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	<title>Comments on: Will the chest CT soon be part of the routine physical?</title>
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		<title>By: Diora</title>
		<link>http://www.kevinmd.com/blog/2006/10/will-chest-ct-soon-be-part-of-routine.html/comment-page-1#comment-68234</link>
		<dc:creator>Diora</dc:creator>
		<pubDate>Fri, 27 Oct 2006 17:12:00 +0000</pubDate>
		<guid isPermaLink="false">http://clients.emmense.com/kevinmd/2006/10/will-the-chest-ct-soon-be-part-of-the-routine-physical.html#comment-68234</guid>
		<description>&lt;i&gt;If I pick up a tumor that is one centimeter today and you live five years or I pick it up four years later and you live one year, it’s the same thing.&quot;&quot;&lt;/i&gt;&lt;br/&gt;&lt;i&gt;A known life-threatening illness changes, in most cases, a person&#039;s priorities. It allows estate planning and adjustments to expenditure and investment of resources.&lt;/i&gt;&lt;br/&gt;Yes, but think about quality of life implications. Keep in mind, they are not talking about people who have &quot;nagging&quot; symptoms - anyone with symptoms should go to the doctor who is likely to order diagnostic tests. Screening is by definition for symptomless people. So if a symptomless person finds out about it 4 years from now, and dies within a year, he lives 4 years as a healthy person and one year as a dying person. Finding out 5 years (without change in the ultimate outcome) means that one lives for 5 years as a cancer patient - with corresponding morbidity from the treatment. So yes, you gain advance knowledge, but you loose what could be last 4 good years of your life. So the benefit of it is not as obvious as it seems. &lt;br/&gt;&lt;br/&gt;Also, for every person who gets this &quot;advance knowldedge&quot;, many healthy people will get false positive results - which in case of this particular test carry significant risks; and some people will get converted into cancer patients even if their &quot;cancer&quot; would never have spread and suffer from side effects, sometimes for lifetime, and can get their life shortened as the result. A poster above listed an estimate, but this is from only one study and from an X-rays. The numbers from a test that is able to pick up even earlier cancers are likely to be higher. &lt;br/&gt;&lt;br/&gt;This why some evidence that CT saves lives is really important; otherwise, more people can get hurt than are helped.</description>
		<content:encoded><![CDATA[<p><i>If I pick up a tumor that is one centimeter today and you live five years or I pick it up four years later and you live one year, it’s the same thing.&#8221;"</i><br /><i>A known life-threatening illness changes, in most cases, a person&#8217;s priorities. It allows estate planning and adjustments to expenditure and investment of resources.</i><br />Yes, but think about quality of life implications. Keep in mind, they are not talking about people who have &#8220;nagging&#8221; symptoms &#8211; anyone with symptoms should go to the doctor who is likely to order diagnostic tests. Screening is by definition for symptomless people. So if a symptomless person finds out about it 4 years from now, and dies within a year, he lives 4 years as a healthy person and one year as a dying person. Finding out 5 years (without change in the ultimate outcome) means that one lives for 5 years as a cancer patient &#8211; with corresponding morbidity from the treatment. So yes, you gain advance knowledge, but you loose what could be last 4 good years of your life. So the benefit of it is not as obvious as it seems. </p>
<p>Also, for every person who gets this &#8220;advance knowldedge&#8221;, many healthy people will get false positive results &#8211; which in case of this particular test carry significant risks; and some people will get converted into cancer patients even if their &#8220;cancer&#8221; would never have spread and suffer from side effects, sometimes for lifetime, and can get their life shortened as the result. A poster above listed an estimate, but this is from only one study and from an X-rays. The numbers from a test that is able to pick up even earlier cancers are likely to be higher. </p>
