4 ms·

It is apparent to me that many diseases, like cancer, start small and progress to the point where they produce systems the patient can see, or feel. These would

It is apparent to me that many diseases, like cancer, start small and progress to the point where they produce systems the patient can see, or feel. These would be blood in pee, blood in poop, pains in guts/balls etc. Sadly, many of these symptoms are not felt or seen until the disease is advanced. The less advanced a disease is when found, the better are the chances of a cure. Testing where there are no symptoms is THE ONLY WAY to detect them at their smaller, most curable stage.(some are terminal when found, even when small, like glioma) In my opinion this lady is making a serious error, a potentially terminal error. I get these tests for men every year, as my doctor directs, and I will do this until I get killed by something that loomed out of the darkness at high speed and killed me, be it a car or brain cancer...

londons_explore 7y ago
The time invested in taking these tests for a disease I'm unlikely to have doesn't seem like an amazing investment. Any day I have a hospital appointment, it's usually at least a half day, or sometimes a whole day invested. From initial research, to scheduling the appointment, to having to reshuffle other things in the calendar, to commuting there, to waiting in the waiting room, to having the test done, to going home, to waiting (anxiously) for results, to researching what the results mean, to getting the bill, to worrying about if insurance will find an excuse not to cover it, etc. Overall, that's a lot of time and effort. When someone can reduce this to a 5 minute test in a grocery store with no appointment, no paperwork, and a "we'll ring you afterwards only if something is up" policy, it will be a clear win
- hodgesrm 7y ago
  The time investment seems small. What's of greater concern to me at least is false positives where you are trading the risk of an actual condition with the risk of unnecessary procedures to prevent it.
  - aurizon 7y ago
    I hope any false positive is re-tested by a more reliable test, it's the false negatives that worry me...
    - DanBC 7y ago
      The more reliable tests cause harm.
- aurizon 7y ago
  That explains the reasons why people die of some easily detectable diseases - they are unable to organise their life to make it a long one. These people, who can not get their shit together, are part of it. Our medical process where everything has to generate an invoice and be paid is a larger part - I expect this is why Americans do not live longer than Cubans - clue - the rich ones do...
  - DanBC 7y ago
    Screening doesn't prevent people dying from early preventable diseases.
  - londons_explore 7y ago
    It's a simple tradeoff right. I could spend 200 days of my life scheduling and taking regular screenings for every disease I can find, or I could do no screenings and have a 5 percent chance of dying 5 years younger. No screenings wins.
redis_mlc 7y ago
Although you're trying to appear logical, you're not. There is no black or white in health care. For example, most men who get prostate cancer die of something else first. The treatment often destroys quality of life, so is worse than the disease. Also, you can't compare women's diseases to male diseases. Women have all kinds of body changes that men don't experience. And doctors generally don't signup for heroic measures after retirement. They know when your time is up, prolonging life in an ICU is not living. You're not going to live forever.
- aurizon 7y ago
  In fact as well as appearance I am logical. Screens are just that, they screen for things, and by their nature some slip through - one hopes later screens will catch the problem as it gets larger
  - DanBC 7y ago
    You're talking about false negatives, but the problem with cancer screening is the false positive: telling someone they have cancer when they don't. https://www.harding-center.mpg.de/en/fact-boxes/early-detection-of-cancer/prostate-cancer-early-detection https://www.harding-center.mpg.de/en/fact-boxes/early-detect... One of the reasons cancer screening is pushed so hard is because people use the wrong metrics. People look at 5 year survival rates, or cancer detection rates, to judge success. Imagine 1000 men with aggressive prostate cancer who don't have screening. After 5 years about 440 of those men will die. That's a survival rate of 44%. Now imagine those exact same men but pooled with 2000 men who do not have prostate cancer (because this is what screening does). After 5 years those men will still be dead. But the survival rate is now 81%. This is the bias caused by over-diagnosis.
    - aurizon 7y ago
      Yes, the flaw is inherent in the accuracy or lack of it of the test method. Things like needle biopsy of the prostate can miss cancerous cells, unless you take 100 samples. An ideal tests would detect cancer markers in the blood for prostate and other cancers. I understand there is progress in that area.
Noumenon72 7y ago
Many things start small. Doesn't mean you should test every dog in case it's developing rabies.
DanBC 7y ago
You're wrong. Imagine two groups of 1000 men over the age of 50. One group has prostate screening every year. The other group doesn't. According to you the group that has screening will have better lives, because we'll be detecting cancer earlier and preventing death. That isn't what happens. In the group that doesn't have screening we see 7 men die from prostate cancer, and we see 210 men who die from any cause. But in the group that does have screening we see exactly the same: 7 men die from prostate cancer, and 210 men die from any cause. But in this screening group we also see men having biopsies (160 men), and we see men having unnecessary surgery (which can lead to incontinence or impotence) (20 men). The problem with screening is not that is misses things which are cancer. It's that it hits things which are not cancer but which look a bit like cancer. https://www.harding-center.mpg.de/en/fact-boxes/early-detection-of-cancer/prostate-cancer-early-detection https://www.harding-center.mpg.de/en/fact-boxes/early-detect... What does the man who discovered PSA say about using it to screen populations? "Testing should absolutely not be deployed to screen the entire population of men over the age of 50, the outcome pushed by those who stand to profit. I never dreamed that my discovery four decades ago would lead to such a profit-driven public health disaster. The medical community must confront reality and stop the inappropriate use of P.S.A. screening. Doing so would save billions of dollars and rescue millions of men from unnecessary, debilitating treatments."

