(5) Ferez Nallaseth and Other Reader's Comment Threads: Social Media, NYT On (A) Cancers, Health Policy, (B) Brain & Mind - Neurosciences, (C) Related Articles, Links , Website: Ferez'nSquashDocs
Updated:19th June, 2016
FULL TEXT LINK:What is the Life Sciences Institute of New Jersey? Why and how does it exist? What are its goals? Ferez S. Nallaseth, PhD, JMB Omics Nallaset, Mol Biol 2015, 4: 3, 2168-9547-1000130.php?aid=60692, http://www.omicsgroup.org/journals/doi: 10.4172/2168-9547.1000130
NYT On (A) Cancers, Health Policy
http://www.nytimes.com/2013/05/02/health/dna-research-points-to-new-insight-into-cancers.html?hp
Comment (in response to the above and other articles on NYT/LinlkedIn/Twitter) - Proposal for A Rational Health Policy:
Objective: Bring a paradigm shift in the Biomedical Sciences from perpetuating the management of consequences (Pathologies, etc..) to pre-empting the Mutational causes of disease states. How? By Systematization and control of Mammalian Chromosome and Genome Biology in Homeostasis and Development with the coverage of all ~6 billion pairs of Nucleotides/Diploid Genome in all ~200 Cell types of all ~10-40 trillion Cells/average Human, from which these Mutations escape.
A dawning that should have occurred with only a small fraction of decades of work! Next - understand and preempt the causes of these 'fingerprints' (mutations?) which is their escape from Genetic Mechanisms maintaining Chromosomes/Genomes in Mammalian Homeostasis and Development. How? By including Evolutionary Diversity (based induction of dysfunctional Chromosome/Genome Biology in Hybrid Zones, etc..), Hybrid Zones and Genetics, hundreds of Genomic Targets, traditional (Orthology, Mapping, Synteny, RI/CC mice, etc..) and contemporary (e.g. miRNAs, Proteomics, Epigenomics, Transcriptomics, Systems, etc..)Scientific methods, assembling Mutation Frequency Histograms and re-configuring perspectives on the Genome from an assembly of Transcription Units to Targets of Regulation of Chromosome/Genome Biology in Systematizing these networks! We need to force a paradigm shift in the Biomedical Sciences from intervention at and cataloging of 'after the mutational facts' (i.e. the consequences of disease which are various Pathologies, symptoms, etc...' ) to 'before the fact preemption of causes of disease i.e. mutations' . To achieve this we need an International Institute of Functional Mammalian Chromosome and Genome Biology assembling tools (e.g. the above methods developed) on a par with diploid Synthetic Lethal Analysis by Microarray (dSLAM) in Yeast.
Conservatively (e.g. Translocations, Aneuploidies, Multifactorials, Mitochondrial diseases, home care costs of Neurodegenerative diseases, etc.. are not included!) costs of more than 6000 monogenic diseases are estimated at tens of trillions of dollars per year. Where is the money to be found for this endeavor? From a fraction of a percent of the Research Budgets of all the National and International, Federal, State Departments and Private Funding Agencies that use DNA and Scientists trained by Public Funds - i.e. ALL! From corporations that spew Mutagens and Carcinogens andthat use DNA and Scientists trained by Public Funds - i.e. ALL! And finally from Sin Taxes (smoking, etc.. that mutate DNA - i.e ALL)! This would secure in perpetuity funding separate from current sources at a level of ~$20 billion dollars or ~ NASA's budget for the International Institute of Functional Mammalian Chromosome & Genome Biology. Of course, this does not mean that the ongoing revolution in the Life Sciences e.g. Next Generation Sequencing, Stem Cell Replacement Therapy, Systems in Brain/Mind, Neurogenesis, Embryogenesis, Structure-function relationships, etc...need be suspended! Just supplemented! What are the payoff rates? Once a threshold of data is attained, perhaps sooner than is estimable from current perspectives, as was so dramatically shown by NGS, their application will lead to the decrease in new cases i.e. over time. What is the return on investment? Conservatively a few billions of dollars will end up saving tens of trillions of dollars and yield a paradigm shift in the Biomedical Sciences to boot!
We are fully in agreement with others on the need for engaging "Citizen Scientists" in this process. However, as things stand, in our rush to ameliorate the various Pathologies of Patients we unwittingly perpetuate the use of their money for disease management and their afflictions for reagents. This is needless, as shown earlier, there are more than enough resources for multiple parallel approaches eventually effecting the necessary paradigm shift to pre-emption of diseases. There is little doubt as to the choices that Patients would make! Can you expect to focus on (after the fact) consequences (Pathologies, etc..) of disease and wake up one day and understand and preempt their (before the fact) Mutational (necessary but possibly insufficient) causes? There are other reasons for resistance to these ideas/proposals besides the necessity for an immediate response to Patient needs! What are they?
They are (1) lack of Scientific Interest and Recognition required to propel studies e.g. Nobel Prize have already been awarded in the relevant fields, (2) the notion that all modern methods e.g.Genomics/Stem Cells are a panacea while all older methods such as Classical/Evolutionary Genetics are passe. Even the immensely promising Cell Replacement Therapies with induced Pluripotent Stem Cells (iPS) presume an ongoing recurrence of de novo cases (e.g. Parkinsons Disease, Diabetes, etc..). This despite the former often being limited to 'after the fact' intervention, having no pre-emptive capacity for de novo disease states, being largely retrospective while in contrast the latter will be preemptive, (3) Lack of thought given to the subject by Scientists ranging from Nobel Laureates to Graduate Students, as is obvious from their assertions e.g. (a) diseases are not caused by Mutations in House Keeping Genes (e.g. for DNA replication) - they are caused by Mutations in Specialized Genes (e.g. P53, BRCA1, etc..). This when the latter Genes are substrates for Regulatory Networks of the former Genes!, (b) KNOCKOUTS of 1% of the Genome have supplanted methods for understanding and controlling mutational pathways over the entire Genome in all ~200 cell types in Development and Homeostasis! This when Evolutionary Diversity (a resource derived from billions of years of divergence) based Dysfunctions and scanning of Networks of Alleles maintaining the Genome are wide spectrum and unbiased scans which would much more closely parallel the Mutational Ontogeny of disease states. Targeted searches such as Knockouts in fact complement Evolutionary Diversity based scans as has been so strikingly demonstrated in Model Organisms, e.g. Fruit Flies, Worms, Arabidopsis, etc.. , (4) In this CONCEPTUAL vacuum these mutations are considered (a) to be inevitable and (b) preempting them a far greater cost than allowing them to 'happen'.
And so ironically, Human accomplishments in other areas overcome barriers that are technically, scientifically and economically far larger than the pre-emption of disease states. We (a) approach the explorable limits of Space by sending craft to Mars, studying Stars Light Years away with the Hubble Telescope, etc.. (b) approach the limits of sub-atomic particles in the Large Hadron Collidor (LHC), (c) explore the depths of the Mariana Trench and (b) Map Tectonic Plate movements. All this is achieved while we remaining strikingly and haplessly accepting of this regulatory cauldron in our Genomes that causes a minimum of 6000 (monogenic) diseases at a cost tens of trillions of dollars per year while exacting a massive Human cost as the equivalent of a happening!