<p>This why some evidence that CT saves lives is really important; otherwise, more people can get hurt than are helped.</p>
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		<title>By: Diora</title>
		<link>http://www.kevinmd.com/blog/2006/10/will-chest-ct-soon-be-part-of-routine.html/comment-page-1#comment-68233</link>
		<dc:creator>Diora</dc:creator>
		<pubDate>Fri, 27 Oct 2006 17:11:00 +0000</pubDate>
		<guid isPermaLink="false">http://clients.emmense.com/kevinmd/2006/10/will-the-chest-ct-soon-be-part-of-the-routine-physical.html#comment-68233</guid>
		<description>&lt;i&gt;If I pick up a tumor that is one centimeter today and you live five years or I pick it up four years later and you live one year, it’s the same thing.&quot;&quot;&lt;/i&gt;&lt;br/&gt;&lt;i&gt;A known life-threatening illness changes, in most cases, a person&#039;s priorities. It allows estate planning and adjustments to expenditure and investment of resources.&lt;/i&gt;&lt;br/&gt;Yes, but think about quality of life implications. Keep in mind, they are not talking about people who have &quot;nagging&quot; symptoms - anyone with symptoms should go to the doctor who is likely to order diagnostic tests. Screening is by definition for symptomless people. So if a symptomless person finds out about it 4 years from now, and dies within a year, he lives 4 years as a healthy person and one year as a dying person. Finding out 5 years (without change in the ultimate outcome) means that one lives for 5 years as a cancer patient - with corresponding morbidity from the treatment. So yes, you gain advance knowledge, but you loose what could be last 4 good years of your life. So the benefit of it is not as obvious as it seems. &lt;br/&gt;&lt;br/&gt;Also, for every person who gets this &quot;advance knowldedge&quot;, many healthy people will get false positive results - which in case of this particular test carry significant risks; and some people will get converted into cancer patients even if their &quot;cancer&quot; would never have spread and suffer from side effects, sometimes for lifetime, and can get their life shortened as the result. A poster above listed an estimate, but this is from only one study and from an X-rays. The numbers from a test that is able to pick up even earlier cancers are likely to be higher. &lt;br/&gt;&lt;br/&gt;This why some evidence that CT saves lives is really important; otherwise, more people can get hurt than are helped.</description>
		<content:encoded><![CDATA[<p><i>If I pick up a tumor that is one centimeter today and you live five years or I pick it up four years later and you live one year, it’s the same thing.&#8221;"</i><br /><i>A known life-threatening illness changes, in most cases, a person&#8217;s priorities. It allows estate planning and adjustments to expenditure and investment of resources.</i><br />Yes, but think about quality of life implications. Keep in mind, they are not talking about people who have &#8220;nagging&#8221; symptoms &#8211; anyone with symptoms should go to the doctor who is likely to order diagnostic tests. Screening is by definition for symptomless people. So if a symptomless person finds out about it 4 years from now, and dies within a year, he lives 4 years as a healthy person and one year as a dying person. Finding out 5 years (without change in the ultimate outcome) means that one lives for 5 years as a cancer patient &#8211; with corresponding morbidity from the treatment. So yes, you gain advance knowledge, but you loose what could be last 4 good years of your life. So the benefit of it is not as obvious as it seems. </p>
<p>Also, for every person who gets this &#8220;advance knowldedge&#8221;, many healthy people will get false positive results &#8211; which in case of this particular test carry significant risks; and some people will get converted into cancer patients even if their &#8220;cancer&#8221; would never have spread and suffer from side effects, sometimes for lifetime, and can get their life shortened as the result. A poster above listed an estimate, but this is from only one study and from an X-rays. The numbers from a test that is able to pick up even earlier cancers are likely to be higher. </p>