londons_explore 7y ago

The time invested in taking these tests for a disease I'm unlikely to have doesn't seem like an amazing investment. Any day I have a hospital appointment, it's usually at least a half day, or sometimes a whole day invested. From initial research, to scheduling the appointment, to having to reshuffle other things in the calendar, to commuting there, to waiting in the waiting room, to having the test done, to going home, to waiting (anxiously) for results, to researching what the results mean, to getting the bill, to worrying about if insurance will find an excuse not to cover it, etc. Overall, that's a lot of time and effort. When someone can reduce this to a 5 minute test in a grocery store with no appointment, no paperwork, and a "we'll ring you afterwards only if something is up" policy, it will be a clear win

hodgesrm 7y ago
The time investment seems small. What's of greater concern to me at least is false positives where you are trading the risk of an actual condition with the risk of unnecessary procedures to prevent it.
- aurizon 7y ago
  I hope any false positive is re-tested by a more reliable test, it's the false negatives that worry me...
  - DanBC 7y ago
    The more reliable tests cause harm.
aurizon 7y ago
That explains the reasons why people die of some easily detectable diseases - they are unable to organise their life to make it a long one. These people, who can not get their shit together, are part of it. Our medical process where everything has to generate an invoice and be paid is a larger part - I expect this is why Americans do not live longer than Cubans - clue - the rich ones do...
- DanBC 7y ago
  Screening doesn't prevent people dying from early preventable diseases.
- londons_explore 7y ago
  It's a simple tradeoff right. I could spend 200 days of my life scheduling and taking regular screenings for every disease I can find, or I could do no screenings and have a 5 percent chance of dying 5 years younger. No screenings wins.

redis_mlc 7y ago

Although you're trying to appear logical, you're not. There is no black or white in health care. For example, most men who get prostate cancer die of something else first. The treatment often destroys quality of life, so is worse than the disease. Also, you can't compare women's diseases to male diseases. Women have all kinds of body changes that men don't experience. And doctors generally don't signup for heroic measures after retirement. They know when your time is up, prolonging life in an ICU is not living. You're not going to live forever.

aurizon 7y ago
In fact as well as appearance I am logical. Screens are just that, they screen for things, and by their nature some slip through - one hopes later screens will catch the problem as it gets larger
- DanBC 7y ago
  You're talking about false negatives, but the problem with cancer screening is the false positive: telling someone they have cancer when they don't. https://www.harding-center.mpg.de/en/fact-boxes/early-detection-of-cancer/prostate-cancer-early-detection https://www.harding-center.mpg.de/en/fact-boxes/early-detect... One of the reasons cancer screening is pushed so hard is because people use the wrong metrics. People look at 5 year survival rates, or cancer detection rates, to judge success. Imagine 1000 men with aggressive prostate cancer who don't have screening. After 5 years about 440 of those men will die. That's a survival rate of 44%. Now imagine those exact same men but pooled with 2000 men who do not have prostate cancer (because this is what screening does). After 5 years those men will still be dead. But the survival rate is now 81%. This is the bias caused by over-diagnosis.
  - aurizon 7y ago
    Yes, the flaw is inherent in the accuracy or lack of it of the test method. Things like needle biopsy of the prostate can miss cancerous cells, unless you take 100 samples. An ideal tests would detect cancer markers in the blood for prostate and other cancers. I understand there is progress in that area.

Noumenon72 7y ago

Many things start small. Doesn't mean you should test every dog in case it's developing rabies.

DanBC 7y ago

You're wrong. Imagine two groups of 1000 men over the age of 50. One group has prostate screening every year. The other group doesn't. According to you the group that has screening will have better lives, because we'll be detecting cancer earlier and preventing death. That isn't what happens. In the group that doesn't have screening we see 7 men die from prostate cancer, and we see 210 men who die from any cause. But in the group that does have screening we see exactly the same: 7 men die from prostate cancer, and 210 men die from any cause. But in this screening group we also see men having biopsies (160 men), and we see men having unnecessary surgery (which can lead to incontinence or impotence) (20 men). The problem with screening is not that is misses things which are cancer. It's that it hits things which are not cancer but which look a bit like cancer. https://www.harding-center.mpg.de/en/fact-boxes/early-detection-of-cancer/prostate-cancer-early-detection https://www.harding-center.mpg.de/en/fact-boxes/early-detect... What does the man who discovered PSA say about using it to screen populations? "Testing should absolutely not be deployed to screen the entire population of men over the age of 50, the outcome pushed by those who stand to profit. I never dreamed that my discovery four decades ago would lead to such a profit-driven public health disaster. The medical community must confront reality and stop the inappropriate use of P.S.A. screening. Doing so would save billions of dollars and rescue millions of men from unnecessary, debilitating treatments."