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Originally Posted by asking

Public health decisions are about maximizing the public good--and that means the greatest number of healthy people. If we only need two-thirds as many mammograms to help women avoid breast cancer, why do more? Just as a symbol?

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I'm going to ask you the same question that I asked others before:

Can you show me one case where LESS cancer screening led to a life being saved?

Can you show me how less cancer screening is BETTER?

Breast cancer is the second largest killer in the USA after heart disease. By 2010 or 2011, if the current trends continue, it is slated to surpass heart disease and become the number one killer in the USA. Can you please explain to me how prescribing fewer mamograms is going to help prevent breast cancer deaths, given that statistical reality?

It may save us some money, but will it save even one additional life?

Elliot

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Originally Posted by asking

You don't think women can understand the message "Fewer mammograms" as opposed to "no mammogram"? I think most women and their doctors are smart enough to know the difference. Also, the recommendations are primarily aimed at younger women. Younger women are less likely to get breast cancer and when they do, it's more likely to be an aggressive, fast growing kind. Mammograms are less useful for catching those. And why increase your exposure to radiation if it's not going to do any good?

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Unlike so many on the left I give more credit to the intelligence of the American people - but - that is exactly one of the objections raised by medical professionals on the mammogram recommendation. And it WILL happen.

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I don't think cost was one of the criteria in this case.

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Didn't say it was, I was specific on the reasons on guidelines by federal health advisory panels.

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Public health decisions are about maximizing the public good--and that means the greatest number of healthy people. If we only need two-thirds as many mammograms to help women avoid breast cancer, why do more? Just as a symbol?

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If my wife was the one saved by an "unnecessary" mammogram I wouldn't give a damn about "maximizing the public good." Health care is not about "maximizing the public good," it's about giving EVERY patient the best care. If it's not patient driven it's not reform.

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Originally Posted by speechlesstx

If my wife was the one saved by an "unnecessary" mammogram I wouldn't give a damn about "maximizing the public good." Health care is not about "maximizing the public good," it's about giving EVERY patient the best care. If it's not patient driven it's not reform.

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If it's not about maximizing the public good... AND it's about getting EVERY patient the best care...

How does that work, exactly? Will I get BETTER care for the same amount of money I pay now when all those people who choose to spend their money on something other than health care now get it for free from the government? I'll get the BEST care? Is that the same BEST care that the rich can afford? Or is it the "best care possible under the circumstances of overworked medical staff, at clinics and hospitals without enough supplies or room, with a greater waiting time for treatment, and the same abuses of the system continuing that happen currently", as I suspect it is?

PS...if your wife's life was saved by an "unnecessary" mammogram, wouldn't you be HAPPY to pay for it out of pocket?

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Originally Posted by asking

I
Public health decisions are about maximizing the public good--and that means the greatest number of healthy people.

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And that is why health decisions should not be "public". They should be between the doctor and the patient, without "public" (read: government) input. Because "public health decisions" don't take the needs of the individual patient into account... only the good of the whole community, which may not be what the PATIENT needs.

This is a question of whether you believe (as the Founding Fathers did) that individual rights supercede the good of the collective community as a whole or not. I, personally, do believe that the rights of the individual to make his own medical decisions are paramount over the "good of the community". That's why the Founding Fathers created the Bill of Rights (especially the 10th Amendment) and wrote the Declaration of Independence as they did. These documents make the rights of the individual paramount over the good of the community as defined by the government.

Elliot

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Originally Posted by ETWolverine

I'm going to ask you the same question that I asked others before:

Can you show me one case where LESS cancer screening led to a life being saved?

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Epidemiology doesn't work that way. You can look at the numbers and see that screening fails to decrease the death rate. But you can't pick out individual people and say, THIS person died because of x ray exposure.

I have a friend who is dying of lung cancer. She never smoked. My grandmother smoked like a chimney and never had lung cancer. Does this mean that lung cancer isn't caused by smoking? No. But it's really hard to show the exact cause of most cancers. Breast cancer is no different. You look at broad patterns.

You CAN say, this person was stressed for a 6 months and had an unnecessary biopsy because of a false positive mammogram.

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Originally Posted by ETWolverine

They should be between the doctor and the patient, without "public" (read: government) input.

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And that's what happens in Canada.

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Originally Posted by ETWolverine

And that is why health decisions should not be "public". They should be between the doctor and the patient, without "public" (read: government) input. Because "public health decisions" don't take the needs of the individual patient into account... only the good of the whole community, which may not be what the PATIENT needs

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I'm baffled by this. You don't believe in public health? You think it should be every man for himself?

If you had your way, we'd still have polio, open sewers. And typhoid.

I'd like to point out here that the ONLY reason that the polio vaccine was able to save so many is that Salk refused to patent it.

Can you see that happening today? Can you HONESTLY see the company that finds the cure for cancer NOT profiting, and profiting GREATLY on it?

Take away patents on medicines that are for "public good" and you've got a heck of a way to reduce medical costs.