How can the Socio-Economic and Political barriers/climate be overcome? Preferably by enlightenment but with financial and legal tools, e.g. invoking of Eminent Domain, if necessary, to inculcate a civic sense and that of good citizenship! What is more the costs of this difficult decision can be balanced by President Obama's Model for rescuing the Motor Industry in Detroit as well as the Banks and allowing the returns on investment made to be paid off with interest. So in addition to the decreasing rates of disease and Human costs and the relieving of enormous Economic Pressures on the Global Economy, on the scale of trillions of dollars, the savings could perhaps even induce a gradual stimulus! There will be money to be made!!!!
And just in case anyone has not noticed, eventually, all this might just put off e.g. the loss of a 13 year old girl to Leukemia.
(1) Editorial on 8/4/2013
Editorial
http://www.nytimes.com/2013/08/05/opinion/mixed-blessings.html?ref=global
Mixed Blessings
Published: August 4, 2013 86 Comments
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Pity the poor patient who tries to make sense of federal advisory committee reports that appear headed in opposite directions. For at least three decades, Americans have been told that it’s best to detect cancers early, when they are theoretically most curable. So it was not all that surprising when an authoritative advisory group recommended that very heavy smokers get an annual CT scan to check for early signs of lung cancer. It was much more surprising, however, when a separate group of experts suggested that for several cancers — including potential lung cancers — early scans are detecting too many abnormalities that aren’t dangerous and should not be treated.
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Oddly enough, both groups, which issued their recommendations last Monday, may be right.
The recommendation on smokers came from the United States Preventive Services Task Force, independent experts who serve as the federal government’s foremost authority on screening procedures. Screening with chest X-rays, long the standard approach, seldom catches a tumor early enough for surgeons to save a life. In 2010, however, a large clinical trial found that low-dose CT scans, which detect much smaller tumors, could reduce mortality by 16 percent among patients at the highest risk of lung cancer because of their age and smoking history.
That led several prominent medical groups to recommend such screening in high-risk current and former smokers. Now, based primarily on that same study, the Preventive Services Task Force, the final arbiter, has recommended that people ages 55 to 79 who have smoked a pack of cigarettes a day for 30 years or two packs a day for 15 years or the equivalent get annual CT scans. That includes former smokers who have quit within the past 15 years. It estimates that such screening could save 20,000 lives a year, among the 160,000 Americans who die each year of lung cancer.
The task force said it had “moderate certainty” that the screening would produce a “moderate net benefit” in these high-risk smokers but did not know whether the same would be true in lower-risk patients. It gave lung cancer screening a grade of B, on a par with mammography. Under the Affordable Care Act, that would require Medicare and private insurers to pay for the screening tests without any cost to consumers.
Meanwhile, three members of a working group advising the National Cancer Institute, the federal government’s pre-eminent supporter of cancer research, suggested that “overdiagnosis” — the detection of tumors that would not cause illness or death if left unattended — is common in cases of breast, lung, prostate and thyroid cancer. Such overdiagnosis often leads to further tests and biopsies to determine if a tiny tumor looks dangerous, followed by surgery, radiation or chemotherapy to eliminate an abnormality that would never have caused illness. In such cases, the cure is worse than the disease it is trying to prevent.
The group said that, ideally, screening tests should focus on tumors that will cause harm and are more likely to be cured if detected early. But that can’t be done until scientists find better ways to identify which lesions are truly worrisome. The group also proposed renaming some conditions to exclude the word cancer so that patients might be less frightened and less apt to press for unneeded tests and treatments. For instance, the tiny breast tumors called ductal carcinoma in situ would be renamed to exclude the word carcinoma.
Recommendations from both these groups come with uncertainties and unanswered questions. This will put the burden on patients, in consultation with their doctors, to decide whether to get early screening for various cancers and what to do based on the findings.
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A version of this editorial appeared in print on August 5, 2013, on page A16 of the New York edition with the headline: Mixed Blessings.
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TD Le
Seattle, WA
If you over-catiously searched for a disease. You'll find one.
Recommend3
Occupy Government
Oakland
when medical research is as well-rewarded for preventing disease as for treating it, our national health prognosis will improve.
Recommend2
Marcia Simon
Potomac, Maryland
What about someone like me, diagnosed at age 52 with metatastic lung cancer. I never smoked and I ate a healthy diet, exercised regularly, and maintained a good weight. Just bad luck, I guess, that I had a mutation that predisposed me to the disease. Smokers at least have an inkling that trouble may lurk down the road.
Recommend1
smg
seattle
While cancer is practically synonymous with fear, not all cancers are created equal. We would do well to couple investments in heatlh education with investments in treatment.
The more we can achieve an understanding that yes, some tumors are indolent and that some will even spontaneously regress, the more we can focus energies on rationally understanding the diagnostic process, and make choices that are well informed vs. reflexive and born from anxiety. All too often, people learn they have a tumor (or elevated PSA) and leap to the conclusion that the tumor--which has probably been growing slowly for years, is suddenly doubling in size, by dint of being discovered. Fear-mongering has got to be curtailed if we are to have any success in helping increase recognition of the over-diagnosis phenomenon.
Two words every student needs to learn at some point in their educational life: "indolent," and "incidentaloma..."
Recommend
Tom Ng
CA
Overdiagnosis is annoying...but underdiagnosis is fatal.
Recommend2
Charlotte Schumacher
Halliday, North Dakota
This ALL assumes there is No OTHER WAY to detect cancer. Why does North America not use blood tests (as is done in Germany, that I know for sure) instead of imaging? Could it be that there is SO MUCH more money to be made by making, selling and using the CT, PET and MRI machines than by using a,simple, VERY accurate, blood test that give a read out of the status and condition of every organ, including cancer!!!!
Recommend3
Jane White
New Jersey
Because no such blood test exists. Other than leukemias, cancer cannot be detected by blood test unless it is in a pretty advanced stage.
Also, blood tests have the same false positive/false negative problems as any other tests.
Recommend1
John Kuntz
CLEARLAKE, CA.
Started dealing with bladder cancer 7-years ago, also squamus skin cancer. 5-operations on bladder. Early detection is deffinitly adviseable. Personal research is also a big help understanding what the doctors know or don't know. There is an awful lot that doctors don't tell you for fear of a lawsuit. There is much understanding to be gained by getting information from organizations like Mayo Clinic through the internet. You know how your body feels. Communication with doctors can sometimes leave you in a void. I have stopped treatment on bladder two years ago. Trying too create family records of sort involving major illness's. Personal research will give you a perspective and understanding for calmness. At 77 years old, I consider the disease and the time left as well as the time spent and pass this information on too the family. Do participate in testing on their advice. But how you choose to treat yourself might be answered best by yourself after your personal research. Resp. Jack
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K.
Ann Arbor MI
NYT Pick
"It estimates that such screening could save 20,000 lives a year"
Interesting term, that..."saving lives."
No life can be "saved" from death in the long run...what the doctors are trying to do is "prevent premature death." Is death at 79 really "premature?"
Recommend1
Susan
Piedmont, California
NYT Pick
Get back to us on this when you are 78.
