Re: Too Much Medicare "Care" Again


"George Conklin" <georgeconklin1@xxxxxxxxxxxxx> wrote in message
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"Skeptic" <bcs002b@xxxxxxxxx> wrote in message
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"George Conklin" <georgeconklin1@xxxxxxxxxxxxx> wrote in message
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"George Conklin" <georgeconklin1@xxxxxxxxxxxxx> wrote in message
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We have known that other nations that spend less on medical care get
better
results. Once again we can see why with this following report:

------

The study of more than 2,000 patients found that those who underwent
the
expensive procedure, known as angioplasty, in non-emergency
situations
were
no less likely to suffer a heart attack or die than those who only
took
aspirin and other medicines to thin their blood and lower blood
pressure
and
cholesterol, along with adopting life style changes.


The study is the first large, well-designed comparison of
angioplasty
to
non-surgical care for patients who are not actually having heart
attack
or
in imminent danger of one. Patients routinely undergo the procedure
to
relieve chest pain and to reduce the risk of having or dying from a
heart
attack.

"The data are compelling," said William E. Boden of the University
of
Buffalo, whose findings were released Monday by The New England
Journal
of
Medicine to coincide with a presentation at a meeting of the
American
College of Cardiology in New Orleans. "We do too many of these
procedures."

Several experts said they expected the findings will prompt a major
shift
in
how doctors treat thousands of patients suffering from heart
disease --
the
nation's leading cause of death.

"These findings are pretty explosive," said Steven Nissen, president
of
the
American College of Cardiology. "I think this is going to shake
things
up
pretty significantly."

The findings underscore the danger of rushing to adopt a procedure
before
careful studies have been conducted to fully determine its benefits,
Boden
and others said.

"There was just this intuitive belief that it would be beneficial,"
Boden
said. "But no one had ever done a proper randomized trial to see
whether
it
actually improved outcomes. In the meantime, a whole industry has
been
created around this."

------
Notice the words:

"The findings underscore the danger of rushing to adopt a procedure
before
careful studies have been conducted to fully determine its
benefits."

Remeber HRT? It was harmful? Now we need to find out about PSA
tests...so
far no good evidence they do any good either.

Ah, there you go again George. Now you just know that's gonna draw me
right
in.

HRT was not harmful. Read the studies and look at the RAW data, not
just
the sensationalistic conclusisions drawn. But you know what, I'm not
here
to talk about HRT.

That is not what mainline science has shown. HRT was harmful,
period.


Let's talk about PSA.

Fact - prostate cancer kills people. Fact - screening with PSA
detects
more
prostate cancer than not screening with PSA. Fact - there have been
randomized controlled done comparing, after a diagnosis of prostate
cancer,
men with no surgery vs. men who undergo surgery. This has shown a
clear
overall and disease specific survival for those treated with surgery.

So we KNOW operating on prostate cancer saves lives.

Actually you should all up the Feds and have them call of the PIVOT
studies
since you already know what they are going to show. Do you have ESP
too?
Or do you just believe in predistination with you serving the role of
God?

Pivot study end points are either not up yet or just reached. Either
way,
we're probably a year or more away from even word of mouth preliminary
results.

For those of you wondering, Pivot is an American study - RCT - similar to
one done in Europe already published.

Actually it is not quite the same at all.

Very similar. I've seen the study design.

And one other study has been
going on for nearly 10 years now and has not published. If there were
even
a 1% advantage to surgery, it would have been stopped and the results
published.

That is very incorrect. To stop the study early a very large and obvious
advantage would have to have been seen.

So far, silence. It must not be what they wanted to find.

Baseless speculation just demonstrates your ignorance of publishing such
studies.

That Euro study showed both a disease
specific and overall survival advantage for operating on prostate cancer
vs.
no surgery. It is by far the best quality data we have regarding the
efficacy of operating for prostate cancer and it showed we should.
Whether
we are doing to that too much or too little will remain debated with
folks
on both sides of that fence. But the bottom line is the same - it saves
lives. Will PIVOT confirm these findings? No one knows yet.

Correct, we don't know yet. And that European study had a committee to
decide what the elderly men died of. It was often unclear.

Maybe so - but it would be equally unclear for both groups.

Just a couple
of committee differences would have changed the result.

No, 2 changes would NOT have changed the results.

With billions spent
on procedures, it is a crime so little is spent on evaluation of outcomes,

There are lots of outcome data on prostatectomies. They are overwhelmingly
favoring a survival advantage. Designing a PROSPECTIVE RANDOMIZED
CONTROLLED TRIAL, however, is not only about money, but about effort,
feasability (especially in the US), ethical and moral obligations, etc etc
etc. There are dozens and dozens of publications showing that prostatectomy
saves lives. That's not even a question any longer. The only question left
is WHICH patients are best to operate on, which are best for radiation,
which are best with hormones, and which are best with watchful
waiting/active surveillance.

as the stent studies showed and HRT showed and so forth and so on. You
are
simply afriad that research might cut down on your cash cow.

As I stated in the part of this post you conveniently cut out - I do not
like doing prostatectomies and I would make MORE money if I didn't do them.
I do them because it is most convenient for my patients and I'm good at
them.


.

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  • Re: Too Much Medicare "Care" Again
    ... The study of more than 2,000 patients found that those who ... expensive procedure, known as angioplasty, in non-emergency ... whose findings were released Monday by The New England ... HRT was not harmful. ...
    (talk.politics.medicine)
  • Re: Too Much Medicare "Care" Again
    ... The study of more than 2,000 patients found that those who ... expensive procedure, known as angioplasty, in non-emergency ... whose findings were released Monday by The New England ... HRT was not harmful. ...
    (talk.politics.medicine)
  • Re: Too Much Medicare "Care" Again
    ... The study of more than 2,000 patients found that those who underwent the ... whose findings were released Monday by The New England Journal ... HRT was not harmful. ... So we KNOW operating on prostate cancer saves lives. ...
    (talk.politics.medicine)
  • Re: Too Much Medicare "Care" Again
    ... The study of more than 2,000 patients found that those who ... expensive procedure, known as angioplasty, in non-emergency ... whose findings were released Monday by The New ... HRT was not harmful. ...
    (talk.politics.medicine)