Comments on: Will the chest CT soon be part of the routine physical? http://www.kevinmd.com/blog/2006/10/will-chest-ct-soon-be-part-of-routine.html Tue, 14 Feb 2012 19:56:00 +0000 hourly 1 By: Diorahttp://www.kevinmd.com/blog/2006/10/will-chest-ct-soon-be-part-of-routine.html#comment-68234 Diora Fri, 27 Oct 2006 17:12:00 +0000 http://clients.emmense.com/kevinmd/2006/10/will-the-chest-ct-soon-be-part-of-the-routine-physical.html#comment-68234 <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.""</i><br/><i>A known life-threatening illness changes, in most cases, a person'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 "nagging" 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. <br/><br/>Also, for every person who gets this "advance knowldedge", 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 "cancer" 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. <br/><br/>This why some evidence that CT saves lives is really important; otherwise, more people can get hurt than are helped. 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.”"
A known life-threatening illness changes, in most cases, a person’s priorities. It allows estate planning and adjustments to expenditure and investment of resources.
Yes, but think about quality of life implications. Keep in mind, they are not talking about people who have “nagging” 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.

Also, for every person who gets this “advance knowldedge”, 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 “cancer” 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.

This why some evidence that CT saves lives is really important; otherwise, more people can get hurt than are helped.

]]> By: Diorahttp://www.kevinmd.com/blog/2006/10/will-chest-ct-soon-be-part-of-routine.html#comment-68233 Diora Fri, 27 Oct 2006 17:11:00 +0000 http://clients.emmense.com/kevinmd/2006/10/will-the-chest-ct-soon-be-part-of-the-routine-physical.html#comment-68233 <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.""</i><br/><i>A known life-threatening illness changes, in most cases, a person'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 "nagging" 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. <br/><br/>Also, for every person who gets this "advance knowldedge", 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 "cancer" 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. <br/><br/>This why some evidence that CT saves lives is really important; otherwise, more people can get hurt than are helped. 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.”"
A known life-threatening illness changes, in most cases, a person’s priorities. It allows estate planning and adjustments to expenditure and investment of resources.
Yes, but think about quality of life implications. Keep in mind, they are not talking about people who have “nagging” 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.

Also, for every person who gets this “advance knowldedge”, 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 “cancer” 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.

This why some evidence that CT saves lives is really important; otherwise, more people can get hurt than are helped.

]]> By: SarahWhttp://www.kevinmd.com/blog/2006/10/will-chest-ct-soon-be-part-of-routine.html#comment-68231 SarahW Fri, 27 Oct 2006 14:30:00 +0000 http://clients.emmense.com/kevinmd/2006/10/will-the-chest-ct-soon-be-part-of-the-routine-physical.html#comment-68231 <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."</i>"<br/><br/>The date of death may be the same.<br/>Why does this physician not realize that knowlege of what is happening in one's own body has value?<br/><br/>A known life-threatening illness changes, in most cases, a person'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'es state of health allows it to be accomplished.<br/><br/>It can explain nagging symptoms that frustrate a patient and the patient's family - ending denial and dismissal or suspicion of the patient as malingerer - sometimes even by the patients physician. <br/><br/>KNowing has value, even if it doesn't alter the actual date of death. “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.”“

The date of death may be the same.
Why does this physician not realize that knowlege of what is happening in one’s own body has value?

A known life-threatening illness changes, in most cases, a person’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’es state of health allows it to be accomplished.

It can explain nagging symptoms that frustrate a patient and the patient’s family – ending denial and dismissal or suspicion of the patient as malingerer – sometimes even by the patients physician.

KNowing has value, even if it doesn’t alter the actual date of death.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2006/10/will-chest-ct-soon-be-part-of-routine.html#comment-68229 Anonymous Fri, 27 Oct 2006 14:04:00 +0000 http://clients.emmense.com/kevinmd/2006/10/will-the-chest-ct-soon-be-part-of-the-routine-physical.html#comment-68229 "The only logical response to this article is to buy stock in Siemens and GE."<br/><br/>I beg to differ. GE is a huge company, some extra CT scans won't bump it's bottom line. I would buy the radiology outsourcers, ie Nighthawk radiology (NWHK) all they do is read films. On the same theme, there'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. <br/><br/>I have no postions in any of these stocks, though my mutual funds own GE. “The only logical response to this article is to buy stock in Siemens and GE.”

I beg to differ. GE is a huge company, some extra CT scans won’t bump it’s bottom line. I would buy the radiology outsourcers, ie Nighthawk radiology (NWHK) all they do is read films. On the same theme, there’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.