Recommend12
kcrc
Winston-Salem, NC
It all depends on how old you are! If your family has a history of long life spans 79 is quite young! At 79 my mother was taking care of me after my surgery and was still babysitting my niece and nephews. She died at 95. She had 16 years of productive life after 79. She regularly attended college football games and booster club meetings, was active in her church, walked a mile a day and gardened and canned the most delicious tomatoes and green beans I've ever tasted. So, to answer your question, dying at 79 can be premature.
Recommend5
Patrick
Long Island NY
I am terribly grateful to the New York Times for addressing this story in this editorial and in a prior article.
It has been said many times that one in three smokers will die of smoking related diseases. I smoked two packs a day for 29 years and quit smoking 14 years ago. I feel like a million bucks now, and thanks to your article which included a link to a Memorial Sloan Kettering mortality calculator, I have learned my chances of dying from lung cancer have been reduced to 8 out of one thousand smokers or those who quit. That is about one out of a hundred chances. I was elated!
Quit smoking, quit smoking, quit smoking,.....Just do it!
Recommend5
EveT
Connecticut
What a shame that, some 5 decades after the famed Surgeon General's report, our population still has so many people who "smoked a pack of cigarettes a day for 30 years or two packs a day for 15 years." We all know how bad tobacco is. Yet millions continue to use it.
Recommend4
Robert C. Leif
San Diego, CA
The best solution is to improve the diagnosis. In the case of cervical cancer, the lesion is easily accessible and in women past child bearing age and the morbidity associated with treatment is often much less than with other cancers, such as lung. This is one of the reasons for the acceptance of cervical cytology. The use of HPV testing has also improved the accuracy of screening.
One of the solutions for other types of screening is to develop minimally invasive second steps to verify the diagnosis. Fortunately, molecular techniques can now be used to augment morphology. The present combination stain for pathology, hematoxylin and eosin was independently introduced in in 1865 and 1875. Therefore it has been around for at least 138 years http://www.scribd.com/doc/115968647/H-E-Staining. Fortunately, new technologies including new dyes and diagnostic agents and detection technologies that are specific for individual types of molecules are being and have been developed. There is a reasonable chance that the use of these new technologies together with fine needle biopsies can serve as a second step that will improve the accuracy of pathology and ability of pathologists to grade specimens and therefore reduce the need for more invasive and expensive procedures.
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victor888
Lexington MA
The more various screening tests are studied, the less useful and more harmful they seem to be. Early detection often just means living longer with a diagnosis but dying at the same age. PSA, mammograms and colonoscopy fall into this category of screening tests that are not nearly as useful as was once thought.
Recommend2
liz larson
northfield mn
Who has told us that mammography is "not as useful as was once thought"
Do we really trust insurance companies and huge hospitals? Is BIG MONEY whom we should be listening to?
Recommend
Susan
Piedmont, California
The financial imperatives go in the other direction from measurement and good sense.
We pay physicians by the procedure. Therefore, the more procedures, the more money they make. Accordingly I have been advised to have a bone scan every two years (I am 68) although my current scan shows that there is nothing at all wrong with my bones. ("Osteopenia" means that someday something or other might happen but it hasn't yet.) Radiologists have to make money too I guess.
This makes sense neither for me (who am being irradiated a tiny amount every time) nor for Medicare (which is paying for this) nor for the taxpayers (who are funding Medicare). What everyone would like would be if I could be "diagnosed" with some marginal defect, whereupon the drug manufacturers could get on the gravy train with the radiologists.
I am not claiming that osteoporosis is not a serious condition which should be treated. I'm just claiming, in line with the one scan that I did have, that I don't have the disease. In fact I'm learning horseback riding, and I have fallen off cantering horses twice in the last year without incurring any injury at all.
Not every woman in her late 60's is at risk for osteoporosis. These tools should be reserved for women who need them.
Recommend6
DrG13Miami
Miami FL
Early detection= better outcomes.
Every year there are new techniques and better chemo to treat many, but not all, cancers. If you want to fight cancer for your life, then you must be informed. Yes, we need to try to achieve more specific guidelines what forms to be aggressive with or not.
Let me give you a few examples: Yes, they may have been "lucky" or perhaps not.
1) When my uncle was in his mid 70's, he called me to ask my opinion about his prostate cancer. I told him that I could not render a decent opinion (since I'm a dermatologist) but that I could tell him my general thoughts. I told him that, as far as I knew, there were several variations in the aggressiveness of "prostate cancer." I suggested he listen to a trusted urologist or two. I told him that certainly people died from prostate cancer; and that many did not die. He decided to not do surgery for his prostate cancer. He died at age 96 from non-cancer related old age stuff.
2) When another uncle asked me about his basal cell carcinoma skin cancer near his eye, he was about 75 or 76. I told him to let me have a look at it every once in a while, but to not be aggressive in Mohs or other surgery. He didn't bother with it and died from an unrelated stroke at about age 82. (to be continued)
Recommend
splg
sacramento,ca
From the perspective of one who has endured the diagnosis and treatment for prostate cancer for the last five years, my impression is that much of our misconceptions and controversies about screenings for disease are less matters of incompetence, fear of lawsuits, or bottom-line profit, than simply the public's impression that we have made more progress with the tools for diagnosing than we have.
We're forever reading or hearing about being on the cusp of breakthroughs many of which we later discover were actually begun and touted years earlier but still hadn't delivered on promises in strengthening our abilities to combat cancer.
The oft repeated and encountered " promising " drugs for treating advanced stage prostate cancer should not obscure the fact a basic tool , androgen deprivation therapy, dates from the early forties even if drugs largely replace actual orchiectomy.
One would hope that as scientific research proceeds, as it inevitably will, we can look back and bid adieu to this and other barbaric remedies for combatting cancer.
Recommend
Ferez Nallaseth, Ph.D.
Belle Mead, NJ
The Biomedical Sciences community needs a paradigm shift from treating consequences of disease (pathologies, etc..) to preempting their causes - mutations escaping from genetic networks maintaining chromosomes/genomes in mammalian homeostasis & development. How? By systematizing these networks with evolutionary genetics & diversity, classical & contemporary science.
Conservatively estimated costs of 6000 monogenic diseases? Tens of trillions of dollar/year. Where is the funding to be found? From a fraction of a percent of the Research Budgets of all National and International, Federal, State Departments & Private Funding Agencies which use DNA & Scientists - i.e. ALL! And corporations that spew Mutagens & Carcinogens - i.e ALL! And Sin Taxes (smoking, etc.) that mutate DNA.This could secure in perpetuity funding, separate from current sources,at a level of ~$20 billion dollars or ~ NASA's budget. Of course, this does not mean ending the ongoing revolution in biology e.g. genomics, stem cell replacement therapy, systems etc.! Just supplementing it! The payoff? Rates of new cases will, over time, decrease. The return? Conservatively - a few billion of dollars will save tens of trillions of dollars with a paradigm shift to boot! How to solve the politics? Preferably by enlightenment but with financial & legal tools that built the US if necessary!
And just in case anyone has not noticed, eventually, all this might just put off e.g. the loss of a 13 year old girl to Leukemia.
Recommend
Jack
Las Vegas
There is no certainty of anything in life, much less results of diagnostic tests. The tests are only effective, medically and economically, if patients understand them and have to pay for some of the cost, and doctors are not greedy. Medical treatments are not exact science. So we have to consider economical and social factors equally.
Throwing money at cancer, like any other problem such as poverty, is not the only answer.