<p>This why some evidence that CT saves lives is really important; otherwise, more people can get hurt than are helped.</p>
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		<title>By: SarahW</title>
		<link>http://www.kevinmd.com/blog/2006/10/will-chest-ct-soon-be-part-of-routine.html/comment-page-1#comment-68231</link>
		<dc:creator>SarahW</dc:creator>
		<pubDate>Fri, 27 Oct 2006 14:30:00 +0000</pubDate>
		<guid isPermaLink="false">http://clients.emmense.com/kevinmd/2006/10/will-the-chest-ct-soon-be-part-of-the-routine-physical.html#comment-68231</guid>
		<description>&lt;i&gt; &quot;If I pick up a tumor that is one centimeter today and you live five years or I pick it up four years later and you live one year, it’s the same thing.&quot;&lt;/i&gt;&quot;&lt;br/&gt;&lt;br/&gt;The date of death may be the same.&lt;br/&gt;Why does this physician not realize that knowlege of what is happening in one&#039;s own body has value?&lt;br/&gt;&lt;br/&gt;A known life-threatening illness changes, in most cases, a person&#039;s priorities.  It allows estate planning and adjustments to expenditure and investment of resources.  Events otherwise postponed by the person move to the front burner ( a marriage, a trip, a task, a purchase, etc....) - to get things done while on&#039;es state of health allows it to be accomplished.&lt;br/&gt;&lt;br/&gt;It can explain nagging symptoms that frustrate a patient and the patient&#039;s family - ending denial and dismissal or suspicion of the patient as malingerer - sometimes even by the patients physician. &lt;br/&gt;&lt;br/&gt;KNowing has value, even if it doesn&#039;t alter the actual date of death.</description>
		<content:encoded><![CDATA[<p><i> &#8220;If I pick up a tumor that is one centimeter today and you live five years or I pick it up four years later and you live one year, it’s the same thing.&#8221;</i>&#8220;</p>
<p>The date of death may be the same.<br />Why does this physician not realize that knowlege of what is happening in one&#8217;s own body has value?</p>
<p>A known life-threatening illness changes, in most cases, a person&#8217;s priorities.  It allows estate planning and adjustments to expenditure and investment of resources.  Events otherwise postponed by the person move to the front burner ( a marriage, a trip, a task, a purchase, etc&#8230;.) &#8211; to get things done while on&#8217;es state of health allows it to be accomplished.</p>
<p>It can explain nagging symptoms that frustrate a patient and the patient&#8217;s family &#8211; ending denial and dismissal or suspicion of the patient as malingerer &#8211; sometimes even by the patients physician. </p>
<p>KNowing has value, even if it doesn&#8217;t alter the actual date of death.</p>
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		<title>By: Anonymous</title>
		<link>http://www.kevinmd.com/blog/2006/10/will-chest-ct-soon-be-part-of-routine.html/comment-page-1#comment-68229</link>
		<dc:creator>Anonymous</dc:creator>
		<pubDate>Fri, 27 Oct 2006 14:04:00 +0000</pubDate>
		<guid isPermaLink="false">http://clients.emmense.com/kevinmd/2006/10/will-the-chest-ct-soon-be-part-of-the-routine-physical.html#comment-68229</guid>
		<description>&quot;The only logical response to this article is to buy stock in Siemens and GE.&quot;&lt;br/&gt;&lt;br/&gt;I beg to differ. GE is a huge company, some extra CT scans won&#039;t bump it&#039;s bottom line. I would buy the radiology outsourcers, ie Nighthawk radiology (NWHK) all they do is read films. On the same  theme, there&#039;s a company in San Diego called Biosite (BSTE) that makes alot of the defensive tests we order in the ER, like Troponin and BNP. &lt;br/&gt;&lt;br/&gt;I have no postions in any of these stocks, though my mutual funds own GE.</description>
		<content:encoded><![CDATA[<p>&#8220;The only logical response to this article is to buy stock in Siemens and GE.&#8221;</p>
<p>I beg to differ. GE is a huge company, some extra CT scans won&#8217;t bump it&#8217;s bottom line. I would buy the radiology outsourcers, ie Nighthawk radiology (NWHK) all they do is read films. On the same  theme, there&#8217;s a company in San Diego called Biosite (BSTE) that makes alot of the defensive tests we order in the ER, like Troponin and BNP. </p>
