Critical Thinking Not Fear Based

SandyAust

In any of these decisions there needs to be a consideration of both the economic costs and the social costs.  I think the balance is wrong.  It is not uncalm or uncritical thinking to consider the social cost as being very important.  Emotion is a good thing, it is what keeps us human.  Heaven help us if every decision that was made was cold and dispassionate.

I think personal anecdotes are fine.  They serve to demonstrate the social cost.

I also think my views are the result of my personal experience and the experience of many other young women on these boards.  I do not however think that is a bad thing. Decision makers need to understand the real world reality of the impact of their decisions.

I appreciate that benign biopsies can put women through some trauma.  I recently had half my thyroid removed due to a suspected cancer.  My surgeon explained that in my circumstances there is no way of knowing without the surgery.  She said we treat the five to save the one.

If 33 in 1000 have to have a biopsy to save the life of one young women. I would say to those women, I am sorry you had to go through that but you need to "suck it up" there are a lot worse things in life.  Being grateful for your benign diagnosis - I know I was.

lewing

It's really good to have a thoughtful discussion of this issue, about which many of us - myself included - feel so ambivalent.  I was diagnosed at age 46 as the result of a routine screening mammogram.  Did that mammogram save my life?  Or did it just shove me into cancer-land a year or two sooner, with no real difference in my treatment or prognosis?

I don't know, and never will. 

But wait, there's more: I'd had a clear mammogram exactly a year earlier.  So did two small tumors and a whopping big hunk of DCIS suddenly materialize in the space of a year?  Or were they missed because, well, mammography doesn't work so well in younger women?  (Which I can also attest to, but that's a whole 'nother story.)  Maybe if I'd been screened every 6 months - heck, make that every 3 months - something would have turned up earlier, before I had lymph node involvment.  Maybe there wouldn't have been DCIS diffused throughout my breast, and I could have kept it. 

Maybe.  So should all women my age get screened every few months to catch their cancers even earlier?  Um . . . I don't think so.

My point is that personal experience informs us, it makes us passionate, it's incredibly important - but at the end of the day, it's not the best source of guidelines for big populations.  It can seem cold to talk about incidence per 1,000 or whatever, and something in us rebels against that, because we know a little about the beautiful lives those numbers hide.  But how can you tell what works and what doesn't - whether we're talking about screening methods and frequencies, as we are now, or about alternative treatments - if you don't rely on statistical evidence.  That's why it's really disconcerting to see a serious treatment of a serious issue (which, agree or disagree with them,  the USPSTF recommendations are) turned into a political football and media circus, with panel members demonized.  This thread is a welcome antidote to that.

Linda

iodine

I, too, am worried about the future and present young docs who seem to follow what ever is the latest in recommendations, with little further education and little experience.

Just what is the super specialist of today and tomorrow, who has no training in other than her/his specialty, going to say to a woman who asks if she should have a mammo.  Heard a doc today on NPR who was in favor of the recommendations: I would tell her the pros and cons and let her make the decision.  Even with several further questions, he could only repeat that statement, he would tell her nothing   Just how helpful is that going to be to someone who hasn't been taught to even ask the question. and How are the pros and cons going to be presented?  And I complained when I had all those decisions to make on my own, too.

I am further put off re: anxiety, etc in the recommendation: Liked the statement, even from a conservative: Anxiety won't kill people, breast cancer can.

One more thing: treatment for mets: est 200,000; cost of 1900 mammos: 380,000, multiply that by the 10 year figure they were using. 

(If I'm way off on the math, I'm on the "good" drugs today for my back.  Sorry)

Eldub

Thank you for starting this thread.

I was alarmed by the new recommendations.  But I have been appalled by most of the reactions I've read - on bc.org and elsewhere.

Don't get me wrong.  I am deeply concerned about the new recommendations.  It appears to me that the research used was deeply flawed (too old - doesn't even include digital mammography), or irrelevent to the situation in the US (Sweden has lower bc rates (especially for younger women!), far stricter environmental regulation, and far less pollution than virtually anywhere in the US).  These are mistakes that likely would not have been made if actual breast cancer docs had been included on the panel.  But the fact of these recommendations coming out right now has absolutely nothing to do with the current administration or the attempt to finally overhaul the healthcare system - instead, it's been in the pipeline for YEARS and it was just a terrible coincidence that these recommendations came out now.  (My understanding is that all members of this panel came onboard during George W. Bush's term, not Barack Obama's.)