Recommend1
Andrea
New England
Why do all of the healthy people who don't smoke, use drugs, drink too much or refuse to wear seat belts always have to pay for the healthcare of those who make their own bad choices?
Tax the heck out of cigarettes and all of the foods (fast foods, sugars etc.) that lead to obesity, diabetes and everything else that is running up the exorbitant medical bills that we are all paying for. Put that tax money straight into healthcare funds.
Just like high risk drivers have their own high risk premiums - high risk patients should pay more for their own bad choices.
Funny how so many red states that don't want healthcare reform - they just want to have the most obese, unhealthy populations and make the rest of us to pay for their healthcare and disability later once they get sick.
Recommend3
daniel. vlock
Cambridge, MA
The issues with screening have less to do with the benefit of finding cancers at an earlier and more treatable stage than the current status of the interventions that can be made once those tumors are detected. If we step back and take a much longer view it is clear that early detection has led to a phenomenon known as stage migration where there has been an increase in the detection of early stage (and more treatable) cancers and a reduction in the diagnosis of later more advanced disease. With breast cancer this has resulted in a marked increase in the detection of early stage disease and an improvement in long-term survival of those patients.
Questioning the value of these early cancer detection technologies is a bit like “shooting the messenger”. The problem is that our detection technologies have advanced far beyond the therapeutic interventions we are subsequently able to offer. Right now the risks associated with biopsies, surgery and other treatments are unacceptably high. What would be more productive and in the long run have a greater impact on individual patient survival and the overall cost to society of treating cancer would be focus on improving cost, safety and accuracy of early stage interventions.
Recommend2
Clive Deverall
Perth, Australia
We have been 'over-diagnosing' cancer for years. Mammography is now being seriously questioned in context of finding early cancers which may have been better left alone. And the biggest one of all - PSA (Prostate Specific Antigen) so-called screening for prostate cancer. All it has done is generate thousands of impotent and incontinent men who were also probably best left alone. There wasn't a govt health dept in the western world that recommended PSA testing for healthy men and even the American Cancer Society stopped recommending it, shortly after, a Urologist, Dr Otis Brawling(?) became the Society's Medical Director. Why? Because the PSA test did more harm than good. In the case of cancer of the prostate very early detection was not necessarily the best pathway. But too late for all those men who had been persuaded by their peers or their Rotary Clubs to go along for the test.. Even the pathologist who developed the test regretted his initiative. Many cancers are 'indolent' and change their pathology over time. Rushing in with unproven so-called screening tests is not the way to go. With breast cancer the debate is more complicated. Billions have gone into breast cancer research but still no one knows what causes it & how to prevent it. The only option appears to be mammography - despite the doubts as to its efficacy. How many headlines/breakthroughs will be served up before a simplified test is developed? Whatever you do: proceed with caution.
Recommend3
Gene Amparo
Sacramento, CA
Spend the money on campaigns to eradicate smoking in all age groups or on programs to quit smoking rather than spending it on annual CT scans to screen for lung cancer in smokers.
Different cancers behave differently and screening tests for various cancers vary in effectiveness. If you compare deaths from cancer in a screened population with deaths from cancer in a matching population that did not undergo the screening test, and the number of deaths in the screened population are significantly lower, then it is a good screening test. An example of this is screening mammography for women between ages 50 and 74.
If, however, the number of deaths from cancer in the screened population is not significantly lower, then it is not a good screening test. An example of this is PSA screening for prostate cancer in men between ages 55 and 69.
And the benefits of the screening test must outweigh the risks. The benefits of screening mammography outweigh the risks of radiation (which can also cause cancer). On the other hand, the risks of PSA screening (complications of prostate surgery for a cancer that won't kill the patient) do not outweigh the benefits (no difference in deaths between screened and unscreened patients).
Another important consideration is the that recommendation for screening tests apply to the general population, not to patients who have risk factors for cancer, such as a family history of breast cancer or prostate cancer.
Recommend
Grams
Sarasota, FL
I was a heavy smoker, 2 packs a day by the time I stopped. Then 5 years ago (16 after I stopped smoking), I was diagnosed with lung cancer. Fortunately, my doctor (Dr. Wayne Warren, New Haven, CT) was proactive and insisted on an annual chest x-ray. So with all the previous years to compare against, it was pretty clear that I had a lesion in my upper right lobe. I was lucky, one of the ten-percenters caught early when survival is optimum. And, yet, most doctors do not proscribe an annual chest x-ray as part of the physical exam and many insurance companies will not pay for it. And while I was going through all the preliminary tests and then surgery, I kept reading how if cancer was found on an x-ray, it was already too late. I thought I was going to die, convinced, in fact. It's not a feeling I'd recommend. I'm still here, minus the upper right lobe but otherwise healthy, happy, enjoying life and grandchildren.So was I the aberration or is an annual chest x-ray, and a doctor who knows how to read it, the solution to an expensive and potentially harmful annual CT scan?
Recommend1
Robert Y
St. Louis, MO
In a word, you were lucky. Many studies have demonstrated, from the 1960's on, that chest x-rays are not useful for diagnosing early lung cancer in the population, at large. Yes, you might pick one up here or there, but there are many places for them to hide that they cannot be expected to be found until they are large. So you are lucky...
On the other hand, some lung cancers are more aggressive than others and more likely to spread and shorten your life, no matter when you find them. So maybe you were lucky in this regard as well, perhaps having a less aggressive lung cancer.
Then again, some lung cancers are so biologically unaggressive that perhaps nothing at all need be done. We just cannot tell which one these are, even with invasive and cutting edge testing. Maybe you had one of these, and you are unlucky that you had to undergo surgery and treatment.
The more you look at the data, the biology, and the recommendations, the more confusing things become. Mixed blessings indeed!
Recommend
SayNoToChemo
Chico, CA
Someday, genetic sequencing will identify the exact cancer(s) involved, then using a masking form of mRNA derived from one's own stem cells will allow one's own biology to repair itself, but we are not there yet. Separate to the disease of cancer is the use of chemotherapy and radiation. Unfortunately, many people including doctors singularly combine the disease of cancer and the treatment of it - with automatic chemotherapy. Unfortunately, most people can not survive the types of chemotherapy which basically kill all cells, both cancer and healthy. Once the patient is at Death's door, the treating physician attempts to retrieve the patient with blood transfusions, bone marrow transplants, antibiotics, bed rest in ICU and finally, the patient's own biological ability to recover. If the patient dies during this procedure the cause of death will be listed as "death from cancer" when in fact the patient has died from chemotherapy poisoning. IOWs, the cure is worst than the disease. Over 100 years ago mercury was used to attempt cures of cancer, syphilis and other diseases. The death from mercury poisoning is beyond description.
As with mercury so it is with the common agents used in chemotherapy. Once one has been exposed it must be remembered that there is no cure for chemotherapy. It is not a question of how strong one can fight or how much pain one can endure. Yes, the chemo agents will wash out from the patient's body but the damage they have caused can not be reversed.
