Follow the mammogram money
Wall Street Journal's Alicia Mundy reported that the final health care bill in Congress is likely to require coverage for more mammagrams than the US recommended after women's groups, doctors and imaging equipment makers stepped up pressure on lawmakers.
From the article:
Adriane Fugh-Berman, a professor at Georgetown University's medical school in Washington, D.C., said the evidence supports less-frequent mammograms. "You have to ask if there's conflict of interest, because breast-cancer advocacy has become a big business," she said.
Ties between nonprofits and companies have been under attack by some consumer watchdogs. Sen. Chuck Grassley, an Iowa Republican, sent letters last month asking 33 major nonprofit groups including the American Cancer Society to disclose their industry funding.
The American Cancer Society said it has received less than $1 million from screening-device makers in the past five years. Its spokesman said the donations, which are small relative to the society's annual revenue of more than $1 billion, don't influence its recommendations.
The American College of Radiology, a trade group, called the new government guidelines scientifically unfounded, and said that if the guidelines are adopted, "two decades of decline in breast-cancer mortality could be reversed and countless American women may die needlessly."
Its flagship research program studies the role of radiology in medicine. It received donations of at least $1 million each from General Electric Co.'s GE Healthcare and Siemens AG, according to the trade group's 2007-08 annual report. Both companies make mammography equipment and MRI scanners. Several other medical-device makers donated at least $100,000.
A spokesman for GE said the new guidelines conflict with successful early-screening programs. A representative of Siemens didn't respond to a request for comment. The college of radiology said sponsors haven't influenced its research. It has spent $480,000 on lobbying in the past two years, while the imaging industry spent more than $2.5 million.
One of the largest breast-cancer-awareness groups, Susan G. Komen for the Cure, has worked with GE and other companies. Komen turned to GE in October when it lit the Great Pyramids pink to mark a major screening initiative in Egypt. Neither GE nor the Komen group would say how much the event cost.
In 2007, GE sold limited-edition pink cameras to Home Shopping Network, which donated a portion of the sales to Komen. Imaging and film companies whose products go into mammography equipment have made pink DVD players, pink computer flash drives and pink cellphones, a portion of whose sales raise money for Komen and other breast-cancer groups.
In events at the Capitol, Komen for the Cure founder Nancy Brinker has praised GE's digital mammography technology, and she received a public-service award from the company.
Ms. Brinker, sister of the late Susan G. Komen, said some patient-advocacy groups tended to represent industry views, but her organization's push has always been early detection.
A traveling mammogram van purchased this fall by the American Cancer Society, Komen and other advocacy groups for the Dana-Farber Cancer Institute in Boston touts a new GE Healthcare Senographe Essential digital-mammography system.
A lobbying group leading the charge in Washington against the new guidelines is the Access to Medical Imaging Coalition, whose members include GE and Siemens and several nonprofit patient groups, the college of radiology and leading doctors societies.
The coalition's director, Tim Trysla, is a lobbyist at a Washington law firm. He has been working in Congress against proposals to cut billions of dollars in Medicare spending in the health-overhaul bill that could hurt imaging-device makers.
Comments
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(This excerpt is from the same article cp418 told us about earlier today. The focus of this excerpt is the apparent link between opposition to the 2009 USPSTF guidelines on mammography, and profits obtained by doing more mammograms.)
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It is interesting that many of the perople protesting the 2009 USPSTF guidlelines have a financial interest in mammograms.
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I agree Lisa. Very interesting!!! Thanks to the Sen. Grassley for inquiring into this.
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Although I'm not American and the guidelines to do not apply to me, I'm just going to add my 2 cents' worth to this discussion. Hope you Americans don't mind....
In Ontario, screening mammos are available to all women at the age of 50. Those who are concerned, or who have family history or other medical history concerns, are able to get a diagnostic mammo at any age with their doc's recommendation. All of my female relatives 40 and over have had diagnostic mammos. I had my first one at age 37. Our single-payer system means we are not out-of-pocket.
When you look at the 2008 5-yr survival rates (according to Factcheck.org) there is very little difference between Cdn (82.5%) and U.S. (83.9%) rates. While I have been astounded (and very disturbed) by the number of under 50 women who have contributed their stories on this forum and signed the petition, I'm also wondering why, if there is so little difference in the Cdn/U.S. statistics, there is really a distinct advantage to keeping the screening age at 40. It's been suggested that more younger women in the U.S. are diagnosed at a much earlier stage, hence the slightly better survival rates.