I'm all for science-based decision making, done well.  If this or another panel were to use studies of current mammography techniques and treatment results, and look only at women within the US, then I'd be hard-pressed not to seriously consider the merits of their recommendations.  But the recommendations can be no better than the data used to reach them - and there are very serious problems with the data.

Gotta go to bed - my preschooler will be up early, regardless of when mommy went to bed!  Thanks again for starting this thread.

Linda

Blundin2005

Good monring all.  

Flash and Beesie -- I agree that the Medical Guidelines become the template for reimbursement to providers by insurance companies, including government.  In 1982 passage of Tax Equity and Fiscal Responsibility Act was the country's first introduction to health care cost containment.   In 1983 DRG's (Diagnostic Related Groups) were implemented to contain hospital costs.  Doctors wondered then if it would have any impact on them. They soon learned how quickly insurance companies could adapt when HMOs were developed for cost containment and doctors lost some of their medical decisions to gate keepers. Following are excerpts of papers I wrote in college -- "DRG Impact on the Organizational Systems of XXXXXXXX Hospital" (1989 Wharton School, Management 38, Teacher: Prof. Pennings) and "Paradigm Shift Within the Healthcare Industry:  The Impact on an Institutional Culture" (1993 Neumann College, Managing Diversity Mgt 308XX, Teacher: Mark Osborn Sr.) The topics are at the core of this discussion.

"There has been a major shift of thinking regarding the provision and delivery of health care services in the United States.  Since providing these services is contingent on the allocation of limited resources, any change to the equation disrupts the balance.  The increasing costs of health care has led to a critical examination of the industry as a whole by our medical professionals, business and political leaders.  The response from the government was to implement a prospective payment system for medical services provided to medicare patients.  These payments are based on Diagnosis Related Groups (DRGs).

In a letter to the Editor of the New England Journal of Medicine (Aug. 23, 1984), it was noted that "....one rarely picks up an issue of the Journal these days without reading about diagnosis related groups or health maintenance organizations or some other topic related to money and medicine."  The author's concerns prompted him to count the number of articles dealing with issues of health insurance, reimbursement and economic policies and cost in medical care that had been published during calendar years 1963, 73, and 83.  The outcome of total articles was as follows:  1963 = 15%    1973 = 27%    1983 = 60%.  The author further lamented that "we may one day find ourselves reading newly titled publication, the New England Journal of Money and Medicine."

1983 is when the federal government implemented DRGs in an effort to control the cost of healthcare.  At the same time the government was aggressive to prosecute and convict providers of billing fraud and abuse.  This action resulted in a dramatic change in the industry that led to the development of new payment schedules by insurance companies and a shift of payment from the employer/insurance company to the patient.  "Consumerism in Healthcare" was a seminar presented by the Rand Corporation at our school.  Prior to that, services were paid by employer paid insurance policies and the government (medicare and medicaid).

"Diagnosis Related Groups is a technique of hospital reimbursement that converts the hospital billing and reimbursement method to one based on the patient's diagnosis.  The DRG rate is a fixed sum based on the average cost of treatment adjusted for inflation, overhead and other factors.  The old method involved billing according to the amount of services consumed and the period of time spent in the hospital.  Under this method, there was no incentive to the hospital to contain costs.

DRGs were developed by Professor J.D. Thompson and Robert B. Fetter PhD at Yale University in the late 1970's.  The goal was to develop a patient classification to be used in utilization review process.  Over Time, the application expanded to budgeting, planning and reimbursement." 

Probably, the socio economic factors are considered but outcomes are not known before implementation of the models.  Phd's at Yale put their pants on one leg at a time like everyone else.  

AnnNY -- I didn't realize that bc.org has rights to everything we write until I read your post some time ago. That's how insurance companies negotiate too. Is that the hidden cost to have access with each other?  I suppose. There's no free lunch anywhere.

One last item of transparency--I worked and paid into Medicare from the age of 12.  I no longer have private US health care insurance since I moved to Italy in 2002 with my husband and utilize a combination of the national health system and the private system here.  It is similar to what you might have read about in other countries.  I'm eligible for medicare next year.  I live within these means.   

So many great comments.  I hope that we can keep this momentum going.

Blundin2005

My husband called me to the table for lunch so I ended the post before I finished.

http://www.ahrq.gov/clinic/uspstfab.htm 

I found the task force to see who was on it.  I'm looking for the guidelines next.