Recommend
Ann Cameron
Panajachel, Guatemala
I had lung cancer in lymph nodes between my lungs diagnosed in November 2012 by PET scan as "avid for sugar" and "growing rapidly." I drank the juice of five pounds of carrots a day--this comes to a quart and a cup of juice. In eight weeks a scan showed the tumors stopped growing. A new scan shows that the cancer is gone. In five months I cured myself without chemo or radiation, just with carrots. Details on this at the sites CancerIsOver.org and ChrisBeatCancer.com The anti-cancer chemicals in carrots have been proved at a lower dose, to retard the growth of tumors in lab rats in UK experiments. I think trying carrots beats chemo and radiation by far and unlike those treatments, does no harm. I am not the only one who has been cured this way, and I believe it could help millions. If treatment weren't often so terribly damaging, if it were carrots or turmeric or kale in the diet, treating early wouldn't hurt.
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MetroJournalist
NY Metro Area
Verified
Here's an idea. Why doesn't the U.S. spend more money on medical research and finding cures instead of funding wars which will never be won, except by the CEOs whose interest is in encouraging young men and women to risk their lives so the few can have more?
Recommend25
Julia
Atlanta
The problem is surgeons don't know which low-grade cancers (or abnormal cells) will become invasive. If a patient is willing to take that risks and undergo, frequent testing w/o anxiety.....well, fine for them. Sometimes low grade cancers like DCIS are the tip of the iceberg and further tests reveal more extensive DCIS and even underlying invasive cancers in early stages before they reach the lymph system. Given limitations of current imaging technology, I'd rather 'overkill' the cancer than have it kill me.
Recommend9
MJ
California
That is also not entirely correct . For some of the most aggressive cancers in the lungs and breast, early detection has not been able to change mortality. So we are lulled in a sense of security that if you detect a tumor early , you will survive . No so. Rather, if it is NOT an aggressive tumor, no matter when you detect it, you will survive and if it is aggressive, you get aggressive treatment but die anyway.
Recommend2
kcrc
Winston-Salem, NC
MJ is also not entirely correct. A friend was diagnosed with an advanced aggressive breast cancer. Her prognosis wasn't good but she had a mastectomy, chemo and radiation. She'll be the first to tell you that the side effects were pretty bad but she got through it and returned to her teaching job. Her doctor prescribed regular CT scans because that was the only way he could tell if the treatment was working. The insurance company denied it but after a campaign by her doctor and letters from many of her friends and members of the medical community the insurance company reconsidered (they said they had never denied it!). Today it is more that 7 years since the initial diagnosis. She is still going strong and is eternally grateful for the CT scans and aggressive treatment!
Recommend1
Dave
SC
I suspect that CT scans are actually underused. Radiation risk of CT scans is based on assumptions that many experts regard as dubious. Costs of machines to the public are greater when machines are used below their capacity much as a metro bus may be cost ineffective if used by too few passengers. I know that these statements go against common beliefs about how to hold down medical costs. However, CT scans can detect brain and heart aneurysms, early cancers, and many other conditions that now escape early treatment. A laudable goal would be to reduce costs of CT scans and make their use more widely available. Who wouldn't like to know that they have a brain aneurysm waiting to burst or other life-limiting condition that could be corrected, for example. Society should move forward and embrace technologies that can improve life.
Recommend5
acuteobserver
NY
Sounds like a stock-holder in a freestanding radiology facility!
Just performing more tests with a CT does not decrease its costs, only increases profits over debt service.
It is a fundamental principal that mass screening of asymptomatic populations for uncommon diseases produces far more false positives than true positives - leading to more work up and costs, more morbidity from the pointless workups and more anxiety in patients.
Recommend
Bernd
Germany
Actually the radiation dose is quite high. If a person has a high-resolution CT-Scan from head to toe to look for "....many other conditions that now escape early treatment" he will receive approximately 20 miSv. How much is that? It corresponds to 5 years of natural background radiation (appr. 3-4 miSv / year) or 400 conventionell chest X-rays (at 0,05 miSv each).
If you opt for yearly CT-scans for disease prevention, you may as well opt for volunteer work with the clean-up crew at the Fukushima power plant.
An aging human body has so many signs of early disease, you dont want to know them all. What can you do? Dont smoke, never ever, keep you weight down, do sports and get as few CT-scans as possible. Go to the doctor only if you feel ill, never for prevention.
Recommend1
jb
new york
In the case of heavy current smokers, why should society (Medicare, Medicaid and private insurance plans) bear the costs of lung cancer treatment when for over 50 years the links between smoking and lung cancer have been well known?
Long time, heavy smokers should just know that lung cancer is inevitable and the insurance plans should exclude diagnosis and treatment for such individuals.
For other cancers, the links are not that we'll known at this point in it and there are uncontrollable genetic and environmental factors.
Recommend3
Nancy
New York
It's true that smoking causes about 30% of US cancer deaths. But papilloma virus causes all cervical cancers and an increasing number of head and neck cancers - should we deny coverage to people who don't get vaccinated (or have don't have pap smears)? Colonoscopy reduces death from colon cancer by a huge fraction - perhaps as high as 90% when done by good practitioners - again - deny coverage for those who don't get colonoscopy? Finally, scientists believe that another 20% of cancer deaths are due to physical inactivity and obesity. Should fat people be denied insurance? Just asking...
Recommend
george
Princeton , NJ
I initially agreed with jb's reaction, but excluding treatment for long time, heavy smokers from insurance plans is a painfully harsh punishment. How about adding a federal tax to tobacco products, to fund the cost of lung cancer treatment? That would have the simultaneous benefit of raising the cost per pack to astronomical heights, and get a few more smokers to choose between smoking and starvation.
Recommend
Robert Y
St. Louis, MO
I am professionally involved in the early diagnosis of lung, breast, and thyroid malignancy. The mantra of "lives will be saved if we catch it early" is undergoing some revision. It turns out that what we call "cancer" is a more heterogeneous group of diseases that we in the medical community and especially in the lay community once believed.
Every day, people are harmed by early diagnosis of cancer--physically, emotionally, and financially. We must continue to support research that will help us differentiate aggressive cancer that can indeed be cured if detected earlier from the cancer that will unfortunately kill no matter when it is found and from the so-called cancer that is not aggressive and better left alone or simply monitored. We have a very long way to go in making these distinctions, and until we do, we will continue to practice and live in a confusing mess of mixed signals and recommendations.
Recommend35
Linda
NYC
There are occasions when the answer is so clear, so definitive, almost obvious. Other times, it's a matter of weighing the options, at least for the lucky people who have options.
Some people want to politicize this or use it as an opportunity to accuse health-care providers of corruption. To me, it's life, and life is mostly gray areas. Please, for heaven's sake, give the doctors a break. If you really think they're all corrupt and want to do treatments just to enrich themselves -- which is really evil --then don't go to them. (That works well, doesn't it.)
Recommend8
FTP
Fort Myers, Florida
How is it possible that large corporations can manufacture and promote products that substantially increase the risk of a serious, often deadly disease and then pass the cost of treatment on to everyone else regardless of whether they use these products or not. People who use tobacco products, and the companies who market them should be held accountable for their actions. In other words, they should pay the cost of these expensive tests and treatments instead of passing them off to rest of us in the form of higher health care premiums. It has been estimated that the cost of smoking alone comes to over $100 billion dollars a year in increased health care costs. These costs could easily be recovered by increasing the tax on tobacco related products. It has been shown that increasing the cost of these products results in substantial reductions in their use.
