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Lung cancer screenings in Medicare population? WSJ gets it wrong

“Nearly 70% of lung cancer occurs in the Medicare population.”  That’s the scare statistic the authors of this article use to incite fear and indignation: “Oh no, they’re killing Granny.”

The statistic is probably accurate. But some of these people are in their 80s and 90s. Lung cancer screening makes sense, at best, till age 74. Some elderly folks have other medical conditions that would preclude treatment, regardless of screening outcomes. And when you’re in your 80s and 90s, you could be treated for lung cancer only to end up with some form of cognitive impairment and/or incarceration (I use that word advisedly) in a nursing home with a loss of dignity and independence.

The article reports, “From 2002 to 2010, the NLST evaluated the impact of low-dose computed tomography—or CT—scans in more than 53,000 individuals and demonstrated a 20% reduction in lung-cancer mortality.”

That number is meaningless. We need to know the number of survivors in the screened group vs the number in the non-screened group. If these groups are self-selected the results will be muddled even further because there are differences in people who successfully seek screening vs. those who don’t seek screening or don’t have access.

It’s hard to trust any screening recommendations from radiologists and cancer centers, who stand to profit from screening and from investigating false positive. Here are links to published research studies showing far less impressive results. If newer research is available, let’s see the links.

“Cumulative lung cancer incidence rates through 13 years of follow-up were 20.1 per 10,000 person-years in the intervention group and 19.2 per 10,000 person-years in the usual care group (rate ratio [RR] …” In other words, intervention – presumably this screening – saved less than one person-year.

“Overdiagnosis is of particular concern in lung cancer screening because newer screening modalities can identify small nodules of unknown clinical significance. Previously published analyses of data from the Mayo Lung Project, a large randomized controlled trial conducted among 9211 male cigarette smokers in the 1970s and early 1980s indicated that overdiagnosis might exist in lung cancer screening…”


Let’s forget about lung cancer screening and use the money for massage.

Health Care Waste: Useless Medical Procedures

A really good article from the New York Times. What’s scary is that useless procedures have no more validity than witchcraft or alternative medicine, yet they’re accepted and reimbursed by insurance companies. Doctors don’t like questions like, “If I have this test and the results are positive, what will you do? And what is the effectiveness of that treatment?”
 Medical Procedures May Be Useless, or Worse

Highlights summarized here:

From a report that appears in the August issue of Mayo Clinic Proceedings: Out of 363 studies reported in the NEJM from 2001-2010, 146 found that the current drugs or procedures were no better – or even worse – than those previously used.

Over 40% of “established practices studied” were ineffective or harmful
Just 38% were beneficial.
Remaining 22% were unknown.  

Examples of harm:

— routine use of hormone therapy in postmenopausal women;

— high-dose chemotherapy and stem cell transplant for breast cancer

— intensive  lowering of glucose levels of intensive care patients (which increased mortality and conferred no benefit)

The article quotes a doctor who says that procedures often seem to “make sense” despite evidence of benefit. For instance, if you have cholesterol-clogged arteries, it seems reasonable to open them up – but this procedures doesn’t increase survival.

The advice to patients: “You shouldn’t ask how does it work, but whether it works at all.”

Okay, guys, we get it. Now just how many of us are going to get booted from a doctor’s practice when  we attempt to put this in practice?