Snyderman continues to extol the benefits of studies done by and for the exclusive financial benefit of the drug companies VS the more rational, and typically more in-depth independent studies. Her ”’Big Profits for Deep Pockets”’ approach to the promotion of a “drugged up America” is in stark contrast to general health advise and typical precautions she should be providing the viewers.

How would you feel if YOUR CANCER could have been detected earlier and saved your life?

Contrary to popular belief, doctors are not out to get you. If you think yours is doing the wrong thing, get another one.

What does her family history has to do with recommending PSA?

Guidelines are not the measure of what is appropriate for any given patient, which is worked out in context of the patient’s own life philosophy, discomfort avoidance orientation, disease anxiety, and the doctor-patient relationship.

Financial considerations are also an appropriate factor for the patient. If people paid for their healthcare at the time of service rather than collectivize the cost, then the difference in finacial cost for the patient vs society would not be a consideration. But the real cost of a $1000 screening procedure varies from patient to patient because the value of the$1000 varies in proportion to how hard the person had to work to get it and what competing demands are extant for that money. Insurance, in mitigating that inequality, creates other inequalities in which people spend other’s money with abandon on themselves for things that they would not consider worthwhile if it were their money.

These are not decisions that should be made collectively, they should be made individually, but our collectivization of payment is driving us ever closer to a lose of individual liberty in healthcare.

My father died of colon cancer in his 30’s. His brother contracted colon cancer in his early 40’s. This was 30 years ago, but there is reason to believe this represents HNPCC, the screening recommendations for which are much more stringent than the routine guidelines referenced by the original blogger. The recommendations include ANNUAL colonoscopy starting at age 40.

I don’t know the specifics of Dr. Snyderman’s situation, but it is entirely possible she is correct in her colonoscopy screening regimen.

Yes, public may not care about cost. But I think the reasons they don’t worry about false positives are a) they don’t quite understand the risks of potentially invasive tests b) they don’t know how high is the probability of having a false positive after years of testing c) they don’t understand that a small risk of harm from a test becomes much larger after years of testing d) they overestimate the benefit. The former is rarely mentioned in the media, the latter is always made seem larger. How often do we see a word “overdiagnosis” mentioned in the media, by the way?

Ever seen Fox Sunday Housecall? The doctor there is a professor at Cornell (at least according to the credentials they mention), apparently he also published a bunch of books. So naturally he is viewed as an expert. Yet some time ago he listed PSA as a must-have for men (I doubt he was afraid of lawsuits as I am sure media disclaimers take care of this, so what is his excuse?) as well as CT scan for smokers. A couple of weeks ago, a woman called saying how her own ObGyn recommended stopping pap smears because she had a hysterectomy for benign condition. After some disclaimers about being a cardiologist and her putting him in bad position of contradicting her doctor, he mentioned that he talked with a few of his ObGyn friends and they told him they continue it because of a small risk of vaginal cancer (he forgot to mention, no evidence of benefit or D recommendation from USPSTF). All the while a host talking to him was sitting right there, nodding and saying how it is better to be safe. So, now this woman is going to think her own doctor gave her bad advice, even though her own doctor tried to follow the evidence. Mind you, I thought it was rather stupid of her to call a cardiologist to question her own ObGyn, but it shows how much influence these TV shows have.