Recommend11
Laurie Mann
Pittsburgh, PA
There's an awful lot of cancer on my husband's side of the family. His Mom died of lung cancer at 56 (smoker), his father of pancreatic cancer at 69 (smoker) and his father's brother died of pancreatic cancer at 85 (non-smoker). So would it do my non-smoking husband any good to have a genetic test for pancreatic cancer? It still has, what, a 95% mortality rate within 5 years? And what should he do if he has the genetic test for a disease that's pretty much still incurable?
I think it probably does make sense to have genetic tests for diseases with a decent cure rate, like breast cancer. But some forms of cancer still don't have a decent cure rate.
Recommend1
markomd
Cary, NC
Thanks for writing this fine editorial.
Because each patient has individual needs, choices on diagnostic testing are still best left to a patient and his/her physician.
New guidelines based on sound medical and mathematical principles can help patients and physicians make better decisions.
Even with improved guidelines we will still over diagnose some problems that really aren’t there and we will still under diagnose some serious problems that really are there.
That's an inevitable outcome due to the underlying mathematics of medical science.
But more patients will benefit than be harmed than under the previous guidelines and IMHO, this justifies the changes so long as they're not carved in stone.
Mark Gary Blumenthal, MD, MPH
Cary, NC
Recommend8
Mark
Providence, RI
And one can safely bet that the recommendations will change again, and again and again, based on new incoming data. Only one thing can be relied on: today's medical truisms will be modified tomorrow. Such is the nature of evidence based medicine. Good for newspaper sales, but not for knowing how to manage our health.
Recommend4
Richard Luettgen
New Jersey
If the screenings are free or nearly so, they will come; and if remedial surgeries, radiation and chemo are free or nearly so, they'll sign up, regardless of the odds that a small tumor will actually lead to pervasive disease.
This will happen until we find, as the Euros have found with single-payer systems, that we can't afford it. Then, as with them, rationales will be discovered why it's not sensible to allow the procedures until the tumors get too large to do anything but make end-of-life decisions.
One way or another, if ObamaCare survives, the likelihood is high that we'll be forced to adopt a lot of the cost-curve-bending practices of the Euro health care market anyway, which include dictating prices to providers, hospitals, device and drug manufacturers. Perhaps after a couple decades of that we'll spin off enough cash to actually focus on curing cancer, once and for all.
Recommend
Jim
Boynton Beach, Fl.
What do you think private "health" insurance companies do in this country?
They limit the amount they pay for all treatments and they're your kind of people- repugnants. You're not too good at looking in- only out.
Recommend1
surgres
usa
Welcome the challenges when decision making is centralized! In the 1990's, colonoscopy was approved as screening for colon cancer. The result? Increase spending without improved outcomes. Why? Because screening low risk patients yields false positive results that require an expensive workup without benefit.
Unfortunately, the organizations making these recommendations directly benefit from the increased spending, even if their patients do not. That is why the word of "experts" should not be considered as dogma. But as long as Obama and the CMS trust the experts over the public, we will continue to have increased costs without benefits, no matter what they think.
Recommend1
Charles Focht
Lincoln, NE
Given a choice, I would much prefer to trust the trained "experts" to advise me on health care issues rather than an uninformed public.
Recommend
Jim
Boynton Beach, Fl.
'TRUST THE EXPERTS OVER THE PUBLIC"?What exactly do you mean by that? We should be the ones to determine what tests and treatment
we'll have? Some of us do but the majority of Americans are too stupid to do that. You do know that the Affordable health act hasn't gone into effect yet don't you? Why is President Obama being blamed for what Doctors have been doing for years?
Recommend
Thoreau101
Earth's eye
Anyone who smokes should be concerned about cancer. The cause and effect relationship is well documented.
As for the prostate, it's almost an impossible situation. Sometimes a biopsy is essential if only to see if a cancer is present or spread, then to act accordingly.
Recommend
Jim
Boynton Beach, Fl.
A biopsy will tell you if you have prostate cancer- a bone scan will tell you if it has spread.
Recommend
carpen45
New Hampshire
That kind of scares me. I smoked three packs a day but quit about 25 years ago. I thought I did not have to worry about getting lung cancer. I will have to ask my Doctor if I would be eligible for a cat scan under Medicare.
Recommend
ekunsman
San Diego, CA
I was a heavy smoker as well and quit 20 years ago. I have had two operations for lung cancer (the surgeon got it all out) but have had to undergo chemo and radiology treatments, just in case. I thought I didn't have to worry about it either.
Recommend
Robert Y
St. Louis, MO
Medicare does not currently pay for screening CTs for lung cancer. Given the recent USPSTF conclusions, it is likely that this will change in the future.
Recommend
carpen45
New Hampshire
RobertY....thank you for the info
ekunsman ......sorry for your experience...I hope you continue to do well.
I carried two of my three children while I smoked and yup those two smoke and seem unable to quit....I can't tell you the guilt I feel about that. In those days Doctor never said a word about smoking. Truth be told I worry more about them especially the oldest. His dad died of Lung Cancer at 43 and he smoked much less than I did. I rue the day I ever picked up my first cigarette.
Recommend
Ann Wyrick
Red Hook, NY
I, for one, feel that I am not a breast cancer survivor as much as a Breast Cancer Industry victim. The last treatment was the most heartless and I opted for this treatment myself, to avoid more testing and more x-ray. Pitiful to be so frightened as to be willing to undergo disfiguring and barbaric surgery to feel almost 'cancer free'.
Earlier in my life I was part of the hysterectomy hysteria and opted for that organ to be removed, for no reason, in the end.
Ah woe to women who get suckered into the 'cancer industry' scares
.
Recommend7
kcrc
Winston-Salem, NC
NYT Pick
Ann, I'm sorry you feel you were a breast cancer industry victim. I had a breast tumor removed when I was in my late twenties. It was diagnosed as a benign fibroadenoma. Fast forward 20 years and I had a tumor in the same location. Tumor was removed and diagnosed as a fibroadenoma. The following year I found another lump in the same location. The surgeon took a wider margin of breast tissue this time. This time the diagnosis was a phalloides tumor, which looks very much like a fibroadenoma. There were some suspicious cells on the margin and they were removed. A year later the lump recurred in the same location. I researched that tumor and found that it is usually benign but if it recurs it can be cancerous and if it is, there is no known treatment. I opted for a mastectomy because I felt my life had much to offer and I didn't want to spend the rest of it worried about a recurrence that could possibly be cancerous. On followup, my doctor said he believed that all of the tumors were phalloides tumors and that I had done the right thing. Radiation and chemotherapy weren't necessary. That was more than 10 years ago. I haven't missed my lost breast but I also haven't missed my four grandchildren and a full life unmuddied by worry about my health. To me life is so much more important than missing a body part!
Recommend2
Coolhunter
NJ
If you think all this is confusing, wait until the Obamacare 'Death Panels' kick in. Then science will take a back seat to economics. Each year the Panel will decide how much we can spend on health care, and then allocate it so that effective rationing takes place. You live in a dream world if you think patients and doctors will be in charge of health care decisions, government will decide if you live or die. Welcome to a brave new world where science takes a back seat to dollars.