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Originally Posted by Synnen

If it's not about maximizing the public good... AND it's about getting EVERY patient the best care...

How does that work, exactly?

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"Maximizing the public good" is just a platitude. If we don't begin with reform being patient driven we can't maximize the public good. Every "solution" offered by the Democrats is cost-driven. Federally managed health care will be no other way. It may expand coverage but at the expense of something, quality of care, innovation, availability, etc. Which is Canada is experiencing a huge growth in private clinics in spite of the government's wishes (look it up, NK, I've posted several articles).

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PS... if your wife's life was saved by an "unnecessary" mammogram, wouldn't you be HAPPY to pay for it out of pocket?

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Under Obamacare will I be able to?

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I'd like to point out here that the ONLY reason that the polio vaccine was able to save so many is that Salk refused to patent it.

Can you see that happening today? Can you HONESTLY see the company that finds the cure for cancer NOT profiting, and profiting GREATLY on it?

Take away patents on medicines that are for "public good" and you've got a heck of a way to reduce medical costs.

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What did it cost Salk to do it? Nothing ;he was working on grant money from the 'Infantile Paralysis Foundation '.

Synnen,
Are you arguing with me? Not sure who your comments are directed to.

The first fungicide (and these are important medicines) was marketed only BECAUSE it was patented and rights to make it given to a single company. Nobody wants to invest in production, distribution, and marketing without some promise of exclusivity for at least a while.
I think we are agreeing...

(And I'm not exactly the number one fan of big pharma.)

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Originally Posted by tomder55

What did it cost Salk to do it? Nothing ;he was working on grant money from the 'Infantile Paralysis Foundation '.

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The cost of the research IS a public health decision in most cases. Who decides how much money to allocate to breast cancer or prostate cancer research? Policy people. Public health officials. They are the ones who think, this disease kills 2,000 people per year while this other one kills 200,000.

We have $20 million. If we invest in research or preventive measures for either disease, we can SAVE 10% of those people.

You HAVE to choose one of the diseases. If you split the money, you won't save anybody. So what's the right answer?

You can say, ask the patients because they feel most strongly, but you are going to get a different answer depending on who you ask.

So, the answer is obviously saving 10% of 200,000 people is a better than saving 10% of 2000. It's not "cold hearted" to save 20,000 people instead of 200.

The reality is that (in part thanks to our pointless wars overseas) there IS a limited amount of money for health care and health research. We only have so much to spend. Public health experts make the best decisions they can. Do I always agree with their decisions? No. But the idea that they shouldn't exist is absurd. Nobody thinks that!

If those evil pharmceutical companies pay for the funding they should indeed get exclusive patent rights and reap the rewards of their effort. As you point out ; Developing a drug is an expensive proposition. Take that right away and they will shut down their R & D. .

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Originally Posted by tomder55

What did it cost Salk to do it? Nothing ;he was working on grant money from the 'Infantile Paralysis Foundation '.

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How many organizations work under grant money? How much of that grant money is paid for by tax dollars?

Government Grant money gets distributed primarily through the NIH .But Salk was working with private grant money from what is now called the MARCH OF DIMES(formerly National Foundation for Infantile Paralysis ). He had no ownership claim for the vaccine ;the foundation that paid for it did... and despite the fame he got from his oft quoted interview with Edward R Murrow about patenting the sun;the truth is that the National Foundation for Infantile Paralysis lawyers explored the possibility and found that they could not do it under the standard laws of the day. Salk in his defense probably believed what he said. But in reality ,if the vaccine could've been patented ,it would've happened. (source.. Jane
Smith ' Patenting the Sun:Polio and the Salk Vaccine')

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Originally Posted by tomder55

Developing a drug is an expensive proposition. Take that right away and they will shut down their R & D . .

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Exactly my point.

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Originally Posted by tomder55

... in reality ,if the vaccine could've been patented ,it would've happened. (source ..Jane
Smith ' Patenting the Sun:Polio and the Salk Vaccine')

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Interesting. I have this book on my shelf and have never got around to reading it. Maybe I'll check it out this winter.

The government funds a HUGE amount of research. A single institute at the national institutes of health can have an annual budget of a billion dollars and there are 20? Institutes. I forget. And that's just NIH, which only does biomedical research. NSF has a much smaller budget. But then there's the Department of Energy, DARPA, NOAA, and several others.

I would say that public funding is an important source for the research and development of orphan drugs. But ,given a standard medical problem ,the private sector can identify and test new pharmaceutical products cheaper and more efficiently than through the public sector . Government efforts are far less accountable for failure, waste, ethics and safety than private initiatives.

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Originally Posted by tomder55

I would say that public funding is an important source for the reasearch and development of orphan drugs. But ,given a standard medical problem ,the private sector can identify and test new pharmaceutical products cheaper and more efficiently than through the public sector . Government efforts are far less accountable for failure, waste, ethics and safety than private initiatives.

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Which is EXACTLY why nationalized medicine will not work.