61–70 of 94 posts
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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?
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…
With chronic and serious conditions, like in oncology, some tests are pretty much the only way to see if there's any progress with the treatment and how the general health levels of the patient are (bloodtests).
False positives will be much more rare in practice with the new guidelines used (Lung RADS) which cut false positives by 50% or more while mostly preserving sensitivity. That doctor should really update his diagram to reflect the current standard of care for lung cancer screening. Using the false positive rate from the 2011 study is intellectually dishonest! In addition the amount of lung cancer deaths prevented was…
Honestly curious: are most radiologists actually following guidelines like Lung RADS in practice, especially just after publication? Is it part of any standardized CME? It's my impression that there's often a big gap between ACR best practices and what's happening on the ground in most places, which was a key point the doctor in the article was making.
It's not codified into Federal Law, but if reimbursement requires a Lung-Rads code, then it's more or less mandated.
I'd argue out of all the fields of medicine, Radiology is pretty quick to adopt new technology or reporting schemes "on the ground". See the proliferation of Lung-Rads, TI-Rads, Cad-Rads, LI-Rads, PI-Rads, etc.
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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.
From a practical perspective, setting aside issues like blame and responsibility and the dollar value of one life vs another, studying all types of disease increases our knowledge of human biology, and our knowledge of disease in general.
Keytruda is one example of a therapy that was developed to treat lung cancer (and melanoma), but now looks like it could be effective against other solid tumors that fit a genetic profile.
This is not to argue against smoking cessation (or more importantly, prevention) programs. Just that there are reasons to pursue lung cancer treatment research that go beyond the lungs entirely.
False positives will be much more rare in practice with the new guidelines used (Lung RADS) which cut false positives by 50% or more while mostly preserving sensitivity. That doctor should really update his diagram to reflect the current standard of care for lung cancer screening. Using the false positive rate from the 2011 study is intellectually dishonest! In addition the amount of lung cancer deaths prevented was…
https://www.uspreventiveservicestaskforce.org/BrowseRec/Inde...
It presents an evidence based pros v cons listing on screening and tries to present a informed approach, with less financial bias. The most toxic component of this entire issues also has to do with a form of defensive medicine that physicians engage in. Basically if you don't want problems don't look for them, not to say all physicians engage in this type of behavior. This mentality is very common amongst the older generations of physicians who fear the repercussion associated with minor mistakes.. Ie. doctor sends patient for CT suspicious finding are noted, doctor forgets to order future followup or some other variety of mistake... Patient ends up having cancer and the physician is slapped with a malpractice suit.
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>>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.
Compromise is inevitable.
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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.
> There's nothing inherently immoral about rationing healthcare. That a subjective statement, it is only true for you and those who agree with you. >In fact healthcare is already rationed everywhere for most patients. That is not an argument for the morality of rationed healthcare. We could make some sort of objective argument based upon ethics though. Suppose the smoker became addicted to cigarettes as a by-protect…
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"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…
“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.” Does it really make a difference what it is? Will you do anything differently?