I've mentioned before that there are far more tests and scans performed per capita in the U.S. than in any other first-world country, and it seems clear to me that the profit motive plays a very large role. These tests and scans do not seem to lead to much better outcomes, it seems. JMHO, of course....
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I can't knock Komen for their support. Here in Italy there is a van equipped for mammos...we know they help at this point.....
....this point is in need of progress. My friend's research targets personal needs not one size fits all. This is the next big step. If they can identify the what that cascades into the occurrence of cancer in each of our individual bodies, then just maybe they can find the why. In our conversations we talked about Luc Montagnier 2008 Nobel Prize for Medicine. Did you know that some of his work 25 years ago involved an interest of breast cancer...viral oncology....it led him to AIDS...and he's not finished yet.....25, yes 25 years ago. All in divine time.
With all the conversations that swirls around politics and business models, we forget that there are scientists simply doing their work that hopefully will help us all.....thank goodness!
We've been chatting here often about the breast cancer connection to thyroid disease....and we race to connect it to iodine. What if it's a bigger picture that involves the immune system of the body and the thyroid, that regulates metabolism, goes haywire because of a virus....simultaneous with the rest of our immune system such our defense to cancer.
And if they are right about their research, then mammos become support characters to blood tests....imagine the turf wars then!
How long then will them make us wait for technology that helps not harms?
I agree too that Susan Love took the rap for turf wars on who's got the "answer". They are all trying hard to win hearts and minds....I'd prefer they put their energy into winning the race for the cure.
Auguri,
Marilyn
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I was at first upset with Dr.Love, but did take away one good fact: we need BETTER diagnostics, and we should continue to use what we have until we get the better ones, which should be in testing NOW for use within the next 12 mos. Of course, that's not gonna happen, but I can dream.
I would also enjoy seeing a financial report from the good representative in our congress who is cking out how much some of these places rec. in donations. Sorry, but to me it's the pot calling the kettle black. As you will note: many millions are spent on lobby groups to give money to the same congress who is investigating them. HO-hum. business as usual in good ole DC.
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do I think this is crooked, no.
do I think it could look bad, maybe.
In journalism the appearance of conflict of interest is to be avoided.
I'm not sure what Komen should do in this situation.
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Well I think (but what to I know) that Komen and LivingStrong and Love and Voices of Survivors and Breastcancer.org all need to maintain focus....on their original mission. The problem is financial resources to do so. They all dip into the same pot and the same set of accounting and reporting rules. So if the rules can become transparent ... even if it's one layer at a time ... then the mission becomes clearer with it.
Iodine--I think they are all racing to bring the blood test to market. DNA research has brought that a long way. It's always about the money .... the market. We need to accept that and reward the guys and gals in the white hats instead of the mafia element. I remember when a mayor in Philadelphia cleaned the town of Italian mafia...and that effort spread to NY and Chicago, etc. They did a great job and cleaned up the streets....that after that huge effort found the streets back filled with Russian, Chinese, etc. mafia that were far worse....I think though that the Italians have since raised their bar to meet the others. It's a mess everywhere. And these jerks have their claws into everything, including black market drugs. That's why people in Africa are receiving counterfeit AIDS drugs...that are worthless. The computer age gave birth to a whole new way for mafia to connect easier too. It's not just our chats that were made easier.
Sorry to be so dark about it all. I go to www.Ted.com when I need to reenergize my faith in people...or invite some over for a meal!
Best wishes to all as always,
Marilyn
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Marilyn-Are you saying that they are finally looking at the link between bc, thyroid, iodine and bc in Europe? I am convinced that this is the key because I know that my breasts have totally changed for the better since I started taking iodine, and my energy is through the roof. I belong to the iodine group on yahoo and everyday I see someone that says something that points to my own iodine deficiency symptoms. Dr. Brownstein is studying this through breastcancerchoices. I do believe this will be the direction bc is going to go. The proof is irrefutable. But I also heard from EU members of the iodine group, that Codex has outlawed iodine in Europe. The drug companies are trying to do the same thing here. They do not want people to know that this will replace all their hormone drugs. After all, people will choose a cheap solution that makes you feel great any day over a hormone blocking drug that makes you feel like you are 90.