Equally important to this discussion is Sandy's comment that emotions are important. That they are high, or passionate, or ambiquous or exhausted.  Emotions need to be kept in check during times of crisis.  That said, they certainly don't disappear.  They also impact our decisions and actions.  So true Sandy.

RunswithScissors

I wonder why the experts are locked into this paradigm of 10 year increments - why 40-49? That's a pretty huge group.  Plus,  it is an age range that varies greatly in terms of  our reprodutive health/status - some women actively growing their families while others are zooming along to menopause -    

How might the study results have changed if they looked at women 40 - 44  separate from those who are   45 -49, for instance?

Or maybe age isn't the right  criteria to use at all? 

revkat

I really enjoyed the historical perspective of this article:

http://www.nytimes.com/2009/11/20/opinion/20aronowitz.html 

Ok, maybe enjoyed is not the right word. I found it interesting.

konakat

Well Blundin -- the conversation has degraded to bantering around "fascism" and "walking time bombs" on other threads.  I can't be bothered with those threads anymore.  Hopefully this one will not get off track or bordering on the ridiculous.

iodine

I certainly agree that the attacks on the president are unfounded (I hope this is not a trial baloon for changes in insurance/care/caid coverage.)

Yes, politics are unfortunately becomming way too much of the discussion.

I agree that the data is way off and hope the group will reassess their findings with updated material.=----and from the US.

Colette37

Konakat...People are calling it the way they are seeing it.  If you look at the definition of fascism, what Bush Jr. and BO are doing are suspicious that is for sure.  Look at the "Patriot" act and all the bills past directly after 9/11 that are still being used today...without any sign of the government retracting them.

iodine...Why are they unfounded?  The "Health care reform bill" that BO is trying to shove through and protecting as not having any baring from the U.S. Preventive Services Task Force, point blank states on page 17, that the standards of care that insurances cover are based ON this "panel" (Their terminology on the USPSTF website, NOT mine)

The reason why politics is becoming too much of the argument is because it IS the problem in the first place!  The people who wrote and support the health care bill and those who are on the USPSTF panel are attacking all women by their actions.

AnnNYC

Colette, that Senate bill wasn't written by President Obama.  The legislative branch writes legislation.  The bill (amendment to HR 3590) is a merger of two bills, one developed by the Senate Finance Committee (the "Baucus" bill) and one by the Senate Health, Education, Labor and Pensions (HELP) Committee...

I'm sure that with opposition to the mammography guidelines coming from the left, right, and center, any Senator who wants to pass this bill will try to modify or remove language about the USPSTF recommendations...  I certainly hope so.

I've felt all along that the USPSTF panel members were clueless "ivory tower" academicians (to quote Iodine from another thread), and that suspicion was confirmed for me today by an article in the NY Times headlined "Mammogram Debate Took Group by Surprise."

I'm hoping their admissions of their own cluelessness will lead to a complete revamping of the AHRQ -- this USPSTF seems ludicrous to me, and if it's not entirely disbanded, there should be a lot more oversight of what questions are addressed, and assurance that people with relevant expertise address these questions...  I mean, who can take them seriously when the Vice-Chairwoman of the panel says this:

Dr. Diana Petitti, the vice chairwoman of the task force, said Thursday that she had been taken aback by the reaction. She did not realize, she said, the extent of the context. There has been an intense controversy over the screening of younger women, dating back more than a decade and involving Congressional hearings.

"I was relatively unaware of it," she said. "I have been made aware of it now."

iodine

I guess the president is the lightening rod for everything, he is after all where the buck stops.  I choose to address my concerns to the men writing the bill and making additions to it (read pork) in the Senate and Congress.  They seem to owe too many favors to each other and I believe all need to be replaced.  So this is where the politics comes in.

I have begun voting for no incumbents as they seem too encumbered by their need for campaign money for their next election to take care of the nation's business.

As much as I object to Bill Clinton, his personal actions, I do agree that a bill needed to be passed.  I was hoping they'd just pass it so they could begin tearing it down and then reconstructing it -- which should take several months.  Then they can begin to work out the kinks in it.  Another year or two.  I do agree with some of the bill (as little as I know of it)and would support everyone having some form of health insurance, just as we all have to have car insurance.  It's all the added on pork that I object to.

iodine

Ann, very informative article re: the group and their history---I doubt many have ever heard of them.  LOL, and yet the started such a firestorm that they are startled.

