attempt to save money by limiting mammograms has the effect of placing a dollar value on a human life."

The U.S. Preventative Services Task Force, an independent panel of doctors and scientists that makes health recommendations to the government, issued these guidelines. USPSTF’s decisions are neither binding nor final, but RNC officials say it shows how the government could ration care. “Tomorrow it will be prostate exams,” they warned.

. . .

The full text of the letter is below:

Mr. President:

"We are writing to you today to express our outrage at the insensitivity towards women your White House has shown on the issue of health care. Your Administration's attempt to ration and limit access to potentially life-saving mammograms is profoundly dangerous. This thinly veiled attempt to save money by limiting mammograms has the effect of placing a dollar value on a human life.

Even worse, decisions like this are at the heart of the concern Americans have with a government run healthcare system because they cause the most harm to the least fortunate. Women rely on programs like Medicaid for access to annual mammograms. Limiting access to annual tests unnecessarily jeopardizes the health of women and places an unfair burden on those living near or below the poverty level.

This government panel claims to be concerned with the anxiety caused by mammograms resulting in false positives. That anxiety, however, pales in comparison to the threat posed by an unknown positive. It is clear that this decision is just the first step toward total government rationing of health care. Today it is mammograms. Tomorrow it will be prostate exams. In the future it will be complete government control of the tests we receive, the doctors we see and the care the government decides that we deserve.

. . .

That strikes me as being so blown out of proportion that it falls somewhere between true stupidity and cynical dishonesty. Downright embarrassing.

I'm growing more and more convinced that being out of power actively causes people to go crazy.

- Drak



-----------------

P.S., I noticed as I posted this that the USPSTF page has a pretty good study attached to it, too, justifying the recommendations. You can find the links at the bottom of the page. The numbers are in the ballpark of the study I was reading, though they measure something slightly different:

Screening biennially from ages 50 to 69 years achieved a median 16.5% (range, 15% to 23%) reduction in breast cancer deaths versus no screening. Initiating biennial screening at age 40 years (vs. 50 years) reduced mortality by an additional 3% (range, 1% to 6%), consumed more resources, and yielded more false-positive results.

[fliptw]

I wouldn't say go crazy, i'd say not having a full understanding what a false positive means wrt to cancer treatment in general and breast cancer in particular.

Out of touch... yes, thats a given for politicians.

[Tunnelcat]

Thanks Drakona, I was wondering if there had been a study on radiation exposure amounts and mammogram screenings. Nice information to have.

However, just last Sunday on the back page of one section of our local Oregonian newspaper, there was THIS ad:



The gist of the ad and what women should do is below AND they're fishing for class-action lawsuit victims too:

http://www.wdolaw.com/CM/HRT/HRT-Litera ... maries.asp

http://www.wdolaw.com/CM/HRT/HRT-Breast-Cancer.asp

I didn't even know that doctors were still prescribing this crap anymore. I thought that after the WHI Study was ended in 2002 that Prempro and Premarin were essentially going to be fazed out since bioidentical versions of estrogen and progesterone are available. Also, doctors were supposed to be only prescribing it for a couple of years during the worst part of perimenopause.

It turns out that there was a follow up WHI study in 2005 and synthetic progestins have also been implicated in increased breast cancer rates and THEY are still being used in combo E +P drug formulations. I know from personal use that of 2 of the suspect hormone patch formulations have synthetic progestins in them.

http://www.whi.org/findings/ht/eplusp_bc2.php

On top of that, they also found that using synthetic hormone therapy increased the frequency of abnormal mammograms and biopsies and decreased the effectiveness of these tests, in other words, more false positives, anxiety and costs.

http://www.whi.org/findings/ht/eplusp_mam.php

If a woman uses these synthetic hormones continuously for 5 years, and a lot of women do because perimenopause can go on for 10 years or more, it DOUBLES the risk of breast cancer! Why in the hell has the medical community not put a stop to the use of these drugs if they cause cancer AND mess up the tests to find that same cancer? If the government's going to recommend a less aggressive mammogram screening schedule, they'd better put some action behind banning synthetic hormones. STUPID GOVERNMENT! They let the horse out of the barn before closing the barn door! Why is it taking ambulance chasing class-action lawyers to bring this to light for women? Women can't even trust their doctors! Sorry for venting guys. It's gotten personal now.

[AlphaDoG]

A male perspective:
Male Breast Cancer in the News Thanks to Peter Criss

http://www.emaxhealth.com/1024/98/34528 ... criss.html

Oh by the way, he describes mammography as being akin to medieval torture techniques.

[Tunnelcat]

Oh by the way, he describes mammography as being akin to medieval torture techniques.

Oh, it is! The equivalent male experience would be having the testicles squeezed flat in a vice while getting them X-rayed. If a woman has fibrocystic or tender breasts (quite normal after menopause), the equivalent male experience would be getting kicked in the testicles FIRST and THEN having to put them in the vice for the X-ray!

[Spidey]

Ooooo, kiss me before you start talking dirty.

[Insurrectionist]

Medieval torture device



This is used by inserting the device into your penis or urethra.

Going to your doctor now days leaves you feeling violated. Lube you or the device up and probe you.

I do now know I have no cancer in my bladder.

[Duper]

wow dude....

you win!

/me walk away hold myself >.<

[Tunnelcat]

A contest, eh? Well the speculum used for the orifice stretching pelvic exams that women endure (recommended EVERY 2 years by the way), is probably a direct descendant of this nice little medieval torture device:

The Pear of Anguish

[Duper]

I'm not EVEN going to ask how you knew about that....

[Tunnelcat]

You can learn more weird things on the History Channel.

[Duper]

U.S. Debt Clock


one reason there is NO WAY we can afford Socialized health care.

[Grendel]

Got a better idea ?

[Duper]

how about getting our finances in order BEFORE we try and buy a Lamborghini?

In the next 5 years, if our dollar doesn't rival the pesos, it will be a miracle. That isn't sarcasm.

If you look at the lists, we can't even pay for social security. How are we supposed to finance a national compulsory health plan?? THAT hasn't even been addressed with any kind of detail.

Better idea? hell yeah! SHELF THE IDEA.

[Birdseye]

how about getting our finances in order BEFORE we try and buy a Lamborghini?

In the next 5 years, if our dollar doesn't rival the pesos, it will be a miracle. That isn't sarcasm.

If you look at the lists, we can't even pay for social security. How are we supposed to finance a national compulsory health plan?? THAT hasn't even been addressed with any kind of detail.

Better idea? hell yeah! SHELF THE IDEA.

ive been saying for 15 years (YES SINCE I WAS 12 YEARS OLD) that the easiest way to get yummy goodies like universal health care etc and be able to afford them the BEST thing to do is pay down the debt and we'll open up a massive portion of our budget as such a silly portion goes to amortizing the debt.

get your money 1/2 chinese 1/2 euros imo, bail out of the dollar asap