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Re-evaluating the Benefits of Cancer Screening
uncleO writes "An article in the NY Times describes two studies that weigh the harm caused by cancer screenings against the benefits they provide. From the article, 'Two recent clinical trials of prostate cancer screening cast doubt on whether many lives — or any — are saved. And it said that screening often leads to what can be disabling treatments for men whose cancer otherwise would never have harmed them. A new analysis of mammography concluded that while mammograms find cancer in 138,000 women each year, as many as 120,000 to 134,000 of those women either have cancers that are already lethal or have cancers that grow so slowly they do not need to be treated. ... In recent years, researchers have found that many, if not most, cancers are indolent. They grow very slowly or stop growing altogether. Some even regress and do not need to be treated — they are harmless."
The thing is that cancer is not one disorder, or even just a few disorders. Heart disease can reasonably be considered one disorder (although it is probably more accurately viewed as three or four disorders). There are hundreds of different disorders that we lump together under the term cancer.
The truth is that all men having power ought to be mistrusted. James Madison
Presumably for the reasons enumerated in the summary. Too many costly, and quite frankly terrifying, false positives. Keep in mind, when you start talk about putting everyone through a screening, whether it be for cancer or HIV or terrorism, your screen had better be crazily accurate. Imagine there's a (really exceptionally good) false positive rate of 0.1% on your hypothetical test, if you give it to every person in the US twice a year you're going to produce 74,000 false positives a year. Or to put it another way, more false negatives than there are cancer deaths.
as many as 120,000 to 134,000 of those women either have cancers that are already lethal or
There are a lot of cancers that are incurable, but can still be controlled for a while. Statements like this make it sound as though catching these cancers early and controlling them for a while is a worthless endeavor.
My wife is one year into a battle with a cancer that she has only roughly a 25% chance of surviving with treatment. Without treatment, she would have been dead a few weeks after diagnosis. She is grateful to have spent the past year alive instead of dead, and of course the children and I are also grateful. I guess the point that I'm trying to make here is that treating a cancer that will most likely be lethal still has significant value. None of us would have been very happy if some government bureaucrat had told us that since the cancer was so likely to kill her, they wouldn't bother treating.
They don't grade fathers, but if your daughter's a stripper, you fucked up. --Chris Rock
What people always forget when talking about the "government takeover of health care" is that there are already bureaucrats sitting between you and your doctor--the private insurance companies--and you already have limited mobility between providers, due to limited open seasons and pre-existing conditions and whatever else your employer stipulates. But instead of being handled by a government agency overseen by elected officials, you are beholden to a for-profit organization who wants everyone to pay in more than they draw out. While I'm sure there are arguments to be made that efficiency gains can be produced in a properly regulated market versus a single-payer system, I don't think the market we have meets that criteria at the moment. It will be a little better after Obamacare goes into effect, but a lot of the health insurance system is still not working in the best interests of the patients.
We could break apart the back room collective bargaining and price fixing and actually make health care something that people actually pay for, like car insurance and automotive services. That way, at least, we can see some competition for price and maybe people will even understand the resources they waste every time they go to the doctor about a cold. (Well, at least after they paid $80 to hear the doc say "It's a cold, drink some juice and get some rest" they'll think twice before doing it again.)
This is a common fallacy -- that the costs of going to doctors for minor discretionary ailments are a significant part of health care costs. As the economist Paul Krugman has explained, the major expenses in health care aren't $80 visits to the doctor, but $50,000 and $100,000 cancers, $20,000 a year lifelong treatments for diabetes, $50,000 a year lifelong treatments for multiple sclerosis, $50,000 and $100,000 heart bypass operations.
Actually, there have been many studies over at least 40 years to see whether charging patients more would produce better -- or even cheaper -- care. They all failed. Look up the Rand Health Insurance Experiment in Wikipedia. Patients who had greater copayments put off necessary care, like blood pressure medication (probably the most cost-efficient intervention we have).
U.S. corporations like IBM tried imposing co-payments on their employees, and they ended those policies when they found that they wound up spending *more* money. Patients with asthma put off maintenance care, and wound up going to the hospital more.
Health insurance isn't like car insurance. If your car is damaged, you know what the problem is and you know what's going on. If your doctor tells you that you have a disease you never heard of, and that you have to treat it right away, you don't know what's going on. It will take you more than a day of Google searches to find out.
If a nurse tells you, "You should go to the hospital right away. It could be life-threatening," what are you going to do? Look it up on the Internet?
Making health care decisions is like a graduate-level exam with questions you're unlikely to understand, and if you get one question wrong, you die.
It would also help the problems with cancer screening: once people see a $10,000+ price tag on treating that maybe-dangerous tumor they'll definitely give waiting and seeing a thought.
Ridiculous. The main thing a cancer patient wants to know is whether (or how long) he's going to live. The only concern about treating a tumor is (1) whether it really is a tumor that has to be treated and (2) what the best treatment is.
Cancer chemotherapy causes heart failure and other cancers. Is the risk of death from treatment greater than the risk of death from no treatment? Nobody takes doxorubicin just because they can get it free.
I know people who are doing watchful waiting, because their doctors think it's one of those false positives. I've talked about the decisions with them.
$10,000 doesn't enter into the decision. How much is your life worth?