As for the mammo guidelines. I do not understand why people are so upset that the new recommendations are for every two years. This may actually save women's lives because they will be exposed to less radiation. I think the whole mammo industry is killing us. It makes me furious that they will not train more people to do thermography and promote it more. If done by a trained tech, it has the same rate of detection, and it is safe and painless, and cheaper. If there is one thing that I am hell bent on doing, and that is promoting this method, and I have no vested interest in doing so. I am just another survivor who has peace of mind with therms every 6 months. My doctor will be doing a powerpoint on mammos, therms, mri's and ultrasound at a preventionconvention I am spearheading in the Chicago area in March. If anyone would like to come, send me your email address and I will give you details. I will also have doctors there talking about iodine, thyroid, hormone balance, nutritition, chinese medicine, as well as some fun activities. You only need to pay for your hotel and food.
One last comment. I took a dear friend with me last year for a therm after she had had a mammo that was suspicious, but uncertain. The therm showed an area of interest but our doctor advised her to come back in 6 months and see if things changed. In 6 months, everything looked the same, no evidence of a growing tumor, but still some areas of concern. Her other doctor wanted to biopsy. I got her started on the iodine. She went for another therm last month, and everything was clear!
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The storm that greeted the USPSTF guidelines on mammography screening for women in their 40s prompted the Senate to insert a mandate in its health care reform bill that every insurer cover every mammography screening test at no cost to beneficiaries.
The Journal of the American Medical Association (JAMA) published an article, "The Benefits and Harms of Mammography Screening: Understanding the Trade-offs," reminding physicians and women about the serious health costs of adopting that policy.
The authors, Dartmouth's Steven Woloshin and Lisa Schwartz, used the "number needed to treat" analysis to point out:
Without screening, 3.5 of 1000 women in their 40s will die of breast cancer over the next 10 years (ie, 996.5 of 1000 will not die of the disease).
Screening reduces the chance of breast cancer death from 3.5 to about 3 of 1000. In other words, 2000 women between 40 and 49 must be screened annually for the following ten years to save one life.
For most women with cancer, screening generally does not change the ultimate outcome; the cancer usually is just as treatable or just as deadly regardless of screening.
Finding cancers that were never destined to cause symptoms or result in death is the biggest problem with mammography, especially among younger women. Since it is impossible to know which cancers caught early are benign, all are treated with surgery, chemotherapy, radiation, or some combination. Overdiagnosed women undergo treatment that can only cause harm, and must live with the ongoing fear of cancer recurrence.
While only 7% of women believe there could be breast cancers that grow so slowly that leaving them alone would not affect their health, randomized clinical trials have consistently shown that the groups undergoing mammography have more breast cancer, even after 15 years of follow-up. This persistent difference represents overdiagnosis.
Estimates of the rate of overdiagnosis range from 2 women overdiagnosed for every breast cancer death avoided in one trial, to 10 to 1 in another.
Woloshin and Schwartz concluded: "The politicalization of medical care is wrong. Promoting screening irrespective of the evidence may garner votes but will not create healthier voters. People need balanced information. Simplistic slogans touting only the benefit are deceptive. Simple, standardized summaries about the benefits and harms of testing would help foster good decision making." -
Vivre--no I'm not saying that. I'm saying that the body is a system. When our immune system breaks down it starts a chain reaction....like an atom bomb. The scientists are trying to find the sequence and break it or slow it up. This can not be simplified because each of us are so different from the other. I'm not researcher remember...only talk and read like the rest of you. I found that Mag2 (magnesium pidolate) helped my energy levels and cleared my mind as well. When I wrote to a researcher in Sickle Cell anemia about this, I wanted to know why it was helping me and would it eventually hurt me. The balance is delicate for each of us. This is the problem...one size does not fit all...we need to personalize our treatments.
gpawelski--at the risk of being too blunt, when my friend told me about the strides they were making to diagnose, even on an individual basis, my question was "Then what?". His answer was first they need to identify what they need to cure.
When I read how well many cancer patients are surviving and longer, I realize that their efforts are baring fruit. We can't ask for more...but we do.
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Ya know, Greg, I've been reading your "analysis" of mammos and other medical treatment of Breast Cancer patients for a while since you joined. I take issue with many, many of your ideas and opinions, but that is what free speech is for. I just wish you actually had a dog in this fight --- I am so sorry for your loss of your beautiful wife to ovarian cancer and commend you taking care of her during her repeated illness from the '70's thru the 90's.
