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Experts warn yearly checkups carry risks and do not reduce mortality

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Re: Experts warn yearly checkups carry risks and do not reduce mortality

#221

Post by boatsie »

elevatedastalt wrote: post #155
prirun wrote: post #92

Personal example: my primary care physician scheduled me for a physical, including picking the date, without even asking. It just showed up on my online chart. Okay, I hadn't had a physical for a while, so I just went with it. While stopped at an intersection on the way to his office, a woman plowed into me and 2 other cars because she wasn't paying attention, and was likely on her phone. That wreck generated $45K of…

Oh, wow, I had the exact same experience (about elevated AST, ALT, not the car accident). It's got nothing to do with protein shakes, it happens when you start working out after a long break. I went for my regular checkups and my AST ALT levels were through the roof (3-4 times the max value). The doctor ordered a few more tests, an ultrasound etc. I was very shocked, because my levels were perfectly normal a year bef…

Same experience here, though it was just regular intense exercise, not a return to exercise. Of course the doctor sort of chuckled and laughed when I theorized this as the cause of the elevated liver enzymes and said “no, exercise is good for you”.

Re: Experts warn yearly checkups carry risks and do not reduce mortality

#222

Post by briHass »

smileysteve wrote: post #54
watwut wrote: post #15

Earlier quoted context omitted.

I think that in that case, the issue is not that patient had checkup, but that standard reaction to high cholesterol is wrong. Having it checked up less often may help the patient, but real fix for healthcare system would be to not prescribe this medication in this situation.

But how does the statin market stay rich and how do doctors get those marketing dollars

The vast majority of common statins are off patent and extremely inexpensive. Pharmacies often offer them at around $5/month, without insurance, usually free with.

The 'better' cholesterol drugs like the PCSK9s are expensive, but insurance almost always demands a first-line (cheap) drug be tried first for typical hypercholesterolemia.

Re: Experts warn yearly checkups carry risks and do not reduce mortality

#223

Post by ripe »

The physician who acknowledges the imperfections of a diagnostic test will ask, "In view of this test result, how uncertain should I be about this patient?" Fortunately, there is a method for answering this question: the theory of probability. [1] is a primer for applying probability theory to the interpretation of test results and deciding when to do a test rather than treat or do nothing.

Physicians often must start treatment when still uncertain about whether the patient has the disease. If treatment is started, there is a risk of causing harm to a person who does not have the disease, as well as the prospect of benefiting the person who does. If treatment is withheld, a person who is diseased will be denied a chance at a rapid, effective cure.

The method for solving this problem analytically is called the threshold model of medical decisionmaking (Pauker and Kassirer 1975, 1980; Doubilet 1983). The threshold model is an example of expected-value decisionmaking that is applied to a particular type of decision.

The key idea is the treatment threshold probability, which is the probability of disease at which one is indifferent between treating and not treating. The basic principle of the threshold model is the following dictum: Do a test only if the probability of disease could change enough to cross the treatment threshold probability.

[1] Sox H, Stern S, Owens D, et al.; Institute of Medicine (US) Council on Health Care Technology. Assessment of Diagnostic Technology in Health Care: Rationale, Methods, Problems, and Directions: Monograph of the Council on Health Care Technology. Washington (DC): National Academies Press (US); 1989. 2, The Use of Diagnostic Tests: A Probabilistic Approach. https://www.ncbi.nlm.nih.gov/books/NBK235178/

Re: Experts warn yearly checkups carry risks and do not reduce mortality

#224

Post by rurp »

hayst4ck wrote: post #151

Half the posts in this thread bring back the old SlashDot adage: The plural of anecdote is not data. I am not sure what the point this article is trying to make is. I do not feel more informed for having read it. It seems a populist appeal to the idea that the medical institution has no idea what it is doing. Is it good, is it bad? It doesn't matter. The end result is damaged institutional trust. How many people woul…

I think this is unnecessarily conspiratorial. Medical tests often have much more uncertainty than most expect, and many interventions are net negative on average.

This particular research was new to me but I have seen a number of studies of cancer screenings and treatment showing the same or even worse effects. The recommended standards for some cancer screenings have been updated in recent years to be more restrained since it was shown they were having a negative effect in certain cases.

Many tests have fairly high false positive rates. This leads to a lot of unnecessary treatment with negative health consequences. There are also a number of scenarios where treatment reduces the mortality rate from one specific issue, but increases mortality overall because of the associated harm of treatment.

This isn't some homeopothy plug -- that stuff is nonsense. But I would suggest being somewhat skeptical of boilerplate medical advice.

Re: Experts warn yearly checkups carry risks and do not reduce mortality

#225

Post by nemothekid »

jjcon wrote: post #188
hayst4ck wrote: post #166

Earlier quoted context omitted.

Institutional corruption will not be solved by losing trust in the institutions. When the institution dies because nobody trusts it you don't all of a sudden get good health care. So if you believe that our medical institutions are corrupted, anger at the institution itself is misdirected. The corruptive force is billionaires and the measurement for the level of corruption is wealth disparity.

