tag:blogger.com,1999:blog-5877221018800830362.post3118014101629705787..comments2024-02-22T01:35:03.164-05:00Comments on Cure Strategy (formerly, Serious Medicine Strategy): For the Sake of Our Health, Let’s Practice Prevention, Not Ideology--And Not Bean CountingJames P. Pinkertonhttp://www.blogger.com/profile/06914344842339708576noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-5877221018800830362.post-82434899629596233942009-10-28T20:57:45.635-04:002009-10-28T20:57:45.635-04:00Zachary Skaggs here. Honored to have your input on...Zachary Skaggs here. Honored to have your input on my Examiner op-ed, Jim. I've found your commentary (on Fox News and bloggingheads.tv) to be illuminating and astute. Of course, I think you're wrong this time. :) Couple things:<br /><br />Good pick up on Brownlee. I am largely in agreement with her analysis, if not her policy recommendations. "Preventive Medicine Doesn't Work" also wasn't my original title, though I largely stand by it. On the to the substance...<br /><br />You point out that a simple pap smear will prevent cervical cancer deaths by as much as 99%. I am in agreement with you on the effectiveness of pap smears, as well as other forms of screening, such as visual examination for skin cancer. But a whole lot of preventive medicine is wasteful and results in subjecting people to procedures destructive to their health. Thus I'm not only arguing that such screenings and the interventions that follow are expensive and needless; I also argue that they make people less healthy than they otherwise would be.<br /><br />Take PSA screening for prostate cancer. The most recent U.S.-based large, randomized trial to examine the effectiveness of PSA screening, the PLCO, followed 77,000 people and found no mortality benefit for the yearly-PSA group versus the group who did not receive screenings. A large British study, the ERSPC, found a 20% reduction in mortality in the PSA-tested group, but at a significant cost. For every life saved due to early detection via PSA test, 50 patients were subjected to pointless treatment, meaning biopsy, radiation therapy, anti-androgen hormonal therapy, and radical prostatectomy. There's a reason Bob Dole hawks not only PSA "early detection" but Viagra. <br /><br />Or consider mammograms, the holy grail of the preventive medicine camp. A recent study showed that since (roughly) their introduction there has been a 40% increase in breast cancer diagnosis, including a near-doubling of early-stage breast cancer diagnosis, but a decline in incidence of only 10% for late-stage breast cancer. Were the early detection, early treatment mantra true, we should see, along with greater detection of early-stage cancers, a corresponding decline in late-stage cancers. Rather, we just see a bunch of new diagnosis with little effect on mortality.<br /><br />The likely reason for this strange discrepancy is that we are detecting and treating mostly benign, slow-growing cancer and missing the fast-acting, fatal varieties. Prostate cancer, for instance, is present in over half of 65-year-olds, but will only kill perhaps 5% of them (they'll succumb to something else first; the 5 year survival rate following prostate cancer diagnosis is 99%). Almost everyone over the age of 80 has prostate cancer.<br /><br />I'm not sure I understand the relevance of your comparison of the sort of maladies suffered in the third world versus the first.<br /><br />People should be allowed to determine for themselves whether they think the rewards outweigh the risks of screening and other forms of preventive medicine. But I'm no luddite for pointing out that, once one looks at the numbers, much of so-called preventive medicine is merely a foot-in-the door for a series of wasteful and health-harmful interventions.<br /><br />I look forward to reading the rest of your blog. To be sure, I didn't know until this vanity google search that you were involved with the health care issue.<br /><br />Zachary SkaggsZachary Skaggshttp://hspot.tumblr.comnoreply@blogger.comtag:blogger.com,1999:blog-5877221018800830362.post-90134623461976431602009-09-03T11:33:18.083-04:002009-09-03T11:33:18.083-04:00great post... first time at this blog, will be ret...great post... first time at this blog, will be returning often!Williamnoreply@blogger.comtag:blogger.com,1999:blog-5877221018800830362.post-90335668867384482162009-08-29T12:17:19.957-04:002009-08-29T12:17:19.957-04:00Same reason industrialist Henry Kaiser started Kai...Same reason industrialist Henry Kaiser started Kaiser Permanente. When he was building the Grand Coulee Dam he established on-site clinics to provide medical care and preventative medicine to the construction workers in order to keep productivity high. <br /><br />The concept was so successful he implemented on-site medical care at his Richmond Shipyards in Oakland, CA where he built liberty ships and expanded the concept to include everything from exam rooms, pharmacy, labs, radiology and complete hospital care all on one site in a one-stop shop arrangement.<br /><br />Today we know this as group-model managed care.<br /><br />It is the solution. <br /><br />John BrehenyJohn Brehenynoreply@blogger.com