Why Some Doctors Hesitate to Screen Smokers for Lung Cancer (2015) • Hacker News Board

Re: Why Some Doctors Hesitate to Screen Smokers for Lung Cancer (2015)

#31

Post by maxxxxx » Thu, Apr 04, 2019, 5:36 PM UTC

athenot wrote: post #28

maxxxxx wrote: post #7

This sounds familiar. I have watched now quite a few people go through serious diseases. One pattern I saw was tests, tests and more tests. A lot of them very expensive, time consuming and painful. But when you ask what they will do with the test results there often is silence. To me it looks like they are doing something because “we need to do something”. Reminds me a little of data collection practices at companies…

As a patient (or a patient advocate for a loved-one), anytime a test is proposed it is important to ask what actionable information can come out of it. Basically look 2 steps ahead. Some tests will help confirm a course of treatment, or propose a new one. But what if that treatment is something you've already decided you won't do? For example in an older patient too old for a surgery or a baby that you've already dec…

"Some tests will help confirm a course of treatment, or propose a new one. But what if that treatment is something you've already decided you won't do? For example in an older patient too old for a surgery or a baby that you've already decided you'll keep.

"

I had the impression that a lot of doctors go through the same test protocols independent of patient situation. They are more deliberate with the actual treatment but there seems less thought about the necessity of testing.

Re: Why Some Doctors Hesitate to Screen Smokers for Lung Cancer (2015)

#32

Post by WhompingWindows » Thu, Apr 04, 2019, 5:39 PM UTC

skullborg wrote: post #29

nimbius wrote: post #11

I wonder if this is a "dont waste your time" issue coming from management? As an anecdotal example, Im an engine mechanic who routinely sees older trucks from the 80s and 90s. mostly idler/pitman arm replacements, tires, diff fluid, etc... on these which is expected as many are pushing a million miles or more. I had a 1981 International S1700 limp into my garage one day with a misfire problem due to long, long overdu…

Do share more stories on working on old trucks! I have a '99 Ford with a 7.3, and everyone's saying it's not worth fixing, but I just like keeping it on the road...

What kind of MPG does that get?

Re: Why Some Doctors Hesitate to Screen Smokers for Lung Cancer (2015)

#33

Post by crooked-v » Thu, Apr 04, 2019, 5:53 PM UTC

mistrial9 wrote: post #16

nimbius wrote: post #11

I wonder if this is a "dont waste your time" issue coming from management? As an anecdotal example, Im an engine mechanic who routinely sees older trucks from the 80s and 90s. mostly idler/pitman arm replacements, tires, diff fluid, etc... on these which is expected as many are pushing a million miles or more. I had a 1981 International S1700 limp into my garage one day with a misfire problem due to long, long overdu…

thank you for saying this ! The environmental "externalities" world is exactly like this! Saving generations of [insert-charismatic-species] from extinction in the wild is NOT PROFITABLE and will, in certain cases, be HIDDEN from investors and regulators.

Well, yes, paying for externalities is not profitable. That's the whole reason that people have to be forced to pay for them.

Re: Why Some Doctors Hesitate to Screen Smokers for Lung Cancer (2015)

#34

Post by djsumdog » Thu, Apr 04, 2019, 5:55 PM UTC

Didn't we see the exact same thing a decade ago with mammograms and breast cancer?

I remember there being two issues, one being computer aided detection in mammograms at the time was terrible for false positives compared to an experienced doctor (the the computer-aided was a selling/marketing point so people tended to opt for it).

The second was mammograms no longer being recommended for certain age groups, as they were shown in studies to just be ineffective. There was a backlash against such recommendations, under a kind of 'better safe than sorry' argument.

Re: Why Some Doctors Hesitate to Screen Smokers for Lung Cancer (2015)

#35

Post by elhudy » Thu, Apr 04, 2019, 5:56 PM UTC

linsomniac wrote: post #19

I've watched my family go through smoking, and cancer hasn't been the issue. I don't know how representative it is, but my experience definitely reflects the premise of this article: cancer testing could have caused way more harm than good. Both my mother and her father were still smoking frequently when they were on oxygen. In other words: When they should have known better. Her mother was looking really bad at 50 a…

This could be the most controversial thing comment I've posted on here, but...: Why are we even spending resources figuring out how to extend the lives of people who have smoked a pack a day, for 30 years, and are currently in old age? Even if we find cancer and save their lives now, will that prevent then from picking up smoking again? Will it prevent the heart disease they're going to encounter ten more years down the line? Dragging it out seems like a massive burden on the rest of society. I'm unsure how these studies are being funded but I just wonder if the money is better spent on helping people to stop smoking.