I saw the ? second in command, a woman on PBS and she was very much like a deer in headlights, and could only repeat, as could one of the group I saw later, that the information/recommendations were misinterprited and would be reviewed to clarify their stand.  She was not very articulate to say the least, so maybe the do need to rewrite it. (after they get updated data)

Loved the note on another thread: I wonder what they were thinking when they decided to take on strong menapausal women in the first place.  LOL , loved that.  will find out where I saw it and give her credit.---Little C wrote: can't imagine what made them think messing with a bunch of STRONG, MENOPAUSAL woman was a good idea?!?!?

Colette37

AnnNYC...I have a very strong feeling that the USPSTF is one of the 23 working groups that is set up under the "Security and Prosperity Partnership" which is in the process (with the blessing of our leaders of Canada, Mexico and the USA..even to the point of meeting each year) of creating the North American Union government.  They came from no where to be thought of as THE place to go to for all the answers...but then I am getting off of the subject with this info.  To put it bluntly it looked like a "Brownie" moment to me...but it is giving people a chance to see what these people are really doing.

iodine..for the government to have anything to do with health care is careless because what did they do with Social Security?  Every single time they get a wild hair, they dip into it...and then in the next breath yell that it is going broke from their own actions.  I would like to keep my money verses being forced to get something that the government thinks I should have like a good little girl.  And I would be surprised that one "legislature" person wrote even one sentence of the 2,000 page document.  It was the insurance lobbyists who did.  BO has not done one thing yet.  I do agree with the no incumbents comment.  They are worried about getting elected verses not doing their job.

Blundin2005

Revkat - Thanks for the article.  Indeed interesting.  While we are marching in tune with technology, we haven't yet produced a cure.

Possibly the concerns being strongly expressed by many here have roots in the fact that disease specific to women took the same strides as women's rights in the US i.e., much more effort to be heard and researched.  That's a historical perspective too that may be lost and we don't want to walk backwards?  

After I was diagnosed I went looking for "the numbers" here in Italy to see how much success they were having.  Komen found their way here only a short time ago.  I found the women's culture here much more resistant to the education of breast cancer.  When I looked for national numbers I found them concentrated in the north because they weren't collected in other areas.  This has changed since the formation of the European Union and the arrival of Komen (not dependent on each other).  But I don't know if outcomes changed either.  

Beesie maybe you have some info on this globally?

I think too that the roar being made over this is proportionate to the now too familiar awareness that people have of the insurance industry and how they operate.  Medical guidelines are not intended to be financial guidelines.  The concepts are as different as the language used to communicate them.  Medical research requires the freedom to follow science not financial models.  We have the tail wagging the dog to do otherwise and advances in knowledge then are lost.  That said, when I read the guidelines I read the science not the financial impact.  It is imperative to uncouple the two.  We've grown lazy as a society to use the data (what is the plurel of this?) in any other way.

So the healthcare debate was and is of value.  We did learn that we can't trust the insurance industry to behave in our best interest.  We did learn that government responds far too late to crisis.  But we have not yet resolved how to integrate that knowledge into public policy....or is that what is happening now in this debate?

I have more thoughts but not time to write...gotta go for now.  I'll check back later.   

  

palaminoridesagain

I have actualy been around for along time, but left for about a year.  I was diagnosed at age 55 with stage 2 breast cancer which progressed to stage 4 this year.  What I found amazing when I first came to bco were how many women were so young - too young to be dealing with breast cancer, the treatment, and all the emotions that go along with it.  My heart ached about 2 weeks ago when a very good person passed away at the age of 41 from this disease.  The same age as my son.

I had hoped that the direction we were going was early detection and prevention.  So this sort of through me into a loop of anger and frustration for yet the new group of younger women who will be in their 40's soon.  I actually wonder what is the average age of women here at bco, I would guess younger than 50 - not scientific, just a guess.

When I was 45 I saw my gyne who was very concerned about my mammogram.  So concerned he sent me to a surgeon to be evaluated.  The surgeon said nothing was wrong.  Then each time I got a mammogram there was concern and followed up with an ultrasound.  I sometimes wonder if I was diagnosed then would I not be stage 4 today, but one can't look back you can only look forward. 

My mammogram did not show my 3 cm spiculated tumor.  I could feel the lump and knew it was there and also thought to myself, not me - this isn't cancer.  The mammogram did show microcalcifications and then off to another ultrasound and sure enough there was that large tumor hiding.  The rest is history.