I have no postions in any of these stocks, though my mutual funds own GE.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2006/10/will-chest-ct-soon-be-part-of-routine.html#comment-68228 Anonymous Fri, 27 Oct 2006 10:27:00 +0000 http://clients.emmense.com/kevinmd/2006/10/will-the-chest-ct-soon-be-part-of-the-routine-physical.html#comment-68228 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 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.
b

]]> By: Anonymoushttp://www.kevinmd.com/blog/2006/10/will-chest-ct-soon-be-part-of-routine.html#comment-68225 Anonymous Fri, 27 Oct 2006 03:06:00 +0000 http://clients.emmense.com/kevinmd/2006/10/will-the-chest-ct-soon-be-part-of-the-routine-physical.html#comment-68225 "How many people do we subject to needless evaluations?" <br/><br/>How many people have plaintiff's attorneys subjected to needless evaluations in cahoots with slimeball physicians in asbestos litigation screenings? How about cardiac evaluations for fen-phen? I'm sure we could get the trial bar to fund these screening CT's; no need to get health insurers involved. “How many people do we subject to needless evaluations?”

How many people have plaintiff’s attorneys subjected to needless evaluations in cahoots with slimeball physicians in asbestos litigation screenings? How about cardiac evaluations for fen-phen? I’m sure we could get the trial bar to fund these screening CT’s; no need to get health insurers involved.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2006/10/will-chest-ct-soon-be-part-of-routine.html#comment-68224 Anonymous Fri, 27 Oct 2006 02:54:00 +0000 http://clients.emmense.com/kevinmd/2006/10/will-the-chest-ct-soon-be-part-of-the-routine-physical.html#comment-68224 "I haven't even open the doors to my internal medicine practice and I already feel like it's not worth it. ..... You know, maybe this country doesn't deserve my services as a community physician"<br/><br/><br/>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't want you either. BTW do you know how many taxpayer dollars subsidized your training? “I haven’t even open the doors to my internal medicine practice and I already feel like it’s not worth it. ….. You know, maybe this country doesn’t deserve my services as a community physician”

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’t want you either. BTW do you know how many taxpayer dollars subsidized your training?

]]> By: Diorahttp://www.kevinmd.com/blog/2006/10/will-chest-ct-soon-be-part-of-routine.html#comment-68221 Diora Fri, 27 Oct 2006 01:43:00 +0000 http://clients.emmense.com/kevinmd/2006/10/will-the-chest-ct-soon-be-part-of-the-routine-physical.html#comment-68221 Slugger, thanks.<br/> <br/>But if chest CT is able to detect cancer even earlier, wouldn't there be more overdiagnosis?<br/><br/>Also, haven't there been studies of chest X-ray that failed to find any mortality benefit? <br/><br/>Just asking -- too much work nowadays to look stuff up myself. Slugger, thanks.

But if chest CT is able to detect cancer even earlier, wouldn’t there be more overdiagnosis?

Also, haven’t there been studies of chest X-ray that failed to find any mortality benefit?

Just asking — too much work nowadays to look stuff up myself.

]]> By: sluggerhttp://www.kevinmd.com/blog/2006/10/will-chest-ct-soon-be-part-of-routine.html#comment-68215 slugger Thu, 26 Oct 2006 20:05:00 +0000 http://clients.emmense.com/kevinmd/2006/10/will-the-chest-ct-soon-be-part-of-the-routine-physical.html#comment-68215 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. Diora:
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.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2006/10/will-chest-ct-soon-be-part-of-routine.html#comment-68213 Anonymous Thu, 26 Oct 2006 19:48:00 +0000 http://clients.emmense.com/kevinmd/2006/10/will-the-chest-ct-soon-be-part-of-the-routine-physical.html#comment-68213 " But what is to prevent some doctors to start sending everyone for this test and not just smokers?"<br/><br/>Not waking up every morning scared shitless that I'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's just gotten too hard to deal with the daily stress of another frivolous lawsuit for just doing our job. It's called tort reform, but since Politicians don't give a shit, I will keep ordering millions of dollars in useless tests. I don't have a high powered legal team. Test ordering is my ONLY protection and defense. ” But what is to prevent some doctors to start sending everyone for this test and not just smokers?”

Not waking up every morning scared shitless that I’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’s just gotten too hard to deal with the daily stress of another frivolous lawsuit for just doing our job. It’s called tort reform, but since Politicians don’t give a shit, I will keep ordering millions of dollars in useless tests. I don’t have a high powered legal team. Test ordering is my ONLY protection and defense.

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