tag:blogger.com,1999:blog-9263167.post1145310264212585480..comments2024-03-28T15:17:43.056-04:00Comments on Stayin' Alive: Remember, you read it here firstCervanteshttp://www.blogger.com/profile/11302076828795198187noreply@blogger.comBlogger13125tag:blogger.com,1999:blog-9263167.post-12834016487854407702009-10-29T06:26:06.849-04:002009-10-29T06:26:06.849-04:00Re: Somers' book. Coincidentally, after you p...Re: Somers' book. Coincidentally, after you posted this, someone also named Kathy got on my blog and recommended it. I don't know the book, but it seems to have a following.Bixhttps://www.blogger.com/profile/06263963508785739508noreply@blogger.comtag:blogger.com,1999:blog-9263167.post-91363232257156050182009-10-26T12:34:03.203-04:002009-10-26T12:34:03.203-04:00interesting article, bix.
i certainly agree about...interesting article, bix.<br /><br />i certainly agree about the importance of quality of life issues with cancer [and probably other illnesses, too, but a lot of people in my life have had struggles with cancer].<br /><br />on the opposite end from extreme medical intervention at all costs, i heard recently that suzanne sommers has put out a book along the lines of "i had cancer and refused chemo, and i'm just dandy! try these alternative approaches by quacks!" and i think that is reprehensible. apparently her breast cancer was early stage, with a high survival rate for those getting surgery alone -- so her situation is far different from that of many others. and i hate quack medicine more than i hate overly-aggressive traditional medicine.kathy a.https://www.blogger.com/profile/14479337952651746193noreply@blogger.comtag:blogger.com,1999:blog-9263167.post-43030089332662555092009-10-26T10:30:54.935-04:002009-10-26T10:30:54.935-04:00I'm speaking to all of those, and more. I don...I'm speaking to all of those, and more. I don't believe that more interventions necessarily lead to better health. Regarding cancer, I think there are some healthcare environments that are quick to remove and disrupt healthy tissue, at a cost, without good understanding of how much health or time it buys.<br /><br />Every intervention - be it a an x-ray, a scope, a blood test, surgery, a drug - comes with costs.<br /><br />I read a NYTs story over the weekend that made me consider...<br /><br />http://www.nytimes.com/2009/10/25/health/research/25anderson.html?_r=1<br /><br />... How, for many, cancer is a chronic condition. As such, we might want to elevate quality-of-life (mental and physical) in the treatment equation.<br /><br />This probably gets back to QALYs.Bixhttps://www.blogger.com/profile/06263963508785739508noreply@blogger.comtag:blogger.com,1999:blog-9263167.post-33086971663845243722009-10-25T16:28:48.745-04:002009-10-25T16:28:48.745-04:00bix, i'm interested in learning more about you...bix, i'm interested in learning more about your perspective -- are you speaking to end of life? basically incurable cancers? or very invasive biopsies to even see if there is cancer? or what?kathy a.https://www.blogger.com/profile/14479337952651746193noreply@blogger.comtag:blogger.com,1999:blog-9263167.post-19350714738378044482009-10-24T07:01:35.980-04:002009-10-24T07:01:35.980-04:00Yes, especially that 5th paragraph.
An unfortunat...Yes, especially that 5th paragraph.<br /><br />An unfortunate outcome from this aggressive testing - all the good body parts that have been excised or damaged, needlessly, and all the needless risky radiation exposure.<br /><br />There's something almost barbaric about how we approach cancer - all this cutting out.<br /><br />We need to spend (we need to have spent) a commensurate amount of money characterizing and staging tumors, so we're comfortable choosing no-action. (I know no-action isn't profitable in our system. Maybe the proposed Comparative-Effectiveness Institute would address this.)<br /><br />It's like ... okay, we have a tumor, now what? Even a wait-and-see approach is costly, tests cost, there is a cost in risk from the test itself, not to mention the cost in emotional health. (Which is a whole other area that doesn't get addressed - mental health.)Bixhttps://www.blogger.com/profile/06263963508785739508noreply@blogger.comtag:blogger.com,1999:blog-9263167.post-70486606956589983682009-10-23T12:47:00.139-04:002009-10-23T12:47:00.139-04:00Cervantes, I don't rely on CBS news for my hea...Cervantes, I don't rely on CBS news for my health information, especially when devoid of any real data and when parts of this story include fear-mongering. Yes, most cases are not confirmed, but plenty of lab testing continues to happen. There is more than just "assuming" going on here. Part of the science behind this is here: http://www.cdc.gov/flu/weekly/Nathannoreply@blogger.comtag:blogger.com,1999:blog-9263167.post-66547529602903810992009-10-22T22:52:36.818-04:002009-10-22T22:52:36.818-04:00kathy: yes, the hype is real, but to say that H1N1...kathy: yes, the hype is real, but to say that H1N1 is "not particularly virulent or deadly" is stretching things a bit. It does seem that we are much further along into a higher-mortality flu season than we'd like, and it's still very early. <br /><br />Not meaning to hijack the thread for flu -- I know Cervantes is, to put it mildly, disinterested in it -- but check Revere's post <a href="http://scienceblogs.com/effectmeasure/2009/10/why_cdc_says_this_years_flu_se.php" rel="nofollow">here</a>. <br /><br />Token on-topic contribution: Cervantes, I *have* been reading it here first for years, and it's nice to see JAMA catching up. It will be interesting to figure out how to respond when, in a year or two, I start hitting the recommended PSA screening age bracket.greghttps://www.blogger.com/profile/16076525911162049138noreply@blogger.comtag:blogger.com,1999:blog-9263167.post-37742788682968999932009-10-22T21:00:20.135-04:002009-10-22T21:00:20.135-04:00i'm just not that interested in what strain of...i'm just not that interested in what strain of flu is going around, since H1N1 doesn't seem to be particularly virulant or deadly. naturally, complications should be investigated.