Re: Too Much Medicare "Care" Again


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In article
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George Conklin <georgeconklin1@xxxxxxxxxxxxx> wrote:

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"George Conklin" <georgeconklin1@xxxxxxxxxxxxx>
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...................

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

HRT had immediate benefits.

..................

You are the fool. If any advantage were large, it
would
have
been
established years ago.

You keep playing the fool. I could just as easily (and as
baselessly)
say
the converse.

It is truly pitiful that surgical procedures have been in
use
for
100
years before there is a true scientific evaluation. This is
just
plan
criminal.

Some surgical procedures have been in use for thousands of
years. Do you think that amputations started only 100
years ago?

I was speaking specifically of prostate surgery.

The current gold standard for prostatectomy is an open radical
retropubic
prostatectomy. As it is done today, it's only a few decades old,
having
undergone a huge revision at that time. The newest method -
robotic -
is
still in its infancy.

So? If you change the lighting in the OR, does that change
cancer
cure
rates too?

your above comment about it being around for a 100 years just isn't
true...
not its current state. Yes, the change in technique a few decades
had
DRAMATIC changes with better success, lymph node sampling, less
blood
loss,
preservation of urine control and erectile dysfunction (still
evolving),
etc.

PSA screening has only been around since the 1990's
and thus the prostate cancer we're operating now is generally
less
advanced
than it was before then, when patients often presented with
metastatic
and
thus inoperable disease - or locally advanced disease. We really
are
in
a
new era of prostate surgery.

Stage can be and has been controlled for in research. Who are
you
trying
to confuse? Yourself?

No, George, it hasn't. The vast majority of cancers treated today
are
stage
T1c. Before PSA came out in the 1990's THERE WAS NO SUCH STAGE AS
T1C.
You
can't contol for it.

In short, you are trying to say that no evaluation of your cash cow

My two biggest money makers are cystoscopies and TRUS biopsies. By
far.
Neither are done in the operating room.

The biopsy leads to the OR, right?

Sometimes yes, other times no. An otherwise healthy 52 year old man with
an
aggressive cancer? Hopefully so. An ill 70 year old year with an
aggressive cancer would be a good XRT candidate. Same guy with a very low
grade cancer would hopefully opt for watchful waiting/active surveillance.
Etc etc. It's up the patient - all I do is give the facts/data and most
often provide an opinion about what to do (only when asked, which is
virtually every time).

is
ever going to be done because you keep changing the definitions and
this
will go on forever. Money first. Results? Who cares? We do, but
you
rely
on faith-based outcomes.

I merely pointed out that you lied. There is no way to control for a
new
stage of cancer that didn't exist 15 years ago and now accounts for 90%
of
diagnosed prostate cancer.


Not the issue now is it? Surgery has been going on for over 100 years
and none of it scientifically evaluated even controlling for stage.

Of course it is. There are dozens and dozens of outcomes papers. What
you
want is an RCT comparing one treatment modality to another which is hard
to
do for legal and ethical reasons. But the one done in Europe - the only
one
we have right now - showed a survival advantage for operating.

And now
what? Next there will another change, and then you will say that that
cannot be evaluated. It never ends.

It can't. Evaluation of outcomes should be done continuously and
permanently.

Well, PIVOT is out there and I am sure
you will discount whatever it finds, unless it finds what you want.
Like
HRT, right?

Dude, so far YOU are the one to selectively discount studies - like the
Euro
study showing a clear survival advantage. You have things backwards.

Only after a committee decided what the men might have died of, where the
different classification of several would have negated the results.

Here is a quote from today's paper:

Sure, aggressive treatment is reducing mortality and improving the quality
of life for some patients. Sometimes it even cures. But for many others, the
cancer machine offers only marginal benefits at best, and providers push
screening and aggressive treatment in part because they have nothing else to
give, but also because it's profitable. How much of the money we spend on
unnecessary or futile cancer treatment might be put to better use searching
for real advances?




.

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  • Re: Too Much Medicare "Care" Again
    ... I was speaking specifically of prostate surgery. ... you are trying to say that no evaluation of your cash cow ... grade cancer would hopefully opt for watchful waiting/active surveillance. ... There are dozens and dozens of outcomes papers. ...
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  • Re: Too Much Medicare "Care" Again
    ... HRT had immediate benefits. ... I was speaking specifically of prostate surgery. ... If you change the lighting in the OR, does that change cancer ... you are trying to say that no evaluation of your cash cow ...
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    ... HRT had immediate benefits. ... I was speaking specifically of prostate surgery. ... If you change the lighting in the OR, does that change cancer ... you are trying to say that no evaluation of your cash cow ...
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    ... George Conklin wrote: ... I was speaking specifically of prostate surgery. ... If you change the lighting in the OR, does that change cancer ... My twobiggest money makers are cystoscopies and TRUS biopsies. ...
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