Comments on: NOT RATIONING MAMMOS, EH?

By: jz-md

jz-md — Mon, 30 Nov 2009 23:48:19 +0000

“Why isn’t an oncologist qualified to comment on mammography guidelines?�?

The opinion of an oncologist will suffer from hindsite bias. His/Her experiences are skewed to the True Positives. A physician involved with triage, family doctor or internist, will carry more experience with the false positives, false negatives, and the true negatives.

By: Joseph C.

Joseph C. — Mon, 30 Nov 2009 14:21:55 +0000

I don’t think “the Man” has a consensus on this issue just yet. The debate goes way, way back and they’re still fighting it out.

By: Catron

Catron — Mon, 30 Nov 2009 00:36:53 +0000

“Why isn’t an oncologist qualified to comment on mammography guidelines?”

He’s qualified to comment, of course, but his posts suggest a level of status anxiety that would (in most cases) prevent him from bucking establishment opinion, even if his instincts tell him the CW is dead wrong.

By: Joseph C.

Joseph C. — Mon, 30 Nov 2009 00:21:22 +0000

“I’m even less confident that “Respectful Insolence�? is the best judge in these questions.”

Why isn’t an oncologist qualified to comment on mammography guidelines? Some might even say that it’s his job to stay on top of this area of research.

By: Catron

Catron — Sun, 29 Nov 2009 03:54:56 +0000

I’m not as confident as you are that there is a bright line between science and politics, Joseph.

I’m even less confident that “Respectful Insolence�? is the best judge in these questions. Orac is “insolent�? mainly to the safe, establishment-approved targets, like the anti-vaccine types.

Moreover, as this WaPo piece indicates, these new guidelines were largely based on a “comprehensive analysis of medical literature” from Britain and Sweden. These two countries are already notorious for (you guessed it) rationing.

By: Joseph C.

Joseph C. — Sun, 29 Nov 2009 01:54:21 +0000

Dave,

The new USPSTF recommendations are based on a risk-benefit analysis informed by science, not politics:

http://scienceblogs.com/insolence/2009/11/really_rethinking_breast_cancer_screenin.php

By: Marc Brown

Marc Brown — Thu, 26 Nov 2009 11:12:35 +0000

You really are confused - the discussion on mammography is nothing to to with rationing. It is about applicability - maximizing effectiveness and minimizing harm. In fact, there has never been any attempt to ‘ration’ mammography - quite the reverse, with governments/insurers around the world actively pursuing population screening programs.

By: Catron

Catron — Thu, 26 Nov 2009 00:52:32 +0000

“If you believe rationing is prudent, then who do you trust to make those decisions?”

Rationing isn’t a matter of prudence, it is inevitable. All finite goods and services are rationed. The only choice is how it is done.

Your choices all assume that someone must consciously “control” the rationing process, and you leave out the the market.

The market is, ironically, the only fair and equitable mechanism for rationing, yet very few of our “leaders” understand this.

Thus, they repeatedly attempt to impose top-down, centrally-controlled boondoggles like Obamacare.

By: jz-md

jz-md — Thu, 26 Nov 2009 00:10:13 +0000

are you using the term “rationing” as a dirty, unholy term?

If so, then I ask: “do you believe that all patients ought have access to all they desire, all the time and place of their desires? or do you believe that rationing is prudent?

If you believe rationing is prudent, then who do you trust to make those decisions?
–politicians?
–government beaureaucrats? eg. Preventative Services Task Force?
–insurance administrators?
–patient/doctors with some pts. having no choices because they have no money.
–random patchwork of “all the above” which we currently have , and frustrates many.?

By: Marc Brown

Marc Brown — Wed, 25 Nov 2009 10:12:17 +0000

This is complete nonsense. What you’re saying is that insurance companies should continue to cover procedures that are shown to do more harm than good. In other words, you would prefer to get your healthcare based on voodoo than science. And if you really want it - guess what. There’s nothing stopping you paying for it yourself in true ‘market’ fashion.