Comments on: Mammogram flap changing views on physician testing? http://trueslant.com/rickungar/2009/11/19/mammogram-flap-changing-views-on-physician-testing/ American health care and political policy - commentary and debate Mon, 19 Dec 2011 11:00:56 -0500 http://wordpress.org/?v=2.9.2 hourly 1 By: misterb http://trueslant.com/rickungar/2009/11/19/mammogram-flap-changing-views-on-physician-testing/comment-page-1/#comment-2782 misterb Sat, 21 Nov 2009 04:46:21 +0000 http://trueslant.com/rickungar/?p=6132#comment-2782 Rick, My wife was over 50 so would have taken the tests under the proposed policy. We most likely agree that having insurance companies decide what is the right policy is the wrong policy. Clearly, this is one more case where one size doesn't fit all. A two-stage patient evalution plan makes much more sense than a flat age-based criterion. Screen patients based on genetics, family history, geographic history and lifestyle choices. Then test rigorously for indicated risks. One way to reduce false results is to do more expensive tests. When the tests are applied willy-nilly, they are inevitably the cheap ones. Rick,
My wife was over 50 so would have taken the tests under the proposed policy. We most likely agree that having insurance companies decide what is the right policy is the wrong policy. Clearly, this is one more case where one size doesn’t fit all. A two-stage patient evalution plan makes much more sense than a flat age-based criterion. Screen patients based on genetics, family history, geographic history and lifestyle choices. Then test rigorously for indicated risks.
One way to reduce false results is to do more expensive tests. When the tests are applied willy-nilly, they are inevitably the cheap ones.

]]> By: Rick Ungar http://trueslant.com/rickungar/2009/11/19/mammogram-flap-changing-views-on-physician-testing/comment-page-1/#comment-2753 Rick Ungar Fri, 20 Nov 2009 18:40:57 +0000 http://trueslant.com/rickungar/?p=6132#comment-2753 True enough - however, it does beg the point. There are downsides to testing - but what we are talking about here is the opportunity for physicians and patients to make those calls on an individualized basis. While there may be some downside, your wife - happily- is an example of where the right call was made. I sure would not have wanted her to be a victim of a policy requiring that testing only be done at 50, assuming she was younger when she experienced the disease. If the government sets that policy, health insurance companies will follow suit -and that would be a very unfortunate result. I also thing there is some experience with the market regulating itself in this regard. When the full body scans became popular, insurance refused to cover it taking the position that it was likely to produce false positives or discover disease well before ti needs to be discovered and dealt with. They turned out to be right and the popularity of these tests have subsided significantly as people and doctors realized that the test was doing more harm than good. True enough – however, it does beg the point. There are downsides to testing – but what we are talking about here is the opportunity for physicians and patients to make those calls on an individualized basis. While there may be some downside, your wife – happily- is an example of where the right call was made. I sure would not have wanted her to be a victim of a policy requiring that testing only be done at 50, assuming she was younger when she experienced the disease. If the government sets that policy, health insurance companies will follow suit -and that would be a very unfortunate result.

I also thing there is some experience with the market regulating itself in this regard. When the full body scans became popular, insurance refused to cover it taking the position that it was likely to produce false positives or discover disease well before ti needs to be discovered and dealt with.

They turned out to be right and the popularity of these tests have subsided significantly as people and doctors realized that the test was doing more harm than good.

]]> By: misterb http://trueslant.com/rickungar/2009/11/19/mammogram-flap-changing-views-on-physician-testing/comment-page-1/#comment-2749 misterb Fri, 20 Nov 2009 07:06:38 +0000 http://trueslant.com/rickungar/?p=6132#comment-2749 Rick, I'm sympathetic with your reasoning, but you leave out why excessive testing actually can kill people. No test is perfect and mammograms are no exception. Imperfections show up as false positives (test says cancer, you don't have it) or false negatives (test says cancer-free, you have it) Either of these errors can have fatal consequences. Therefore, your best health outcome may not be to test. I say this even though my wife survived breast cancer because it was detected by a mammogram early enough to be treated successfully. We all want to stay alive, but the best strategy for survival isn't necessarily to submit to the conventional wisdom. We are constantly finding out that they didn't have it quite right even though they seemed very certain. Rick,
I’m sympathetic with your reasoning, but you leave out why excessive testing actually can kill people. No test is perfect and mammograms are no exception. Imperfections show up as false positives (test says cancer, you don’t have it) or false negatives (test says cancer-free, you have it) Either of these errors can have fatal consequences. Therefore, your best health outcome may not be to test.
I say this even though my wife survived breast cancer because it was detected by a mammogram early enough to be treated successfully.
We all want to stay alive, but the best strategy for survival isn’t necessarily to submit to the conventional wisdom. We are constantly finding out that they didn’t have it quite right even though they seemed very certain.

]]> By: F. Paul Wilson http://trueslant.com/rickungar/2009/11/19/mammogram-flap-changing-views-on-physician-testing/comment-page-1/#comment-2748 F. Paul Wilson Thu, 19 Nov 2009 17:47:43 +0000 http://trueslant.com/rickungar/?p=6132#comment-2748 Hear, hear, Rick. Hear, hear, Rick.

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