So when the US FDA is shilling for obesity drugs, says that being obese isn’t a lifestyle problem but is purely genetic. Medical schools are lowering/removing certain standards for admission under the guise of ‘equity’ - thats all just some billionaires faults? Sorry, I don’t buy it. The medical and pharmaceutical industries have been rotting for decades in the US and protecting them, “because it would be better for…

>So when the US FDA is shilling for obesity drugs, says that being obese isn’t a lifestyle problem but is purely genetic

The FDA has never claimed obesity is purely genetic and it's own guidelines state multiple factors for obesity and stringent guidelines for the approval of drugs that target specific genetic disorders.

>Medical schools are lowering/removing certain standards for admission under the guise of ‘equity’

This doesn't seem true at all, and seems like an extension of the "woke" boogeyman we see in undergrad.

The problem with this kind of thinking is it's hard to assign anysort of motivation for these actions without sounding cartoonish. The FDA wants to say obesity is a purely genetic for what reason? Who is enriched when the FDA says this? Does the FDA get some kickback every time there's a new obese person?

>State the problem, state it clearly. Don’t shift blame around to invisible boogeymen.

The for-profit medical system has created a two-tier treatment system that is incentivized to protect profits over providing adequate care. This includes both providing poor treatment to those who cannot pay as well as providing ineffective treatment to wealthier americans in order to sell more expensive, patented drugs. Any political action to change this system is effectively stonewalled due to "invisible boogeymen" who all happen to have the same political interests in keeping current profitable system and are able to easily buy politicians to prevent any radical change from going through. The incentive is clear - to protect profit margins.

Re: Experts warn yearly checkups carry risks and do not reduce mortality

#226

Post by mrtweetyhack »

newsclues wrote: post #95
sklargh wrote: post #18

I have a personal example of this. My father died largely because of his annual physical. He hated doctors, became nervous around them and thus expressed hypertension in-office. He did not have material hypertension but did defer to his physician. Over the long term, despite my best efforts, this killed him. His blood pressure medication regime was poorly managed and severely impacted his quality of life. He eventual…

I listen to my doctors advice, but I don't follow my doctors orders. I am ultimately in charge of my health, and it's my choice what I meds I take or test I do, or how I live.

[dead]

Re: Experts warn yearly checkups carry risks and do not reduce mortality

#227

Post by armitron »

remexre wrote: post #106
armitron wrote: post #22

Earlier quoted context omitted.

A lot of cancers have no symptoms at the beginning, but they can be flagged in blood tests performed as part of general health checkups.

Do annual checkups involve blood tests where you are? I've only had blood taken as part of one once, and that was in direct response to a new diagnosis of a health condition in a grandparent.

Of course, blood and urine. I do them every six months, even though my insurance only covers once a year, I'm happy to pay out of pocket for the second.

Re: Experts warn yearly checkups carry risks and do not reduce mortality

#228

Post by yesbut »

hayst4ck wrote: post #211
yesbut wrote: post #207

Earlier quoted context omitted.

The government is us. Not some aliens. We should be democratically deciding what is correct and what is a violation and what the consequences for violating trust are. We should not hand that decision over to a few elected representatives. This should be a collective democratic process. * legalize abortion? yes or no * go to war? yes or no * arm teachers? yes or no * corporate news outlet allowed to sell ad time to co…

How do "we" decide something? It sounds like you are advocating for mob rule but calling it democracy. Help me understand how that is not what you are saying. What is the "collective democratic process" you are advocating for? How does a law get made and how does a law get enforced?

Democracy is mob rule. Direct democracy. The fear of "too much democracy" is only a fear for people who are afraid that others might not want the same things they do. One person, one vote is mob rule. What that requires is a well informed, well educated population. Instead we have an ignorant, uninformed population that leaves all of the important decisions to a hand full of representatives that tend to run things the way their wealthy donors want.

Re: Experts warn yearly checkups carry risks and do not reduce mortality

#229

Post by firstlink »

newsclues wrote: post #95
sklargh wrote: post #18

I have a personal example of this. My father died largely because of his annual physical. He hated doctors, became nervous around them and thus expressed hypertension in-office. He did not have material hypertension but did defer to his physician. Over the long term, despite my best efforts, this killed him. His blood pressure medication regime was poorly managed and severely impacted his quality of life. He eventual…

I listen to my doctors advice, but I don't follow my doctors orders. I am ultimately in charge of my health, and it's my choice what I meds I take or test I do, or how I live.

> my choice what I meds I take

Well, as long as you want to take a subset of whatever the doctor du jour wants to give you.

Re: Experts warn yearly checkups carry risks and do not reduce mortality

#230

Post by midoridensha »

hayst4ck wrote: post #170
yesbut wrote: post #163

Earlier quoted context omitted.

I don't think the solution is just leaving our complex decisions over to others. I think the solution is that we all need to be better informed. A doctor doesn't decide to do something for us unless we're incapacitated. The doctor informs us of our options and risks and we get to make the decisions ourselves. In the same vein (vain pun would have been better), we need more opportunities to decide for ourselves than w…

What you are arguing is that we should be a low trust society: https://en.wikipedia.org/wiki/High_trust_and_low_trust_socie... No. The government should provide consequences for those who violate trust promoting the idea that I can trust someone else who is from the same society I am. Here is a game that shows what happens at a societal level when doctors lie or mechanics over charge: https://ncase.me/trust/ In the g…

>What you are arguing is that we should be a low trust society

Who's "we"? Not everyone lives in your country.

If you're talking about the US, that's definitely a low-trust society.

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