It must be so helpful to you in your retirement to have persue your goals of informing cancer patients of treatment options and researching all the sources you have, including contacts with medical specialties, by many, many letters.
I am sure that your special interest in Cell Function Analysis will be very informative to us all. And I am sure you will benefit from continuing with your internet postings about how doctors and pharma are ripping we cancer patients off and treating us incorrectly. Good luck with that.
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I agree with you Greg.
I personally believe that the biggest mistake I ever made in my life was to have routine mammogram screenings. Women have had it hammered into their heads that "early detection saves lives" and never think about the repercussions of routine screenings. I thought I was being responsible with my health by doing the yearly screenings. I guess if you look hard enough for something, you will find it. I wish I had known the trade-offs before I ever went in for my first mammogram. I feel duped!!
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Thank you iodine. I tend to write on controversial cancer topics. In general, I provide a much needed balance to the flow of cancer information, which is largely controlled not by bad people, but by people with their own biases and self interests.
It's a fact that the choice of chemotherapy correlates significantly with reimbursement to the treating oncologist. Three decades of prospective, randomized trials in literally hundreds of thousands of patients have, in most cases, failed to define most optimum treatment regimens. NCI's own website haa told us so.
With this being the environment, oncologists tend to choose treatments based on the advantage to the oncologist, more so than to the patient. This is documented in the peer review literature, and supported by unbiased independent studies published online, by candid statements heard in small gatherings at CME meetings, and by private conversations with individual oncologists.
No one has ever suggested the need to perform prospective randomized trials between treatments chosen in the presence and absence of the profit motive. There is a compellingly greater need for such studies than for a great many prospective randomized studies which continue to be pursued.
It is a fact that progress in the most important forms of cancer with regard to drug selection has been negligible. It is a fact that the impact of taxanes has been over-hyped. It is a fact that the prognosis of metastatic breast cancer hasn't improved in thirty years, despite the enrollment of hundreds of thousands of patients in prospective randomized trials.
What important progress may occur will likely come from radically new drugs, rather than from countless iterations of trials to fine tune the administration of the old drugs (including taxanes). It is a fact that advances in the treatment of advanced ovarian cancer are owing much more to improved surgery than to improved chemotherapy and that chemotherapy progress in ovarian cancer has been grossly overstated.
I write a lot about the field of cell function analysis. I'm probably not right about everything, but I care about cancer patients and cancer families no less so than oncologists and NCI researchers. I get nothing out of my endeavors. No pay. No lectureships. No junkets. Not even any free meals.
I'm providing information and a point of view. I'm not making a decision for anyone. The cancer patient's oncologist still holds all the cards in steering the cancer patient in the direction the oncologist wishes. I am simply giving the cancer patient and his/her family a little more information in the most difficult of situations.
People who don't want this information don't go on internet blogs looking for it. People who do want this information have their own responsibility to be capable of dealing with the unfiltered information they receive in this medium.
Yes, iodine, I do have a dog in this fight. Thank you for asking. -
Seems like there are an awful lot of "facts" alleged in the previous post, with absolutely no evidence (citations, quotations, web links) offered to substantiate them.
otter
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Well, I have to say I sure am glad that I had 4 mammograms in my 40's - the last one caught my cancer at stage 1. I have no family history - my tumor was non palpable (by myself or any of my doctors). I would have happily waited until I was 50 - who REALLY wants a mammogram - I did them because it was recommended. THANK GOD I DID!
As to starting mammgrams in Canda at 50 - I wonder what the rates of stage 0 and 1 stage 1's in Canada vs. the US. My tumor would have eventually been "caught" - but at what stage?
Bottom line - we need better diagnostics. I had waited 1.5 years inbetween my last 2 mammograms and can go along with the every 2 years guidelines for women with no family history or concerns. Wait until 50? NO WAY. Let's be proactive, and stay ahead of things - not reactive when things are worse.
However, in my case that mammogram caught my tumor at stage 1 - and I am so grateful.
I do not think the 4 mammograms I had (was 44 at diagnosis) have anything to do with my tumor. I always had digital which is less radiation and have never been exposed to radiation (except dental xrays once in a while). Never broken a bone, etc. etc. SO HEALTHY!!!!!!
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aprilgirl -- It is thought that the (very) slightly higher 5-year survival rate attributed to U.S. bc patients is because more cancers are caught at Stage 0 or Stage 1. But even so, overall survival rates, independent of stage, are practically the same.
