Brilliant insight once again Vinay. Nothing like spending your life mimicking Sisyphus in your quest of opening people's minds, but someone has to do it!
As a gastroenterologist who has performed > 25,000 colonoscopies, I have seen and removed thousands of colon polyps. My ADR (adenomatous polyp detection rate) is 45-50% for screening colonoscopies. Adenomatous polyps as well sessile serrated polyps are the main precursors for the development of colon cancer. By finding those particular polyps and subsequent removal prevents colon cancer. However, the vast majority of colon polyps never develop into colon cancer. The population of the USA for ages 45-75 (the age recommended for colon cancer screening) is about 84.7 million. If my ADR reflects on the general population, then 40-42 million Americans harbor silent colon polyps. The incidence of colon cancer is about 155,000 yearly; therefore, most Americans will never develop colon cancer. The efforts of medicine should be channeled to identify individuals with the polyps that are higher risk for colon cancer development as opposed to mass screening.
YES YES YES this! Causing unnecessary utilization and harm, driving up costs, annoying our patients (try getting an 88 yo long-term care patient to go out and get a mammogram!) so that we can "check a box" -- never mind an annual flu/COVID/RSV/PNA shot. Ugh!
Thank you, Vinay, as always, for your intellectual rigor and honesty! I am so glad to have someone trustworthy to scrutinize the studies for us, since it is quite impossible for a lay person (such as myself, unwilling to put in the years needed to learn) to do so. Always glad to see cutting out of any kind of waste!
"Obamacare ties coverage decisions to the uspstf, which has ironically made the group more subject to lobbying pressure."
Great article by Vinay, but this shouldn't be considered ironic at all. The entire healthcare sector seems to run on regulatory capture, so it's more par for the course.
Abolition of this department would be a good first step in eliminating the entire public health bureaucracy. On the subject of masks and respiratory disorders, how about some scientifically valid proof of contagion before recommending "preventive" strategies that seem to be based on whims and guesses.
I am a 75+ year-old Gynecologic oncologist. My mother died of colon cancer. I have seen many men and women die of pelvic cancers with local and nodal metastasis. “All-cause mortality “ reduction is not what I seek for myself. I get annual PCA. I get colonoscopy every 3 years rs, and polyps are always removed. I want early detection, and I want vigorous treatment of all pelvic cancer except limited, histologically low grade prostate cancer, to prevent advanced pelvic cancer with pain, fistula, stomas, and obstruction. Even if my date of death is unchanged!
The outcome variable of randomized trials is important, and neither ca nicer-related mortality nor all-cause mortality captures what I consider to be the relevant issues.
Excellent as usual. I’ve been teaching your thoughts for years. Still, USPSTF is the best unbiased resource available to physicians. Better to beef it up than throw it away. Physicians and trainees need an unbiased resource.
When I consider how refreshing your good nature is, Doc, I am unsurprised that you are surprised that they are surprised.
The iron law of institution hereinafter obtains, and the combination of arrogance, incompetence and deceit forms a heady brew.
Consider how routinely "noble" lies are propagated, and that those who suppress fraud for a living are very familiar with how small lies become big ones. Incompetence and fraud are categorically discrete, but there is a great deal of overlap. Add the effect of an arrogant sense of superiority, and you have a dawning conceptualization of how that arrogance leads one accustomed to deceit, to deceive themselves into thinking that the cash flow will never cease.
Conveyance of surprise is also a common rhetorical tactic, one that the internet age has rebranded as a form of "concern trolling." Still and all, can anyone be amazed at someone defending their sinecure?
Your recommendations sound great but are almost impossible to put in place. Take prostate cancer, something I know a little about. There was a large, expensive, US based study that looked at just this thing. It had many flaws, most of which were unavoidable in a US based study. A similar study was done in Europe which was much better because there, men follow directions and if they don't, the state forces them to. That study showed that PSA screening is helpful and decreases prostate cancer specific mortality.
Now you want to do a study in the US again, but it will have the same problems because men in the control group just wind up going for screening and treatment outside of the study and you can't stop them. And you know that or should know that.
Brilliant insight once again Vinay. Nothing like spending your life mimicking Sisyphus in your quest of opening people's minds, but someone has to do it!
