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We’re a Lot Better at Fighting Cancer Than We Realized

cshl.nautil.us

41–50 of 142 posts

Re: We’re a Lot Better at Fighting Cancer Than We Realized

#41
post #16

Earlier quoted context omitted.

I'm curious about what kind of cancer masquerades as iron deficiency, an infection, and a benign tumor?

>I'm curious about what kind of cancer masquerades as iron deficiency, an infection, and a benign tumor? The kind of cancer where the patient can be easily dismissed by the doctor because of course they know best.

"...doctor because of course they know best" is a really strange thing to say. I don't mean to invoke paternalism here -- but between a patient with Google and a doctor with years of medical training, residency and practice, they more than likely do know best. At least, better than the patient. They won't always be right, and you can ask for a second opinion, but they do know better. If they didn't, you could practice your own medicine.

Re: We’re a Lot Better at Fighting Cancer Than We Realized

#43
post #31

Earlier quoted context omitted.

U.S. cancer treatment is the best in the world. The greatest research, innovation and results[1] happen in America. These are products of American Society. American Society is actually pretty good at fighting this disease. We devote huge resources to preventing, diagnosing and treating and have made great progress. The CAR T-Cell innovations are very promising and American research is making it work. Families often f…

> Specifically, the U.S. has the best cancer survival rates in the world. This is a misunderstanding of what "5 year survival rate" means. You're missing "lead time bias", and "over diagnosis bias". From Risk Savvy by Gerd Gigerenzer --begin quote While running for president of the United States, former New York City mayor Rudy Giuliani said in a 2007 campaign advertisement:1 "I had prostate cancer, 5, 6 years ago. M…

Thank you for sharing this quote, I learned about this a long time ago and have been looking for a compelling way to make the case. People are often surprised at how ineffective early and frequent screenings can be -- depending on the disease of course. The risk of unnecessary exploratory surgery and other adverse effects of a false positive can actually add to aggregate patient risk, not reduce it.

Re: We’re a Lot Better at Fighting Cancer Than We Realized

#44

Earlier quoted context omitted.

That doesn't mean that the system isn't dysfunctional. Merely that it's less dysfunctional than elsewhere.

Or that its excellence in treating cancers is biased towards certain populations. I dare say cancer treatment in people 65+ is bound to be better. And higher life expectancy in general seem to point to that. The cancers of the elderly are slower growing, in many demographic scenarios those people have more money & voice to get better treatment, and because they're old and often have comorbidities the doctor is more l…

You certainly highlight the difficulty of making an early and correct diagnosis in a patient group where that diagnosis is extremely rare. The real question is how much of this is cognitive bias, and how much is a reasonable balance between the harms of overtesting and the harms of misdiagnosis and late diagnosis.

The first is absolutely the responsibility of the medical profession, and we need to improve that. And if it was obvious malpractice, the family should sue the doctor or the healthcare organization that employs them - unfortunately I think there do still exist some healthcare organizations where the only way to get them to do the right thing in future is a risk of (another) massive lawsuit.

On the other hand, it's also a good doctor's responsibility to prevent harm from overtesting https://www.newyorker.com/magazine/2015/05/11/overkill-atul-... . And the US is probably worse in this regard than other countries. In fact, a quote front hat article specifically refers to back pain: "The researchers called it 'low-value care.' But, really, it was no-value care. They studied how often people received one of twenty-six tests or treatments that scientific and professional organizations have consistently determined to have no benefit or to be outright harmful. Their list included doing an EEG for an uncomplicated headache (EEGs are for diagnosing seizure disorders, not headaches), or doing a CT or MRI scan for low-back pain in patients without any signs of a neurological problem (studies consistently show that scanning such patients adds nothing except cost)".

But sometimes it's just bad luck, that a particular patient has a complaint that on average would not benefit from an MRI, but in their particular case, they probably would have.

Unfortunately, the only way for a non-medical person to tell if a particular patient's situation lies in the first group or the second is by suing the doctor (assuming that actually asking the doctor why they didn't do the test failed to provide a satisfactory answer). Most medical malpractice lawyers are "no win, no fee", so you can usually get a free consultation with a law firm that specialises in medical malpractice cases, and if they think there is a case there, they will take on the case. If they don't take on the case, it's usually because the care was reasonable (and therefore defensible), even though there was a terrible outcome.

None of that takes away from the pain suffered by patients and families in this kind of situations, but sometimes knowing there is a way to find out more and maybe address a specific injustice can be helpful.

Re: We’re a Lot Better at Fighting Cancer Than We Realized

#46
post #13

Earlier quoted context omitted.

