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Why Doctors Hate Science
theodp writes "A 2004 study found some 10 million women lacking a cervix were still getting Pap tests. Only problem is, a Pap test screens for cervical cancer — no cervix, no cancer. With this tale, Newsweek's Sharon Begley makes her case for comparative-effectiveness research (CER), which is receiving $1 billion under the stimulus bill for studies to determine which treatments, including drugs, are more medically sound and cost-effective than others for a given ailment. Physicians, Begley says, must stop treatments that are rooted more in local medical culture than in medical science, embrace practices that have been shown scientifically to be superior to others, and ignore critics who paint CER as government control of doctors' decision-making."
Substantially less useful; but not entirely useless. Breast Cancer in males is uncommon; but not unheard of.
I'm 53 and my physician makes a regular practice of PSA tests for men my age, actually I started having them @ 50. Also just had my first colonoscopy recently and good thing as I had one tumor removed that was pre-cancer.
This is rule of thumb, and Dr. Merenstein should have known this.
Actually the previous poster is right. Population based studies suggest that more harm than good is done by screening for prostate cancer.
The evidence goes like this. Once you have an elevated PSA, you see the urologist who orders a biopsy. Biopsies and treatments for prostate cancer carry risks like bleeding and infection, urinary incontinence and impotence. Now most prostate cancers will not kill you or cause problems in your lifetime. So investigations and treatments for prostate cancer cause more harm to people than the cancer does. This makes sense in a population, but not to the guy who got a bad cancer.
The current guidelines do not suggest PSA's in all men over fifty, but rather that you discuss the risks and benefits of screening, plus potential harm of further workup of a positive screen vs. the harm of developing prostate cancer. In practice, there is no patient who can actually understand enough of this to truly make an informed decision. Many docs haven't heard of the 'new' evidence and continue screening. The ones who do know of that evidence often ignore it because it's hard to explain, and patients will love you for finding an early cancer, even if it would never have affected them.
As far as your colon cancer screening comment, what you describe is standard of care.
The other thing to consider is that medicine in the US is HUGELY biased by the litiginousness of US culture. US emergency medicine guidelines, for example, are extremely aggressive and notorious for over investigating. The priority is protecting practitioners from litigation rather than appropriately treating the patient. A lot of those investigations are not recommended in socialized health care systems because they are not cost effective, nor do the benefits outweigh the disadvantages.
1. Private insurance will not pay for a woman's well visit if they don't have a Pap smear. They don't care that the woman doesn't have a cervix. If you don't do it, you don't get paid, and it's just easier to do it no matter how nonsensical it is than it is to get on the phone with someone who is not medically trained and argue that, yes, you did do a well woman exam even though you didn't do a Pap smear.
2. There is a case to be made for anal Pap smears, because HSV also causes anorectal cancer in people who participate in anal sex. Unfortunately, because it's not standard of care, private insurance won't pay for that either. (We don't even need to talk about Medicare or Medicaid because they don't pay for preventative visits.)
There are a few reasons for what you're talking about. I am a primary care provider myself, a nurse practitioner, and the BIGGEST reason we give out the drugs the reps bring us is because when we give out the drugs we get as samples there is no cost to the patient. You would probably be shocked at how many people can't afford a $4 wal-mart prescription. If this means I give aciphex instead of prilosec I'm going to jump on that pretty quickly.
That said, there was a recent ethics thing where drug reps can't give us pharma schwag (I'll miss getting my viagra clock every year...) anymore, nor can they take us out to dinner at expensive restaurants. *sniffle*
In conclusion, even if you don't have a cervix it makes sense to get a pap of that area, because if you don't have one it probably means that you had all those bits removed for some reason, and the dysplasia or cancer may be present in the areas immediately adjacent to what was removed. Sometimes it doesn't make sense, but sometimes it does.
I call shenanigans. When *I* listen to my patients' hearts, I'm listening for new or changed murmurs, irregularity in the rate, bounding of pulses -- and you're taught to do things systematically, and for a reason. Insurance companies give us about 15 minutes per patient if we want to be able to keep our head over water, so if you think anyone wastes time with useless mumbo-jumbo, you're way off-base. Anyway, you don't diagnose a "heart attack" with your stethoscope.
Go talk to someone in the military about that whole free government provided healthcare...you get what you pay for...
I agree that the VA is underfunded relative to its size and patient population but, given its funding limitations, it's actually the best performing health system in the US when measured objectively in terms of patient outcomes.
Da Blog
To throw in a real world data point to back your claim, my healthy, active and vibrant 82 year old grandfather went in to have an operation to deal with prostate cancer, his doctor suggested that as he was in such good shape if he got rid of the cancer he could live on for quite a while longer.
He died suddenly in the hospital from internal bleeding caused by the surgery a few hours later. Now the cancer might have gotten him eventually, but how long, five years? ten? He was 82 and healthy and happy so it was kinda pointless operating really.
He thought so too, but let himself be talked into it by his doctor.
Worst thing was he was completely lucid, happy and rational minutes before he died, it was very sudden and unexpected.
HMOs and federally mandated employer-based healthcare was proposed and signed into law by President Nixon. In fact, there is an infamous tape of Nixon and his adviser discussing the plan as proposed by Edgar Kaiser of Kaiser Permanente where they blatantly talked about how the emphasis would be on profit (for the HMO) and "providing less care."
What we have today wasn't the result of some master-plan hatched in a secret lair in the lower recesses of an evil University by bleeding heart liberals or whatever you've been told. No, our entire employer based healthcare system is the result of special interest pork legislation written by the industry and pushed upon the public by a Republican administration. It's the DMCA of 1971.
With regard to your child's heartburn, you need to start asserting yourself as a patient and parent. Take an active role in your child's health and specifically ASK your doctor for generic prescriptions. I'm going to go out on a limb and guess that your doctor prescribed Nexium or some other namebrand Proton Pump Inhibitor. The generic, Omeprazole, is available Over-The-Counter, costs a fraction of the price, and works virtually identically. Call your doctor and ask him or her if this is appropriate for your daughter. No doctor I've ever met would mind a call such as this. In fact, I think most would welcome it. Fifteen seconds of his or her time for one potentially satisfied, engaged patient is what you call a clinical no-brainer.
-Grym
I've experienced both systems first-hand -- I'm an American living in Britain. Government-provided health care is FAR superior to what I received in the USA. Easier to get, cheaper, and of equivalent quality. No comparison.
I piss off bigots.