As a gastroenterologist who has performed > 25,000 colonoscopies, I have seen and removed thousands of colon polyps. My ADR (adenomatous polyp detection rate) is 45-50% for screening colonoscopies. Adenomatous polyps as well sessile serrated polyps are the main precursors for the development of colon cancer. By finding those particular polyps and subsequent removal prevents colon cancer. However, the vast majority of colon polyps never develop into colon cancer. The population of the USA for ages 45-75 (the age recommended for colon cancer screening) is about 84.7 million. If my ADR reflects on the general population, then 40-42 million Americans harbor silent colon polyps. The incidence of colon cancer is about 155,000 yearly; therefore, most Americans will never develop colon cancer. The efforts of medicine should be channeled to identify individuals with the polyps that are higher risk for colon cancer development as opposed to mass screening.
Wow, what a helpful perspective—thank you so much for sharing!
YES YES YES this! Causing unnecessary utilization and harm, driving up costs, annoying our patients (try getting an 88 yo long-term care patient to go out and get a mammogram!) so that we can "check a box" -- never mind an annual flu/COVID/RSV/PNA shot. Ugh!
Add a bone density scan while she is there! And a carotid artery study! Stat!
Thank you, Vinay, as always, for your intellectual rigor and honesty! I am so glad to have someone trustworthy to scrutinize the studies for us, since it is quite impossible for a lay person (such as myself, unwilling to put in the years needed to learn) to do so. Always glad to see cutting out of any kind of waste!
"Obamacare ties coverage decisions to the uspstf, which has ironically made the group more subject to lobbying pressure."
Great article by Vinay, but this shouldn't be considered ironic at all. The entire healthcare sector seems to run on regulatory capture, so it's more par for the course.
Like a breath of fresh air...thank you once again.
Great perspective, also tendentious to my vocabulary
Me too!
Do you mean conducive or beneficial to?
^also adding tendentious to my vocabulary
“AI: Tendentious means expressing a strong, biased opinion on a controversial topic instead of being fair and neutral.”
Abolition of this department would be a good first step in eliminating the entire public health bureaucracy. On the subject of masks and respiratory disorders, how about some scientifically valid proof of contagion before recommending "preventive" strategies that seem to be based on whims and guesses.
Great assessment! There is no critical thinking in medicine. The docs in the box are there to check off boxes so they can get paid.
If you say: Don't touch USPSTF recommendations with a barge pole, you have more evidence to back that up than the "stand 6 ft apart" rule.
🤣🤣🤣🤣🤣
I am a 75+ year-old Gynecologic oncologist. My mother died of colon cancer. I have seen many men and women die of pelvic cancers with local and nodal metastasis. “All-cause mortality “ reduction is not what I seek for myself. I get annual PCA. I get colonoscopy every 3 years rs, and polyps are always removed. I want early detection, and I want vigorous treatment of all pelvic cancer except limited, histologically low grade prostate cancer, to prevent advanced pelvic cancer with pain, fistula, stomas, and obstruction. Even if my date of death is unchanged!
The outcome variable of randomized trials is important, and neither ca nicer-related mortality nor all-cause mortality captures what I consider to be the relevant issues.
Excellent as usual. I’ve been teaching your thoughts for years. Still, USPSTF is the best unbiased resource available to physicians. Better to beef it up than throw it away. Physicians and trainees need an unbiased resource.
When I consider how refreshing your good nature is, Doc, I am unsurprised that you are surprised that they are surprised.
The iron law of institution hereinafter obtains, and the combination of arrogance, incompetence and deceit forms a heady brew.
Consider how routinely "noble" lies are propagated, and that those who suppress fraud for a living are very familiar with how small lies become big ones. Incompetence and fraud are categorically discrete, but there is a great deal of overlap. Add the effect of an arrogant sense of superiority, and you have a dawning conceptualization of how that arrogance leads one accustomed to deceit, to deceive themselves into thinking that the cash flow will never cease.
Conveyance of surprise is also a common rhetorical tactic, one that the internet age has rebranded as a form of "concern trolling." Still and all, can anyone be amazed at someone defending their sinecure?
Your recommendations sound great but are almost impossible to put in place. Take prostate cancer, something I know a little about. There was a large, expensive, US based study that looked at just this thing. It had many flaws, most of which were unavoidable in a US based study. A similar study was done in Europe which was much better because there, men follow directions and if they don't, the state forces them to. That study showed that PSA screening is helpful and decreases prostate cancer specific mortality.
Now you want to do a study in the US again, but it will have the same problems because men in the control group just wind up going for screening and treatment outside of the study and you can't stop them. And you know that or should know that.
Interesting to know, thanks!