For me, the questions/concerns surround the numbers of highly aggressive bc found in patients under 50. Given that our two countries are so similar (yeah, okay, with some huge differences lol!), I expect that approx. the same number of women in each country fall into that category. One would think earlier screening mammos, leading to earlier tx etc., would mean much higher survival rates, but that doesn't seem to be the case. And it doesn't help that mammos are not very good at picking up tumours in highly dense breasts, which many (most?) pre-meno women have.
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For Otter and Madalyn -
US reimbursement systems encourage fraud and overutilisation
The Lancet Oncology - Volume 10, Issue 10 (October 2009) - Copyright © 2009 Elsevier -
"...In the USA, oncology reimbursements are mainly for diagnostic imaging and the reselling of intravenous chemotherapy drugs, Bach says. "Doctors buy and administer the drugs, and bill the insurer", he explains, "in general, the costs of drugs to oncologists are substantially lower than reimbursement rates. That creates a possibility for profit generation, and when profits are greater, the drugs get used more."
The problem was worse in the 1990s. "Medicare payment rates for oncology drugs influenced the choice of drugs utilised: more generously reimbursed physicians were more likely to prescribe costly regimens", says Mireille Jacobson (RAND Corporation, Santa Monica, CA, USA). "The Medicare Modernization Act changed the way chemotherapy agents are reimbursed. Prior to 2005, for many chemotherapy agents, the reimbursement far exceeded the acquisition cost. [But] starting in 2005, Medicare switched to wholesale transaction prices."...
Does Reimbursement Influence Chemotherapy Treatment For Cancer Patients?
http://content.healthaffairs.org/cgi/content/full/25/2/437
"...Before the Medicare Prescription Drug, Improvement, and ModernizationAct (MMA) of 2003, Medicare reimbursed physicians for chemotherapydrugs at rates that greatly exceeded physicians' costsfor those drugs. We examined the effect of physician reimbursementon chemotherapy treatment of Medicare beneficiaries older thanage sixty-five with metastatic lung, breast, colorectal, orother gastrointestinal cancers between 1995 and 1998 (9,357patients). A physician's decision to administer chemotherapyto metastatic cancer patients was not measurably affected byhigher reimbursement. Providers who were more generously reimbursed,however, prescribed more-costly chemotherapy regimens to metastaticbreast, colorectal, and lung cancer patients...".
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Selling cancer chemotherapy with concessions creates conflicts of interest for oncologists
http://www.healthyskepticism.org/news/2007/Jun.php
A Very Open Letter from an Oncologist
http://www.healthbeatblog.org/2009/01/a-very-open-letter-from-an-oncologist.html
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I was told that my 1.9cm, stage one, er and pr+, her-, lesion, was very treatable. That chemo would help 3% of women like me who chose to take chemo. I didn't like the odds and my onc backed me (against my husband) to decline chemo. I had already chosen a mast. to avoid rads.
I declined these treatments in '02 because of possible long term side effects and I already had enough problems with my joints. Tammox was tolerated (with multi. drugs to treat side effects) for only 2.5 years. And discontinued with my onc's blessing due to quality of life issues.
Maybe I had an unusual onc. and in today's cookbook medicine being taught to residents and fellowships, that may be true. Besides, my onc is past 50 years old and taught to treat PEOPLE, not diseases. He is also a survivior, but I honestly believe he practiced the same level of care before he was dx'd.
Yes, I encourage EVERYONE to become their own advocate in their treatment and educating themselves. But Please, when doing your research, seek out sites like this one (not the suggestions of lay folks who Think they know more than the docs) but the medical info provided at the top of the page. And other reputable sites like WebMD and Johns Hopkins, etc. for ans. to questions one may have. These blogs and know it all lay folks are there with their own agenda. They may have been around a cancer patient----note I said "A" cancer patient. They have not been in the treatment of hundreds of patients---except from the blogs they cover---and they have absolutely NO real idea of true diagnosis and treatment recommended by the treating team.
If you are not comfortable with treatment recommendations: GET A SECOND, THIRD OR FORTH opinion---------------from someone with a degree in medicine and a license to practice it. Not these folks who think they have informed themselves, use big words and give links to all sorts of questionable information. Even the Lancet articles have gotten it wrong.
Your onc is YOUR onc. Don't like him/her and what she has to say: MOVE ON to one you trust with your life, cause that's what you're doing, putting your life in the hands of your onc.