Recommend
Read All 8 Replies
pat
ny
Insurance companies have for decades decided what tests, doctors & hospitals will be paid for. I met a worker for a major insurance company whose job was to reject 30% of all claims! Policy of the industry she was told. This has nothing to do with ACA, just greed from private industry.
Recommend1
usmc-fo
Somewhere in the Maine woods.
Do you really believe for a second that private insurance is not measuring the cost of keeping you alive vs turning a profit? Well, let's discuss bridge sales...I have one you may like to own.
Recommend
carpen45
New Hampshire
I can't believe you are so ignorant as to believe that Sarah Palin "Death Panel" nonsense. She started that when it was announced that part of Obamacare included a FREE consultation with your PCP to discuss Advanced Directives/Living Will IF YOU CHOSE TO DO THAT. I did mine ten years ago and gave copies to all my kids. It cost me fifty dollars. You want to know where the "Death Panels" are. Look at any Health Insurance Provider who deny tests and procedures to their beneficiaries every day.. Shame on you.
Recommend
Elizabeth
Seoul
So much of whether this new recommendation is viewed in a positive or a negative light depends on one's own approach to medicine, health, and life expectations, as well as on the experiences of both self and family.
I watched my father and grandfather plunge headlong into every treatment that a doctor prescribed for my grandmother, leading to a long and painful decline for her. My own approach to medicine is that I am the one who gets to decide what treatment--if any--is right for me. There are plenty of screenings I do not do because I know I would not pursue treatment. However, what is right for me may not be right for anyone else.
It is time for medical professionals to talk frankly and openly with patients about what screenings can and cannot do--and what their own prejudices and beliefs about medicine and health are. Honest communications among patients, caregivers, and providers are what have been missing from too many screening-and-treatment conversations.
Recommend4
Jim
Boynton Beach, Fl.
I agree but keep in mind surgeons will recommend surgery, radiation
Doctors will recommend radiation, laser Doctors will recommend laser-
it still comes down to you and who you want to believe. I rejected all
"normal" treatments for prostate cancer- surgery, radiation, seed implants
and chose cryosurgery which is still not recommended by many urologists-
I have 11 years of undetectable readings on my PSA's.
Recommend
Betsy S
Upstate NY
Anyone who has observed a loved one dying from a disease like prostate cancer will be reluctant to just wait and see how it turns out when early tests suggest the presence of the disease. It's not a trivial decision and statistics don't help much..
Recommend11
J. Davies
Pelham, NY
I take issue with removing the term "carcinoma" from small tumors so as not to scare patients. It is reminiscent of old-school "benevolent" doctor practices in which information was withheld from patients so that they wouldn't be anxious. What the public needs to realize is that cancer is a spectrum, and not every lesion or tumor is life-threatening. It may be harder to educate a patient than to reinvent terms, but that is the responsibility of the doctor. The doctor must explain whether a tumor or lesion is invasive or not, the degree the cancer has spread or not, and the ramifications of treating or not. It is not an easy task, and perhaps doctors need more training in how to communicate such information in ways that are sensitive and compassionate.
Recommend8
Jim
Boynton Beach, Fl.
That's just the next step in removing negative things or words from our lives.
Read some current obits and see the degree writers go to to avoid saying the patient died. Bob was called home- Bob went to be with the Lord- Bob went to his heavenly reward. Another annoying thing for me is when they say an 85 year old died unexpectedly- no they didn't.
Passed on was bad enough- this is worse.
No one has died without a courageous struggle against whatever killed them. I think that means they took all their meds and showed up for tests and procedures.
Recommend
Michael O'Neill
Bandon, Oregon
The Editorial Board is aware that the 'mortality rate' is 100% in every case, are they not?
Which is not to say that extending a life by a few years is not a laudable goal. But that is all these 16% (or 20,000 a year) will receive, a few months or a couple years of surgeries and chemo.
I am just a little tired of the medical industry playing on our unreasoning fear of death to relieve us of every last dime on our way out.
Recommend29
George Wallace
Rochester, NY
Michael: you are a bit cynical, but unfortunately on the right track. Many doctors are moral, my son for example. Some are good scientists and understand how statistics work. Some prey on fear to enrich themselves. So goes the world.
Recommend
harvey osterhoudt
palenville, ny
i share your clear eyed view. we can only be thankful that we won't have to be "just a little tired of the medical industry playing on our unreasoning fear of death to relieve us of every last dime on our way out." interminably.
Recommend
dcaryhart
SOBE
The conspiracy that this is all part of Obamacare "death panels" shall follow shortly.
Recommend4
Nancy
New York
Thank you for this highly accurate and realistic editorial - vs the fanatical 'do this, do that' articles that have dominated the cancer news lately. The anti-screeners are as shameful as the over--screeners.
Early detection and even more so cancer prevention are not one-size-fits all approaches. That's too bad since they are by far the best ways to avoid dying of cancer at the present time. Both require excellent doctors giving excellent advice to individual patients. It's well known that 50% of the cancer deaths in the US today could be prevented over the next 20 years by a combination of prevention and early detection. So to oppose these life-saving measures by blanket orders seems indecent to me.
Recommend3
Jim
Boynton Beach, Fl.
I disagee in part- excellent Doctors are needed for an accurate diagnosis
but treatment option decisions should be made by the patient whenever possible. An excellent surgeon will recommend surgery, an excellent radiologist will recommend radiation. Patients must do some research,
learn about the various treatments, side effects, % of favorable outcomes,
and pick one. If anyone knows a surgeon who has recommended radiation please publish his name so more people can go see him.
Recommend
DJK.
Cleveland, OH
I have seen this info before and am bothered by the way prostate cancer is described. In reality there are aggressive forms and very slow growing forms. Not testing means those with aggressive forms will not be treated early enough to save lives. I don't think it's the testing. It's the recommendations and information supplied afterwards that have patients being treated when it's not necessary.
Recommend17
eomcmars
washington, dc
Exactly. The PSA blood test is no more invasive than a cholesterol test; it's what the doctor does with the results that can be problematic. Most primary care doctors are simply not qualified to properly interpret the results. Many urologists are not much better either, especially if they do not stay current with the latest research. For the vast majority of patients an elevated PSA merely means that the test should be repeated on a regular basis (every 3 or 6 months, for example) to determine the velocity of any change. If the doubling time is less than a year, further decisions become necessary, i.e., whether or not to do a biopsy. But even that decision should not be automatic, as other factors, such as age, overall health, weight, etc. need to be taken into consideration. Unfortunately, too many patients are rushed off for a biopsy after the first elevated PSA, whether they need it or not. And, sadly, because of those often-poor decisions, some "experts" recommend throwing out the baby (PSA testing) with the bath water.
Recommend
George Wallace
Rochester, NY
You should read the Preventative Services Task Force document on the PSA test and on the efficacy of prostate treatments. Also, the American Cancer Society. The editorial is spot on. There are aggressive and slow forms of prostate cancer. Oh that the tests could tell the difference and oh that the treatment did better than extent one life in 1000. Look at the studies.
Recommend
Jane White
New Jersey
Here's the problem. When diagnostic tests pick up an early-stage prostate cancer (or breast cancer, for that matter) doctors have no way to tell whether it's a fast cancer that needs immediate treatment or a slow cancer which won't produce any actual symptoms until after the patient has died of old age.