From a pure conversational/social/emotional perspective, you maybe shouldn't lecture someone who's actually going through the first hand experience with the disease.

Most families deal with cancer at some time. Few are unaffected. Maybe we need focus on the hard part of fixing things. We can acknowledge emotions, get moderation of opinions and celebrate empathy but we need measurable results. U.S. Society is delivering on these.

> U.S. Society is delivering on these.

It simply isn't because of the cost of care is not appropriately distributed. Much of the population can't actually afford the wonderful care you espouse, and if you read down you'll see the US isn't necessarily actually better. More screenings and more diagnostic tests don't necessarily lead to better outcomes -- prostate tests are a great example of this -- but do increase the 5-year survival rates (in that the front end is extended but the back end isn't). What they don't do, though, is increase the cure rates.

In no small part because patients are being "sold" medicine, testing and treatments, and are profited off of. Similarly, doctors are getting sued senselessly. The lawsuits aren't just a nuisance, they're part of the reason these unnecessary tests are carried out in many cases; not doing so would create a liability.

I mean, OP got hit with $40,000 in bills with insurance -- you can't look at me with a straight face and call that world-class.

That's a deep and utter failure of society for allowing this to happen.

Re: We’re a Lot Better at Fighting Cancer Than We Realized

#47

From a science and pharmaceutical perspective, maybe. As the partner of someone in the US dealing with stage 4 cancer in their 40s, who has two hospitals fighting with each other over whether to keep using a chemo drug that's sent them into anaphylactic shock twice in two rounds of chemo because it's _more convenient_ for the infusion clinic to administer, and all of that currently held up by pre-approval from a rela…

The last bit of your comment, regarding misdiagnosis, reminds me of a recent episode of Peter Attia’s podcast The Drive, wherein he interviews an experienced oncologist. Her opinion was strong in that we are overspending in treatment research and underspending in (early) diagnosis research. Her case, as described in the interview, made sense to me and gave me some hope that at least others could benefit in the future…

The incentive for all parties (except the patients) is to increase revenue, rather than decrease costs. Insurance companies may want to reduce costs on a case by case basis, but on a macro level they want to spend more, since they are required to spend 80% of premiums received on treatment. More treatment means higher premiums, which means the 20% not spent on treatment is higher. Hospitals have similar incentives, since a higher top line means a higher bottom line. We need some sort of patient focused agent that is incentivized to minimize long term costs and maximize patient outcomes. Single payer government healthcare systems seem to do a decent job in this role in many countries. If there's a better method I'm open to it, but nothing will change until the economic incentives change or patient bargaining power increases.

Re: We’re a Lot Better at Fighting Cancer Than We Realized

#48

Earlier quoted context omitted.

>I'm curious about what kind of cancer masquerades as iron deficiency, an infection, and a benign tumor? The kind of cancer where the patient can be easily dismissed by the doctor because of course they know best.

"...doctor because of course they know best" is a really strange thing to say. I don't mean to invoke paternalism here -- but between a patient with Google and a doctor with years of medical training, residency and practice, they more than likely do know best. At least, better than the patient. They won't always be right, and you can ask for a second opinion, but they do know better. If they didn't, you could practic…

> If they didn't, you could practice your own medicine.

Which most people do.

Re: We’re a Lot Better at Fighting Cancer Than We Realized

#49

From a science and pharmaceutical perspective, maybe. As the partner of someone in the US dealing with stage 4 cancer in their 40s, who has two hospitals fighting with each other over whether to keep using a chemo drug that's sent them into anaphylactic shock twice in two rounds of chemo because it's _more convenient_ for the infusion clinic to administer, and all of that currently held up by pre-approval from a rela…

When my partner was 23 they were diagnosed with a recurrence of lymphoma. We went through almost six months of chemotherapy, radiation, a bone marrow transplant, and months in the hospital. All the while I was constantly fighting our "good" insurance for approvals and paying tens of thousands out of pocket. It was the worst season in both of our lives.

But today we are actually celebrating our anniversary, and my partner has been in remission for nine years. I hope you find some peace today and know that you are not alone.

Re: We’re a Lot Better at Fighting Cancer Than We Realized

#50
post #45

Yet there is no visible shift in cause of death distribution. Cancer is still up there, successfully competing with cardiovascular diseases for #1 spot.

I don't think that's necessarily a knock against cancer treatments. In the end we all have to die of something and late-life cancer is probably always going to be a leader. I think a better stat would be the average age of those who die of cancer and the survival rates of child cancers.
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