Are you prepared to put your life in the hands of some person whose face you cannot even see, who admits they have no medical training, and get their information by evesdropping around people??
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iodine wrote: "...Not these folks who think they have informed themselves, use big words and give links to all sorts of questionable information. Even the Lancet articles have gotten it wrong...."
Weel, I sure hope you're not talking about me in that remark you made above, although I suspect you are since I'm the one who posted the Lancet article. I wonder - do reputable journals like Lancet only "get it wrong" when you personally disagree (or maybe just rather not believe) with what's being said, or are they really publishing misinformation??
I also hope you're not referring me when you made the remark "...They may have been around a cancer patient ---note I said "A" cancer patient. They have not been in the treatment of hundreds of patients ---" because you couldn't be more wrong if you're referring to me. I spent 14 years working as a hospital oncology nurse in Southern California with additional part-time work for a few years thereafter in oncology offices. I've given chemotherapy to perhaps thousands of patients during those years, mintained national oncology nurse certification throughout most of that time, served on a hospital ethics committee and also coordinated and attended weekly cancer care conferences at which treatment determinations were made for many, many cancer patients. I am not a lay person when it comes to information about the treatment of cancer.
I happen to agree with the information gpawelski provided about the delivery of chemotherapy (and most delivery of medical care for that matter) having profit driven issues. Just because this person posts on blogs about issue of personal concern doesn't automatically mean the information is fabricated and should be ignored - which is why I provided links to reputable information supporting what he says to be the truth. He's not talking BS - it's the TRUTH, like it or not.
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Agreed Madelyn. What about all the non-profit healthcare countries? My Canadian oncologist certainly isn't financially rewarded for choosing one tx over another. Evidence based medicine and the individual's needs dictate tx, not perks and profits. Sure, in the US there are a few rotten apples in every bushel that put profit ahead of patient, but I shudder to think every oncologist is "rotten".
And Greg, if you suspect you aren't correct in some of what you post ("I'm probably not right about everything") why do you risk misleading your readers with information that you aren't sure is correct?
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MarieKelly, I appreciate that you posted a link to an article in Lancet. I didn't post a follow-up comment because access to the full paper is subscription-only and I haven't had a chance to locate it through our library system. Also, based on the excerpt(s) that you did post, much of the concern about profits driving the decisions our oncologist make was alleviated by changes in federal reimbursement policy 4 or 5 years ago. In addition, my own experience was similar to that of iodine, Madalyn, and konakat, with respect to shared decision-making and the absence of pressure from my doctors to accept more expensive treatment options. That might not be the case for everyone, of course. But, just because some oncologists -- or even the "average" oncologist -- might be making treatment decisions based on profit rather than efficacy, that does not mean they all are.
I spent my whole career reading and analyzing articles in medical journals, and then lecturing students on the significance (or not) of those studies. Lancet, like other medical journals, sometimes publishes commentaries and op-ed pieces in addition to research papers. But, regardless of whether it's a peer-reviewed research article or an op-ed piece, I'm inclined to give more credence to something published in a reputable journal -- like Lancet, NEJM, JAMA, J Clin Onco, BMJ, etc. -- than something someone says in a letter to the editor or on his own blog or personal-opinion website.
otter
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Otter, while the medicare reimbursement changes surely put a bit of a crimp in the profit margins, I think you're overlooking an import fact. That crimp applies only to patients who are receiving treatment covered by medicare - i.e those who are permanently disabled and those over the age of 65. Not all patients recieving treatment for cancer are medicare patients, so that has left the remainder unaffected by those reimbursement changes. And the fact that capping those specific reimburement rates happened at all tends to confirm in itself that a problem exists with excessive profits.
Madalyn, I really don't think anyone has suggested that oncologists ONLY give chemo because they make lots of money on it. The concern is that some (not all, just some) oncologists, once having made the decision to give chemo to a patient, are choosing chemo drugs with higher rates of reimbursement in order to realize a greater profit from it. Which of course, means that treatment decisions are being made based on anticipation of increased profit as opposed to purely what's best for the patient. That's unethical. If if were just a rogue few, there wouldn't even be much of an issue about it, but the issue exists at all because it's far more widespread than just a few.
Konakat, in the non-profit health care countries such as Canada, this isn't an issue. So I'm sure your oncologist's decision to treat you with only 4 AC was what was best for you. It's different here in the US so yes, there are "rotten apples" here and unfortunately it's far more than just a few.. This country's health care system is driven by the quest for extreme financial profit.
