1) Claudia Henschke has been coming under fire after the NY Times connected her research to tobacco companies.
My take: She has been the most zealous proponent of CT scans for lung cancer screening. Unreasonably at times, ignoring basic evidence-based medicine principles. Perhaps in the future its time will come. Today, the data is too inconclusive to make a firm recommendation.
Now that we hear that she stands to benefit financially (through the patents she held on the technology), and that Big Tobacco financed her research.
It is unfortunate that the media took her message and ran with it. Hopefully they will report the questions surrounding her research with the same vigor.
2) Medicare is on the road to insolvency.
My take: Dr. Wes alluded to this today.
Physicians are being killed slowly with payments not keeping up with practice costs, patients face rising health premiums, and the number of uninsured continue to grow.
Maybe we should let Medicare die, so some real change can happen.
3) Only half of all patients with heart attacks arrive to the hospital via ambulance.
My take: In cases of acute MI, seconds count. It is foolish to discount chest pain unless proven otherwise. Don’t “tough it out” and drive yourself to the hospital when chest pain occurs.
4) The BBC reported that breast MRIs are having problems with specificity.
My take: Specificity is defined as the frequency of a positive test in the absence of disease. As advanced imaging studies continue to be promoted by the media as “better”, more patients will believe that.
The problem is that CTs, MRIs or PET scans increasingly detect findings that are benign, leading to more invasive tests. Unnecessarily ordering these studies exposes the patient to potential biopsies, which can have serious complications.
Related posts:
- Claudia Henschke disgraced
- CT scans
- Why too many CT and MRI scans can be dangerous for patients
- Did Claudia Henschke take cigarette money?
- A specificity problem with breast MRIs?
- Philip Morris and academic research
- How does cancer screening cause harm?
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Medicare projected cumulative deficits are well into the double figure trillions (no, not a misprint).
Medicare is therefore simply a classic Ponzi Scheme, albeit perhaps the largest in human history, nearing the mathematical end of the scam.
And yet the vast majority of the Ponzi Scheme’s victims (doctors and patients) are totally oblivious to the obvious. The mental mechanism of denial never ceases to amaze.
Dr. Wes’ brilliant analysis is the first blueprint I have read, with prescriptions for surviving the near future inevitable. Well worth a read.
http://drwes.blogspot.com/2008/03/imagine-world-without-medicare.html
At least Claudia Henschke didn’t take a pen or a sticky pad.
I vote for a “Kevin’s Take” section with comments available for each separate post…
#1
Why isn’t this behavior just a logical extension of fee for service medicine? So she’s making a buck(or 2) on a scheme. Would not a true free market supporter(like Kevin) relish this entrepreneurial attitude? Docs are human. Systems need to reflect this.
#3. Gosh Kevin, it sounds like you are infavor of promoting public awareness rather than investigating another coated stent. Is the “public health” side of you showing?
#4.
Ferreting out the nuance and subtlety of statistical screening specificity/sensitivity can only be accomplished by a motivated individual. The only way I can imagine the public finding this motivation is if the decisions involves THEIR money. But screening is an impossible sell to the general public. SO, again, should market forces be applied or a public health model?
Most civilized nations agree the public health is in the public’s interest to fund. And control. Then if the folks with big bucks want an elective Breast screening MRI to feel special…let ‘em.
About once a month someone arrives at our clinic with chest pain or some sort of funky arrhythmia (usally afib with rapid response). I’m blown away at how reluctant staff and patients are to call 911. Someone can be having classic chest pain and they still want to drive to hospital. I think it’s a desire not to squander resources but I wonder what the effect has been of campaigns to stop useless 911 calls. Maybe we need to go back to the early 1980’s campaigns when 911 was first introduced?
According to Kevin, most physicians on here prescribe all kinds of tests people don’t need and that aren’t medically indicated out of a fear that they might not have as much money in their pockets.
But this woman should be vilified for doing the same thing?
Not to mention that nearly every physician is in bed with “Big Tobacco” on tort reform, and all so they can both keep a few dollars, but again this woman should be questioned because she’s also in bed with Big Tobacco?
Sounds like physicians are finding the speck in another’s eye.
Ignoring Cave Troll Lawyer for a moment, I’m still confused about the massive conflict of interest tobacco has with regard to lung cancer scanning. If anything it would detect more lung cancers. It’s typical of the kneejerk reaction that (vilified industry) must have a secret hidden evil reason for everything, much like Dick Cheney in his hidden secret base. Sometimes a cigar is just a cigar.
The patent stuff is totally unacceptable, but she’ll get hammered for that (and rightfully). But the furor over the tobacco money, complete with allegations of “blood money” is absurd.
My antidotal experience with breast MRI’s is that they are not good screening tools.
I interact with a group where all the women have already had breast cancer, so they’re considered high risk. A number have had MRI’s as a matter of their routine follow-on, and more than half (of a very small number) have had biopsies — none of which have resulted in anything besides a fee for the facility.
If I were a payer I would be setting conditions on MRI usage because it seems like they just run up bills and worry without actually finding very much.
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