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

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

#41

Post by pytyper2 »

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...

It would depend on what needs fixing? Are we talking engine internals of the stuff that hangs of the engine?

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

#42

Post by nradov »

moftz wrote: post #36
elhudy wrote: post #35

Earlier quoted context omitted.

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 thin…

Unlike some other forms of cancer, random lung cancer is exceedingly rare. The vast majority of lung cancer patients were smokers.

As a society we have limited resources for healthcare. So it's worth considering whether we might achieve better net results by shifting some resources from lung cancer treatment to smoking cessation programs.

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

#44

Post by nradov »

felipemnoa wrote: post #37
elhudy wrote: post #35

Earlier quoted context omitted.

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.

There's nothing inherently immoral about rationing healthcare. In fact healthcare is already rationed everywhere for most patients. In the US we mostly ration based on wealth, age, and employment status. But that doesn't necessarily mean other approaches are less moral.

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

#45

Post by JamesBarney »

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…

Most diseases have some human choices involved. Living in a city with bad smoke, not running every day, poor diet, or drinking.

Maybe you're perfect and run every day, living in the country side, only eat fruits and vegetable and have never had a cigarette or beer your entire life.

But most of us aren't perfect. And honestly if you are the perfect specimen you are going to cost society far more because everyone dies of something. And slowly dying of alzheimer's disease in your late 90's is way more expensive because you'll live in in a nursing home with full time care for your last ten year and you've been using medicare and social security for 30 years.

Dying in your 50's from lung cancer is it's own punishment.

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

#46

Post by lilbobbytables »

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...

I thought the 7.3's were supposed to be super solid? How many miles does it have, what's wrong with it?

My extremely limited knowledge of diesel engines is something like "they go a ton of miles, then need a major overhaul, then go a ton more miles". If you're at some kind of major overhaul milestone, then I could see the response you're getting.

'99-ish Ford kicked off the Super Duty series, but it isn't sufficiently interestingly old to a lot of people, so I can understand their the why-bother attitude.

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

#47

Post by JamesBarney »

nradov wrote: post #44
felipemnoa wrote: post #37

Earlier quoted context omitted.

>>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.

There's nothing inherently immoral about rationing healthcare. In fact healthcare is already rationed everywhere for most patients. In the US we mostly ration based on wealth, age, and employment status. But that doesn't necessarily mean other approaches are less moral.

But I think we should ration care based on effectiveness of the treatment not moral deservingness.

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

#48

Post by repiret »

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…

No, the argument is specifically that the harm from following up on false positives outweighs the benefit from finding true positives. While the 2011 study that the Medicare policy change is based on specifically concludes that this will not be the case, the concern is that the study found a lower false positive rate than would be seen in the wild, due to better skill and greater diligence from the radiologists participating in the study.

Harm from false positives is a real thing, especially for a test with a relatively high false positive rate and relatively invasive followup to false positives (they don't state it specifically, but the theater analogy implies 66X more false positives than true)

Furthermore, unlike an auto mechanic who might not be able to bill much for finding problems the owner doesn't want fixed, or following up on a diagnostic computer finding that turns out to not be a problem at all, the healthcare system at large stands to profit from both the screening and the follow up on those false positives, so the bean counting manager shouldn't be applying pressure to skip the screening.

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

#49

Post by nradov »

hackeraccount wrote: post #6
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....

"investigate further" is the sticking point. You're swimming in the ocean and notice something beneath you. Is it a friendly dolphin or a dangerous shark? Do you hold your breath and do a deep dive to figure out which it is? Keep in mind the deeper you go the greater the chance that you'll drown. It's a strained analogy but I think it gets at the problem. What if you dive a little bit deep - some minor test - and sti…

I understand your point, but let's dispel the myth of dangerous sharks. The vast majority of shark species never attack humans at all and it's totally safe to swim near them.

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

#50

Post by 52-6F-62 »

sampleinajar wrote: post #4

Anecdotally, as an ex-smoker who quit after my mother died from lung cancer, I spoke to my doctor about screening. He did a lot of dismissing and hand waving about it. It upset me greatly at the time. This article explains it all well enough. Doctor/patient communication is very important.

How long did you smoke?

My own anecdote:

I was athletic when I was younger, but I was a regular smoker through most of my twenties.

I quit a few years back. My doctor would check my breathing, etc, with everything I'd told him about my habit. He gave me the surprising news that my lungs would be virtually back to virgin health in 4-5 years (after nearly 10 years of smoking). And to get back to exercising more.

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