Then yesterday hit with another issue against women regarding pap smears!  Again instead of going towards early detection and prevention we are heading in a different direction.  And I am really questioning why in less than a week have these issues been brought up about women.  Is is a statement that we are not as important as the men who are doing these studies? 

I firmly believe that women should get yearly mammograms starting at the age of 40.  With that being said, I worry so much about the women who are in their 30's and being diagnosed with breast cancer. 

Marilyn, hi to you and glad you started this thread.  This topic has been weighing heavy on my mind this whole week and yesterday when they brought up decreasing pap smears, I think my mind was about to burst without having something to say to someone - amyone. 

Evidnece based medicine does work and is being practiced in most hospitals throughout the USA.  Yet as most studies go, statistics can be so deceiving and can be manipulated by the persons who are entering the information. 

I am saddened by this whole situation and feel women have taken a giant step backwards. 

nnn 

lewing

I found Breast Cancer Action's statement on the controversy over the USPSTF screening recommendations interesting, and thought others here might as well:

http://bcaction.org/index.php?page=does-mammography-screening-save-lives-let-s-talk-about-it

Linda

RunswithScissors

Thanks for that great link, lewing.

AnnNYC

Colette,

The USPSTF was created in 1984.

The "Security and Prosperity Partnership of North America" was launched in 2005.  Their website describes the focus of their health working group as follows:

Health: will seek to enhance public health cross-border coordination in infectious diseases surveillance, prevention and control (e.g., pandemic influenza). Improve the health of our indigenous people through targeted bilateral and/or trilateral activities, including in health promotion, health education, disease prevention, and research. Building upon cooperative efforts under the International Conference on Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use, work towards the identification and adoption of best practices relating to the registration of medicinal products.

I think we shoot ourselves in the foot if we ascribe more power and intelligence to any of these people than they really have.

I think pointing out the lack of expertise and awareness of the USPSTF is the best way to go -- they either have to be totally revamped or else disbanded.  I am really glad you brought to my attention how they are named in the current Senate bill.  The take-home message for me is the dangerous stupidity of bureaucracy -- because there's a Task Force, someone actually believes they are experts.  The members of the Task Force don't even seem to realize that their statements will guide insurance reimbursements! 

Colette37

They have been working since the 1980's, and before,on creating the North American Union.  Do you know who signed the NAFTA bill the first time?  Bush Sr.  Yes, that was in the early 1990's.  This has been in the works for quite some time to say the least.  As far as the SPP is concerned, it was never voted on by our congress and Bush Jr. entered it without consulting the American people.  How long has "Health Care" been pushed to be passed?  The same time frame.

People need to start contacting their Senators and telling them "NO!" on this health care..because it the only reform it will do is start killing people by the dozens by making it almost impossible to get health care.  The USPSTF and this bill are one in the same.

konakat

What's this about a North American Union?  LOL  Trust me, that is the last thing Canadians would enter!!!  As an FYI -- Obama wants to dismantle or at least re-visit NAFTA.

hrf

"with the blessing of our leaders of Canada, Mexico and the USA..even to the point of meeting each year) of creating the North American Union government" .... I don't know who is having this ridiculous fantasy dream but I can assure you that Canadians do not want a North American Union government.......we would have very much to lose and nothing to gain.

covertanjou

The North American Union is a conspiracy theory that posits that NAFTA is really a conduit to  a a single currency between Canada, the US and Mexico, and the creation of a socialist mega-state.  It is the classic fear of the "other."  As with most conspiracy theories, there is no proof.  Of course, the lack of proof does not stop the conspiracy theory from having traction with certain segments of the population.

In an August 2007 press conference in Montebello, Canadian Prime Minister Stephen Harper stated that he didn't believe that the NAU was a "generally expressed concern", while U.S. President George W. Bush called concerns of a North American Union "political scare tactics" and described as "comical" the "difference between reality and what some people are talking on TV about." http://www.spp.gov/

Since the title of this threat is "Critical  Thinking Not Fear-Based," can we keep the conspiracy theories to the many other threads? 

Edited: to put in citation 

konakat

I wonder what the Queen would say about all this?    Ya know, we Canadians still have her on our money and are tied, although loosely, to the British monarchy.

covertanjou

What about the Quebec gov't?  Does anyone believe that the Quebec gov't would agree to anything that may put its culture and language at risk?