<p>I have no postions in any of these stocks, though my mutual funds own GE.</p>
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		<title>By: Anonymous</title>
		<link>http://www.kevinmd.com/blog/2006/10/will-chest-ct-soon-be-part-of-routine.html/comment-page-1#comment-68228</link>
		<dc:creator>Anonymous</dc:creator>
		<pubDate>Fri, 27 Oct 2006 10:27:00 +0000</pubDate>
		<guid isPermaLink="false">http://clients.emmense.com/kevinmd/2006/10/will-the-chest-ct-soon-be-part-of-the-routine-physical.html#comment-68228</guid>
		<description>The only logical response to this article is to buy stock in Siemens and GE.  Siemens medical imaging division is a larger part of their income stream then GI, so a bump in their CT scanner deman will result in more profit per dollar invested.  They are trading at a PE of 27.  Just document you suggested to each smoker they get this and pay for it out of pocket.  Do not fight the system.  Be the stream.  &lt;br/&gt;b</description>
		<content:encoded><![CDATA[<p>The only logical response to this article is to buy stock in Siemens and GE.  Siemens medical imaging division is a larger part of their income stream then GI, so a bump in their CT scanner deman will result in more profit per dollar invested.  They are trading at a PE of 27.  Just document you suggested to each smoker they get this and pay for it out of pocket.  Do not fight the system.  Be the stream.  <br />b</p>
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		<title>By: Anonymous</title>
		<link>http://www.kevinmd.com/blog/2006/10/will-chest-ct-soon-be-part-of-routine.html/comment-page-1#comment-68225</link>
		<dc:creator>Anonymous</dc:creator>
		<pubDate>Fri, 27 Oct 2006 03:06:00 +0000</pubDate>
		<guid isPermaLink="false">http://clients.emmense.com/kevinmd/2006/10/will-the-chest-ct-soon-be-part-of-the-routine-physical.html#comment-68225</guid>
		<description>&quot;How many people do we subject to needless evaluations?&quot; &lt;br/&gt;&lt;br/&gt;How many people have plaintiff&#039;s attorneys subjected to needless evaluations in cahoots with slimeball physicians in asbestos litigation screenings?  How about cardiac evaluations for fen-phen?  I&#039;m sure we could get the trial bar to fund these screening CT&#039;s; no need to get health insurers involved.</description>
		<content:encoded><![CDATA[<p>&#8220;How many people do we subject to needless evaluations?&#8221; </p>
<p>How many people have plaintiff&#8217;s attorneys subjected to needless evaluations in cahoots with slimeball physicians in asbestos litigation screenings?  How about cardiac evaluations for fen-phen?  I&#8217;m sure we could get the trial bar to fund these screening CT&#8217;s; no need to get health insurers involved.</p>
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		<title>By: Anonymous</title>
		<link>http://www.kevinmd.com/blog/2006/10/will-chest-ct-soon-be-part-of-routine.html/comment-page-1#comment-68224</link>
		<dc:creator>Anonymous</dc:creator>
		<pubDate>Fri, 27 Oct 2006 02:54:00 +0000</pubDate>
		<guid isPermaLink="false">http://clients.emmense.com/kevinmd/2006/10/will-the-chest-ct-soon-be-part-of-the-routine-physical.html#comment-68224</guid>
		<description>&quot;I haven&#039;t even open the doors to my internal medicine practice and I already feel like it&#039;s not worth it. ..... You know, maybe this country doesn&#039;t deserve my services as a community physician&quot;&lt;br/&gt;&lt;br/&gt;&lt;br/&gt;With this attitude I can assure you to get out now.  Nobody will want to see you.  Forget even being a concierge at a hotel, they won&#039;t want you either.  BTW do you know how many taxpayer dollars subsidized your training?</description>
		<content:encoded><![CDATA[<p>&#8220;I haven&#8217;t even open the doors to my internal medicine practice and I already feel like it&#8217;s not worth it. &#8230;.. You know, maybe this country doesn&#8217;t deserve my services as a community physician&#8221;</p>
<p>With this attitude I can assure you to get out now.  Nobody will want to see you.  Forget even being a concierge at a hotel, they won&#8217;t want you either.  BTW do you know how many taxpayer dollars subsidized your training?</p>