In the breast, we think that about 70% of DCIS cases will eventually progress to invasive cancer if untreated. (It's tough to be sure, this number relies on population data over decades, not on proper observational studies, as those would be highly unethical.) With prostate cancer, that number is much lower. Technically, most older men have at least a tiny cancer somewhere in the prostate, and most of them will die of something unrelated before it ever progresses.
But if these tiny cancers are diagnosed, how do you tell a patient, "You have cancer, but I'm not going to do anything except schedule a follow-up in 6 months." Even if it's the best thing to do, even if the risks of treatment are worse than the risk of invasive cancer, it's tough for a doctor to do nothing when the patient is afraid.
Recommend
Dr. Dave
Ann Arbor
The editorial speaks of a 16% reduction in risk of lung cancer deaths in those high risk big time smokers screened with CT scans in the lung cancer screening trial.
This relative risk reduction of 16% is the same as an absolute risk reduction of 1/3 % ( one third of a percent), changing the five-year death rate from lung cancer in this high risk population of big time smokers from 1.66% to 1.33 %. In other words, reducing the risk of death of lung cancer by one in three hundred (1 in 300) for this high risk population of big time smokers.
Is the cost- in terms of money, time spent by those who are screened, time spent by those who screen, time away from productive work, anxiety about test results good or bad- and so many more factors- worth it?
Recommend3
A. Taxpayer
Brooklyn NY
Verified
The mission of the administration is not to elevate medical coverage but to level medical insurance to a common, lower, level.
Why else tax quote "premium medical insurance: unquote even provided to municipal workers, etc. However we are fairly certain our politicos are not included.
The answer for employers is to either drop their plan / employee coverage or raises the cost of goods and services provided to thier customers, i.e. a backdoor tax on the taxpayer and not by cutting the billions of fraud in our social programs. Companies will reap greater profits by dropping medical and dental programs for retirees and then current staff, which will aid those in power to achieve a national minimum coverage plan except for politicos of course,
Recommend
Beethy
CA
Verified
'0ver-diagnosis' together aggressive treatment may not be the best solution in every case, all the time. Most of us don't want to wait and see whether it gets worse or stays the same without causing additional health problems, which may have been avoidable early.
The recommendations are not without uncertainties, choices are not entirely risk-free. So, what else is new in medical and healthcare research, patients and their families might wonder?
Recommend5
Mark Thomason
Clawson, MI
Verified
This is both a public health issue and a personal health issue.
Knowing early about something that cannot be helped is a decidedly mixed thing, which will be good or bad according to how person feels about it and handles it, matters in which we differ greatly.
However, if we know of disease earlier in the process, we can develop understanding and treatments that otherwise would not be options. It may not help me, but it might help my kids or my grandkids.
That public health aspect makes a world of difference to me. None of us get out of this world alive. If our trials and tribulations benefit our kids and grandkids, that is about as good as it is going to get.
Recommend24
(2) NYT-Cancers Share Gene Patterns, Studies Affirm, By GINA KOLATA Published: May 1, 2013: Comment Email Thread.
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On Thu, May 2, 2013 at 10:33 AM, wrote:
Dear Ferez S. Nallaseth,
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-----Original Message-----
From: ferez.nallaseth@gmail.com
Sent: 5/2/2013 10:33:29 AM
To: "Care, Customer"
Subject: Re: Comments for article on cancer.
Dear Editor,
I am concerned that my comments for this article will not be accepted by and posted to the online issues NYT:
http://www.nytimes.com/2013/05/02/health/dna-research-points-to-new-insight-into-cancers.html?hpw
The comment:
A dawning that should have occurred with only a small fraction of decades of work! Next - understand & preempt the causes of these 'fingerprints' (mutations?) which is their escape from Mechanisms maintaining Chromosomes/Genomes in Mammalian Homeostasis & Development by including Evolutionary Diversity, Hybrid Zones & Genetics, Histograms, hundreds of Genomic Targets & traditional Science in Systematizing them! The dawning of the age of Functional Mammalian Genomics on a par with dSLAM in Yeast.
less http://lnkd.in/EzV8KF DNA Research Points to New Insight Into Cancers nytimes.com To the surprise of scientists, the most dangerous cancers of the uterine lining closely resemble the worst ovarian and breast cancers, raising the tantalizing possibility that the three deadly cancers might respond to the same...
If this is not a technical problem, as someone who has studied the issue (http://sites.google.com/site/nallasethfs) and understands the limitations of the Biomedical Sciences community in it, this I would consider it an unfortunate lapse by a News Medium with the exceptional record of the New York Times.
Thanks and regards
Ferez S. Nallaseth, Ph.D.
Principal Investigator and Consultant - Life Sciences
Life Sciences Institute
229 Parsons Court
Belle Mead, New Jersey 08502, USA
Tel: 646 283 5163 (M)
908 431 5069 (H, O)
Skype Address: ferez.nallaseth
Websites:
http://sites.google.com/site/nallasethfs
http://www.google.com/profiles?q=ferez+nallaseth
https://sites.google.com/site/fereznsquashdocs
LinkedIn Profile:
http://www.linkedin.com/pub/ferez-soli-nallaseth/14/2a7/311
Twitter address:
NYT On (B) Brain & Mind - Neurosciences
Brain
News about the Brain, including commentary and archival articles published in The New York Times (copy and paste URL below into your browser):
http://topics.nytimes.com/topics/news/health/diseasesconditionsandhealthtopics/brain/index.html
(C) For additional: NYT articles, peer reviewed publications, on Cancer, Public Health Policies, the Brain, Mind, the Neurosciences and the Analytical Nexus of these Sciences with Sports/Squash please visit:
(1) Page 2 of this website - Selected Abstracts, pdfs, PubMed links and Publications
(2) as well as the Website:
(D) Comments on news articles, social media posts and our Scientific History/Contributions that address 'Proposal for A Rational Health Policy' or the Neurosciences
(D1) Comment on an Article reproduced on the front Page of The Times of India :''Jaw-dropping' breakthrough hailed as landmark in fight against hereditary diseases as Crispr technique heralds genetic revolution' Art.TOI on Crispr-FSN-Ltr-Editor_11.7.13.pdf
(D2) Letter and comment on an OpEd article in the New York Times by Correspondent Maureen Dowd on David Page's work on 'Why the Y?'
http://www.nytimes.com/2013/11/24/opinion/sunday/dowd-why-the-y.html?_r=1&#!.
The links to our publications qouted in the above article (D2) maybe inactive but are re-posted below for convenient access:
(1) Nallaseth-YPos-Sequence InstabilityFunctional Inactivation-MBE-9(2)331-1992.pdf
(2) YPos.Interspecific Backcrosses.Mouse Genetics Mtng .6.22-6.25.2011.pdf
(3) DissDevPhyRelRegMammChBiol.Nallaseth et al.GSA.MOHB-CancerGen.WashingtonDC.6.17.2012.pdf
(D7) The Squash.com.au Daily http://paper.li/Squashcomau/1350014352 Squash.com.au (@Squashcomau) mentioned you on Twitter!
Inbox
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Squash.com.au (via Twitter)
Mar 13 (1 day ago)
to me
The Daily is out! Stories via @squashracketrev @fnallase1 - @Squashcomau
Ferez Nallaseth,
You were mentioned in a Tweet!
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