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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)

#81

Post by cellularmitosis »

lilbobbytables wrote: post #46
skullborg wrote: post #29

Earlier quoted context omitted.

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 sufficientl…

> they go a ton of miles, then need a major overhaul, then go a ton more miles

Yup. Not unusual for big rigs to go a million miles between overhauls.

Even for "consumer" diesels, the engine typically outlasts the vehicle around it.

I drove a '97 Dodge which had 300k on the odo, got tired of the poor interior and upgraded to an '06 with 200k. I even threw a mercedes diesel into a 67 chevy pickup, because diesels are great :) https://www.youtube.com/watch?v=yFd1ZL2hgMY

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

#82

Post by tomcam »

unchocked wrote: post #79
skullborg wrote: post #59

Earlier quoted context omitted.

It's nearing 400k miles. It's had service - new turbo and engine control components, suspension and frontend, brakes, glow plugs, etc. Original everything else though, nothing fancy, just a work truck. But anything "newer", even 10 years old, is $25k minimum for any halfways decent duty truck.

Your 7.3 is gold, that engine will last till the heat death of the universe. And you’re maintaining it. For some reason people think that a well maintained vehicle is a grenade because it has service history, while one being run into the ground is great because they haven’t paid for anything recently. Newer trucks aren’t more reliable. They’re just newer. You won’t find a truck cheaper to maintain than the one you’ve…

Please tell me the story about your mother-in-law is an exaggeration

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

#83

Post by athenot »

maxxxxx wrote: post #31
athenot wrote: post #28

Earlier quoted context omitted.

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 treatmen…

It also varies by doctor. Some like to order more tests than their peers. That's why it's important to have a doctor with whom you can openly discuss these tradeoffs. The vast majority are open to that, but some will give you the stink eye if they interpret that as you questionning their algorithm.

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

#84

Post by diob »

nradov wrote: post #42
moftz wrote: post #36

Earlier quoted context omitted.

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.

Just to give you a data point. I grew up in a family that smoked in the house. I've never smoked myself.

I hope you aren't suggesting that I should be condemned for the sins of my parents if I should one day get lung cancer.

Also keep in mind that pollution is going to be a large (if not the largest) contributor to lung cancer in the future.

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

#85

Post by hermitdev »

pytyper2 wrote: post #41
skullborg wrote: post #29

Earlier quoted context omitted.

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?

Typically, diesels are built with maintenance in mind (at least for trucks, no idea what you'd find in a diesel car). The cylinders are sleaved and meant to be replaced every couple 100k miles or so, so the cylinders themselves also last a long time (the sleaves take the brunt of the wear). I think theyre typically less complex than a standard gasoline engine. E.g. they have no spark plugs (and thus no distributor or ignition system), instead glow plugs to start the engine. Possibly more complex in other areas, such as emissions control.

I'm no expert on engines, so the the above may not be entirely accurate or current. Most of my knowledge comes from working for a semi truck/diesel engine manufacturer as an IT intern close to two decades ago and touring factories.

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

#86

Post by kevin_thibedeau »

unchocked wrote: post #79
skullborg wrote: post #59

Earlier quoted context omitted.

It's nearing 400k miles. It's had service - new turbo and engine control components, suspension and frontend, brakes, glow plugs, etc. Original everything else though, nothing fancy, just a work truck. But anything "newer", even 10 years old, is $25k minimum for any halfways decent duty truck.

Your 7.3 is gold, that engine will last till the heat death of the universe. And you’re maintaining it. For some reason people think that a well maintained vehicle is a grenade because it has service history, while one being run into the ground is great because they haven’t paid for anything recently. Newer trucks aren’t more reliable. They’re just newer. You won’t find a truck cheaper to maintain than the one you’ve…

FWIW older generations' experience with cars is that they are unreliable money pits after 10+ years. That was true until relatively recently.

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

#87

Post by [deleted] »

GalacticDomin8r wrote: post #55
nradov wrote: post #44

Earlier quoted context omitted.

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…

[deleted]

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

#88

Post by nradov »

diob wrote: post #84
nradov wrote: post #42

Earlier quoted context omitted.

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.

Just to give you a data point. I grew up in a family that smoked in the house. I've never smoked myself. I hope you aren't suggesting that I should be condemned for the sins of my parents if I should one day get lung cancer. Also keep in mind that pollution is going to be a large (if not the largest) contributor to lung cancer in the future.

Please read my comment again. I in no way suggested you be condemned. What I actually suggested is that we do an economic analysis to determine how to deploy our limited healthcare resources in order to maximize net benefits.

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

#89

Post by pytyper2 »

hermitdev wrote: post #85
pytyper2 wrote: post #41

Earlier quoted context omitted.

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

Typically, diesels are built with maintenance in mind (at least for trucks, no idea what you'd find in a diesel car). The cylinders are sleaved and meant to be replaced every couple 100k miles or so, so the cylinders themselves also last a long time (the sleaves take the brunt of the wear). I think theyre typically less complex than a standard gasoline engine. E.g. they have no spark plugs (and thus no distributor or…

That's about right.

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

#90

Post by Aloha »

elhudy wrote: post #73
aladoc99 wrote: post #39

Earlier quoted context omitted.

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 spe…

>The other strain in your comment suggests that people who are presumably in some way responsible for their disease are less worthy of care I am stating that people who are presumably in some way responsible for their disease are not MORE worthy of care. It is only these people who are receiving free screenings - as per the article.

Where do you draw that line? - I mean no person who understand the addictive power of nicotine would make this kind of statement.
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