Re: Why Some Doctors Hesitate to Screen Smokers for Lung Cancer (2015)

#36

Post by moftz » Thu, Apr 04, 2019, 6:17 PM UTC

elhudy wrote: post #35

linsomniac wrote: post #19

I've watched my family go through smoking, and cancer hasn't been the issue. I don't know how representative it is, but my experience definitely reflects the premise of this article: cancer testing could have caused way more harm than good. Both my mother and her father were still smoking frequently when they were on oxygen. In other words: When they should have known better. Her mother was looking really bad at 50 a…

This could be the most controversial thing comment I've posted on here, but...: Why are we even spending resources figuring out how to extend the lives of people who have smoked a pack a day, for 30 years, and are currently in old age? Even if we find cancer and save their lives now, will that prevent then from picking up smoking again? Will it prevent the heart disease they're going to encounter ten more years down…

Those people (or their insurance) are willing to pay for treatment. If the market is there, why not fund some new research into treating lung cancer? Not every incidence of lung cancer is from smoking two packs a day, sometimes it just happens although its more rare. It's the idiots smoking two packs a day that are helping subsidize the research that can help save the person who just gets lung cancer randomly.

I think it's a hard choice between allowing for personal freedoms and improving society for the better by outlawing dangerous drugs like smoking and alcohol. I think there can be a balance by allowing everyone the same level of access to healthcare but increasing taxes on dangerous recreational drugs to subsidize the healthcare system. You can eat fast food and smoke all you want but it's going to cost you heavily financially.

Re: Why Some Doctors Hesitate to Screen Smokers for Lung Cancer (2015)

#37

Post by felipemnoa » Thu, Apr 04, 2019, 6:18 PM UTC

elhudy wrote: post #35

linsomniac wrote: post #19

I've watched my family go through smoking, and cancer hasn't been the issue. I don't know how representative it is, but my experience definitely reflects the premise of this article: cancer testing could have caused way more harm than good. Both my mother and her father were still smoking frequently when they were on oxygen. In other words: When they should have known better. Her mother was looking really bad at 50 a…

This could be the most controversial thing comment I've posted on here, but...: Why are we even spending resources figuring out how to extend the lives of people who have smoked a pack a day, for 30 years, and are currently in old age? Even if we find cancer and save their lives now, will that prevent then from picking up smoking again? Will it prevent the heart disease they're going to encounter ten more years down…

>>Why are we even spending resources figuring out how to extend the lives of people who have smoked a pack a day, for 30 years, and are currently in old age?

Slippery slope I guess (Plus it is immoral). Next somebody is gonna say why should certain kind of people get medical treatment instead of this other people who clearly deserve it more.

Re: Why Some Doctors Hesitate to Screen Smokers for Lung Cancer (2015)

#38

Post by rurp » Thu, Apr 04, 2019, 6:22 PM UTC

woliveirajr wrote: post #3

> "but [can also] find cancers that were never going to matter." I'm not sure, but isn't better to know that you have it and then investigate further, do more tests, perhaps do some period follow-up with a shorter interval? Otherwise it's just betting: I bet that I don't have a lung cancer that will be agressive....

The issue is that testing often comes with its own health costs and many tests return a fairly high rate of false positives, which in turn leads to surgeries that can take a high toll on the body.

Related to this, I recall reading about a study of elderly men with slow growing prostate cancer. Having surgery to remove the cancer did decrease the chance of dying from prostate cancer, but actually reduced their overall life expectancy. Prostate cancer surgery is hard on the body and an older person with a slow moving cancer has a pretty good chance of dying from some other cause before the cancer gets them.

Re: Why Some Doctors Hesitate to Screen Smokers for Lung Cancer (2015)

#39

Post by aladoc99 » Thu, Apr 04, 2019, 6:26 PM UTC

elhudy wrote: post #35

linsomniac wrote: post #19

I've watched my family go through smoking, and cancer hasn't been the issue. I don't know how representative it is, but my experience definitely reflects the premise of this article: cancer testing could have caused way more harm than good. Both my mother and her father were still smoking frequently when they were on oxygen. In other words: When they should have known better. Her mother was looking really bad at 50 a…

This could be the most controversial thing comment I've posted on here, but...: Why are we even spending resources figuring out how to extend the lives of people who have smoked a pack a day, for 30 years, and are currently in old age? Even if we find cancer and save their lives now, will that prevent then from picking up smoking again? Will it prevent the heart disease they're going to encounter ten more years down…

One of the truisms of medicine is that ultimately every disease and every treatment has a 100% mortality, so we can never truly save a life. What we can do is promote the quality and quantity of life. In the US, the rule of thumb is that it's worth spending $50,000 to keep someone alive for a year, with that being the approximate cost of dialysis therapy. So, to save 10 years of life would be expected to be worth spending a half a million bucks. Which is all to say that an additional 10 years of reasonable quality of life is worth a lot, both to society and to most individuals. The other strain in your comment suggests that people who are presumably in some way responsible for their disease are less worthy of care. This opens up a giant slippery slope. Start with drug use, smoking, alcohol use, being overweight, eating meat, drinking coffee, working too many hours a week... Ultimately only celibate teetotalling vegans are worthy of medical care.

Re: Why Some Doctors Hesitate to Screen Smokers for Lung Cancer (2015)

#40

Post by pytyper2 » Thu, Apr 04, 2019, 6:27 PM UTC

I periodically smoke, yet I don't call myself a smoker. Yet when I buy insurance I buy the smokers plan, the idea being that if I do need to use the insurance I expect the Insurance company to use any information necessary to deny my claim. Should I be worried about this?