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		<title>By: Diora</title>
		<link>http://www.kevinmd.com/blog/2006/10/will-chest-ct-soon-be-part-of-routine.html/comment-page-1#comment-68221</link>
		<dc:creator>Diora</dc:creator>
		<pubDate>Fri, 27 Oct 2006 01:43:00 +0000</pubDate>
		<guid isPermaLink="false">http://clients.emmense.com/kevinmd/2006/10/will-the-chest-ct-soon-be-part-of-the-routine-physical.html#comment-68221</guid>
		<description>Slugger, thanks.&lt;br/&gt; &lt;br/&gt;But if chest CT is able to detect cancer even earlier, wouldn&#039;t there be more overdiagnosis?&lt;br/&gt;&lt;br/&gt;Also, haven&#039;t there been studies of chest X-ray that failed to find any mortality benefit? &lt;br/&gt;&lt;br/&gt;Just asking -- too much work nowadays to look stuff up myself.</description>
		<content:encoded><![CDATA[<p>Slugger, thanks.</p>
<p>But if chest CT is able to detect cancer even earlier, wouldn&#8217;t there be more overdiagnosis?</p>
<p>Also, haven&#8217;t there been studies of chest X-ray that failed to find any mortality benefit? </p>
<p>Just asking &#8212; too much work nowadays to look stuff up myself.</p>
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		<title>By: slugger</title>
		<link>http://www.kevinmd.com/blog/2006/10/will-chest-ct-soon-be-part-of-routine.html/comment-page-1#comment-68215</link>
		<dc:creator>slugger</dc:creator>
		<pubDate>Thu, 26 Oct 2006 20:05:00 +0000</pubDate>
		<guid isPermaLink="false">http://clients.emmense.com/kevinmd/2006/10/will-the-chest-ct-soon-be-part-of-the-routine-physical.html#comment-68215</guid>
		<description>Diora:&lt;br/&gt;The issue of overdiagnosis was looked at by Marcus in J Nat Cancer Inst 98:724 using data for the old Mayo Clinic chest X-ray study that ended in 1983. They found 85 overdx out of 585 cases detected. There were 6100 study participants.</description>
		<content:encoded><![CDATA[<p>Diora:<br />The issue of overdiagnosis was looked at by Marcus in J Nat Cancer Inst 98:724 using data for the old Mayo Clinic chest X-ray study that ended in 1983. They found 85 overdx out of 585 cases detected. There were 6100 study participants.</p>
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		<title>By: Anonymous</title>
		<link>http://www.kevinmd.com/blog/2006/10/will-chest-ct-soon-be-part-of-routine.html/comment-page-1#comment-68213</link>
		<dc:creator>Anonymous</dc:creator>
		<pubDate>Thu, 26 Oct 2006 19:48:00 +0000</pubDate>
		<guid isPermaLink="false">http://clients.emmense.com/kevinmd/2006/10/will-the-chest-ct-soon-be-part-of-the-routine-physical.html#comment-68213</guid>
		<description>&quot; But what is to prevent some doctors to start sending everyone for this test and not just smokers?&quot;&lt;br/&gt;&lt;br/&gt;Not waking up every morning scared shitless that I&#039;m going to end up spending 6 months being sodomized in court just for clocking in at work. Being able to get off the psych meds me and my colleagues have to take because it&#039;s just gotten too hard to deal with the daily stress of another frivolous lawsuit for just doing our job. It&#039;s called tort reform, but since Politicians don&#039;t give a shit, I will keep ordering millions of dollars in useless tests. I don&#039;t have a high powered legal team. Test ordering is my ONLY protection and defense.</description>
		<content:encoded><![CDATA[<p>&#8221; But what is to prevent some doctors to start sending everyone for this test and not just smokers?&#8221;</p>
<p>Not waking up every morning scared shitless that I&#8217;m going to end up spending 6 months being sodomized in court just for clocking in at work. Being able to get off the psych meds me and my colleagues have to take because it&#8217;s just gotten too hard to deal with the daily stress of another frivolous lawsuit for just doing our job. It&#8217;s called tort reform, but since Politicians don&#8217;t give a shit, I will keep ordering millions of dollars in useless tests. I don&#8217;t have a high powered legal team. Test ordering is my ONLY protection and defense.</p>
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