Konakat, maybe the it was the queen's idea?   lol. 

otter

I know... anyone can post anywhere,  But, perhaps we should have a separate thread on this forum to debate the authenticity and merits of a "North American Union"?...  It would be a shame for this thread ("Critical Thinking Not Fear Based") to degenerate into the same "he-said, she said", political mud-slinging that led to the demise of several other BCO threads and to the suspension or banning of some of its members this past year. Maybe we can try to maintain a "refuge" here, where conservatives and liberals aren't constantly at each others' throats.  JMHO, that's all.

Linda, that's an interesting commentary from Breast Cancer Action, whether we support the USPSTF's efforts or want the lot of 'em taken out and shot at sunrise.  There is one part of that BCA commentary that made me cringe. it was the division of women with "early" breast cancer into 3 prognostic categories:

++++++++start quote++++++++++ 

1. They have a type of breast cancer that responds to currently available treatments.

2. They have a type of breast cancer that is not and will never become life-threatening.

3. They have a very aggressive disease that cannot be effectively treated with currently available therapies.

"While we don't know how big these groups are, we do know that the only people who actually benefit from early detection are those in the first group. It's these women whose lives can be saved by early detection, if they get the appropriate treatment in a timely manner. These are the women who need screening." 

++++++++end quote+++++++++

Okay....  so, women in the 2nd group don't need to be screened, because even if they have cancer, it isn't going to kill them; and women in the 3rd group don't need to be screened, because they're going to die of their cancer no matter when it gets diagnosed.

That seemed awfully blunt, so I followed the link back to the BCA "Policy on Breast Cancer Screening and 'Early Detection' ": http://bcaction.org/index.php?page=breast-cancer-screening-policy 

Don't go there if you are having a happy day today, because it will ruin your day.  For that matter, don't go there if you are not having a happy day today. It's kind of funny, because many of us gripe about the rosy outlook -- the "pinkness" -- given to a breast cancer diagnosis by the news media and the public.  We make the same gloomy arguments that are posted on that BCA "policy" page.  I guess I just don't like reading them in a policy statement by a political action group.  (They aren't a charitable organization, are they?)

The problem, of course, is that no one knows which of us will be in which of those 3 BCA groups.  The BCA says no one knows how big the groups are; but I'd venture that the 3rd group (the "hopeless" group) isn't very large; and size of the 2nd group (the group with "harmless" tumors) is un-knowable right now.  That's the group that contains the DCIS that doesn't become invasive, and the invasive tumors that supposedly "vanish".  Those are the women being over-treated.

... Which means that the majority of us dx'd with "early" BC are likely in the 1st group, and we'll benefit from treatment.

Of couse, that's assuming treatment provides no benefit at all to the women in the 3rd group. What is the definition of "effective treatment," anyway?  That's one of the questions swirling around the USPSTF screening guidelines-- are we all in agreement that "death" is the only important endpoint?  How about "added years with our grandchildren," or "time not spent in a hospital," or "sunrises and sunsets witnessed"?

Wouldn't denying "early diagnosis" to the 3rd group be like not doing glucose tolerance testing in someone who's genetically predestined to develop diabetes and die of renal failure?  Or, not monitoring cholesterol levels in someone with a high familial risk of dying of heart disease?  After all, the treatment is only going to delay the inevitable...

Irrational exaggerations, I know.  This is supposed to be the thread for "rational thinkers." Sorry.

otter 

[Edited to add:  I'm happy to see several of you agreeing with what I said in my first paragraph.] 

RunswithScissors

******

otter said: 

I'd venture that the 3rd group (the "hopeless" group) isn't very large; and size of the 2nd group (the group with "harmless" tumors) is un-knowable right now...

... Which means that the majority of us dx'd with "early" BC are likely in the 1st group, and we'll benefit from treatment.

*****

So basically, you're guessing, and reaching a "rational" conclusion based on your  guess. OK!

Still, your argument would have merit if it weren't taken out of context - but it was -because you are ignoring the fact that mammography has risks.  

LittleC

BushSr may have started it, but Clinton signed it into law.  It was a bad idea no matter if you're left or right.

History Channel.com

December 8, 1993

The North American Free Trade Agreement (NAFTA) is signed into law by President Bill Clinton. Clinton said he hoped the agreement would encourage other nations to work toward a broader world-trade pact. 

otter

Pill, I'm ignoring a lot of things lately.

otter