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I did start my BC journey in the US (only just returned to Canada last month) and I never suspected my oncologist in the US of not having my best interests at heart. BTW -- I never did mention what my tx was, that was Madalyn. I've been on chemo non-stop since dx. Fun stuff!!
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konakat
What makes "you" think I'm misleading readers with information? Conclusions of journal articles are not always what they purport to be. This makes medical care all the harder to give.
You don't go to blogs or discussion boards for information per se, but rather for new ideas. Simply reading the comments is an excellent learning process. They are a way of sharing information and stimulating ideas. A great way to get new perspectives and information.
Major health care issues can be discussed on blogs more extensively than they could ever be discussed in academic articles. The interactive format allows rapid responses to medical and health care issues which frequently intertwine moral, ethical and legal concerns, and provides valuable feedback and commentary not available through traditional media.
Blogs are increasing the visibility of people who share tips about treatment and care giving from personal experience, and others have relied on them for straight talk about their health issues and bloggers often provide links to other blogs they favor.
But overall, independent thought (not to be confused with lack of evidence) can be cheerished on sites like this.
Using selective quotation to make someone appear to hold positions which they do not hold seems to be a favorite pastime for some. I would suggest any who may be alarmed by these kinds of quotations to read the information in its entirety.
Fortunately, most intelligent, receptive people are not so threatened by ideas which dare to challenge and question one-size-fits-all, widgets-on-an-assembly-line medicine. I cannot defend an old and dying paradigm of cancer treatment.
I am providing information and a point of view. I'm not making a decision for anyone. The cancer patient's oncologist still holds all the cards in "steering" the cancer patient in the direction they wish. I am simply giving the cancer patient or their loved-ones a little more information in the most difficulat of situations.
Madalyn
Insurance companies have become more and more involved in the practice of medicine by trying to dictate to doctors the procedures they should give to their sick patients and the fees for those services. Doctors complain that they cannot practice medicine independently and are hampered by insurance companies who look over their shoulders and dictate how they should practice medicine.
It's not that all oncologists are bad people. It's just that it is still an impossible conflict of interest (i.e. it's the system which is rotten). Take medical oncologists out of the retail pharmacy business and let them be doctors again. -
Greg -- I only questioned why you would post something if you are uncertain of its veracity. Perhaps it is only in hindsight you find your errors and I misunderstood you. You said you're not always right, I didn't. Lecture away (or should I say pontificate -- it suits you better!) -- your little hobby to enlighten others with your wisdom is touching. Perhaps you should take your own lecture to heart -- to not stifle or condescend to others who have an opinion or experience different from yours.
Edited for content.
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Greg-
The alternative forum is the best place to express your views if you disagree with conventional medicine. It is a different mindset there, not that this mindset is wrong, it is just different.
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Just a note about obtaining information from "blogs:"
Increasingly "bloggers" themselves are guilty of the classic "conflict of interest," in that a great many more than one might realize receive considerable compenstation from a variety of biased sources, and many of those "bloggers" fail to reveal not only from where but also what types of compensation they receive. Yes, this includes so-called "consumer advocate/citizen" bloggers. And there is no place the casual (or even investigative) reader can go to obtain that information, either.
Just sayin'. . .
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MarieKelly, I was not referring to you at all. Hadn't even read your remarks, I think. Hope you felt better in responding tho.
But! When you (whomever YOU are) who determine that Medical care recommended by licensed, trained oncs, with appropriate fellowships in oncology/hematology and experience in diagnosing AND treating (not just administering treatment) and have the responsibility of actually having to WRITE the freekin' chemo orders---maybe I'll listen to your accumulation of "discussion" ideas and information.
Until you have that kind of responsibility to keep you awake at night either reading up on your specialty, or being worried about a patient (and their family ) for whom YOU are responsible, your opinions carry no weight with me. You don't pay for malpractice insurance (again another sign of responsibility) you don't spend years in fellowships and hours upon hours in classes to keep up with everchanging medical care, you just don't have the weight to change my mind. Let alone make recommendations to those who are making LIFE and DEATH decisions for themselves or their children. And who would want that responsibility anyway? But they take it on, and thank God they do, else who else would you have to pick on? Or to blame?
I KNOW oncs who have done it for money. In fact, one local one is in prision for giving not only NOT needed chemo, but diluting it when given. Talk about greed.
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