<br /><br />my friend's daughter was at a summer program, and tons of people got sick -- not so unusual for kids in close quarters -- and everyone recovered in a few days. but they did testing, who knows who paid for it, and lots of the kids had H1N1, sending their long-distance parents into palpitations until the fever went down.kathy a.https://www.blogger.com/profile/14479337952651746193noreply@blogger.comtag:blogger.com,1999:blog-9263167.post-46898176364846514512009-10-22T13:07:54.386-04:002009-10-22T13:07:54.386-04:00The testing criteria have no doubt become more str...The testing criteria have no doubt become more stringent, so a higher pct. will test positive. You may also happen to be in a high prevalence area. Nevertheless the qualitative point remains: it is impossible to make a definitive flu diagnosis clinically.Cervanteshttps://www.blogger.com/profile/11302076828795198187noreply@blogger.comtag:blogger.com,1999:blog-9263167.post-28604137747908091562009-10-22T12:35:03.955-04:002009-10-22T12:35:03.955-04:00I haven't had the time to sort through Revere&...I haven't had the time to sort through Revere's comments yet. But the health people at my small PA college tell me that we send a few samples, taken from cases diagnosed as flu based on symptoms, to CDC each week as part of a CDC surveillance project, and that 2/3 of those are coming back as H1N1. I'm surprised it's that high, and maybe I need to start trying to get my hands on that data, but it's interesting.greghttps://www.blogger.com/profile/16076525911162049138noreply@blogger.comtag:blogger.com,1999:blog-9263167.post-36012638953168503862009-10-22T11:02:03.196-04:002009-10-22T11:02:03.196-04:00Kathy -- because you have a first order relative w...Kathy -- because you have a first order relative who has had breast cancer, you are in a different situation. Your risk is higher, therefore it probably makes sense for you to have regular mammography. These recommendations refer to general population screening only. I should probably put an update on the post to make that clearer.<br /><br />Anonymous: Revere's post is quite wonky as usual, but the main point most of us should take from it is that the flu surveillance system is not designed to give us any sort of reliable numbers on overall incidence; it's a sentinel surveillance system designed to raise red flags that something may be occurring that bears investigation and possibly response.<br /><br />What I want everyone to understand is that all of the reports of "widespread flu activity" and schools closing because of "flu" outbreaks and so on are very likely wrong. We don't know if the people presenting at doctors' offices or staying home from school have flu at all, let alone novel H1N1 - in fact, most of them don't.Cervanteshttps://www.blogger.com/profile/11302076828795198187noreply@blogger.comtag:blogger.com,1999:blog-9263167.post-91915007229702254652009-10-22T08:08:07.550-04:002009-10-22T08:08:07.550-04:00Revere on CBS story that you refer to:
http://scie...Revere on CBS story that you refer to:<br />http://scienceblogs.com/effectmeasure/2009/10/cbs_news_on_swine_flu_testing.php#moreAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-9263167.post-73692274837040429622009-10-21T17:50:11.671-04:002009-10-21T17:50:11.671-04:00well, i was interested in the report of the jama a...well, i was interested in the report of the jama article. and it is a good thing that some cancers are caught early and eradicated, but from what i can gather, the promise of mass screening catching it all at an early point is not panning out. the routine prostate and breast screenings are not catching more serious forms of disease any earlier than testing done because of symptoms or other indications, from what i gather.<br /><br />this is just my view from my personal experiences: it's good to have a baseline mammogram, and followups maybe periodically but certainly when there are changes. <br /><br />i've had 3 rounds of mammography this year, since my sister was diagnosed with an aggressive stage II cancer. the last one was at a cancer center, really because of staffing issues and i think because the medical foundation spent shitloads on building this new cancer place. but after round 3, i finally got enough info that i think the "suspicious" bits on film are actually fibroids that have been there for about ever. [on round 2, i was told they were in a different place than my longstanding lumps, but that wasn't accurate info.] they lost my old mams, by the way -- which were dated, but hopefully they will be able to keep the digital images safe someplace for future reference.<br /><br />my sister with the stage II cancer was pretty diligent about mams, particularly since she had an earlier breast concern. she sought help when she found a new mass.kathy a.https://www.blogger.com/profile/14479337952651746193noreply@blogger.com