The Permanent Mental Health Regime

[dualstow]

All I know about prostates is they're up in your butthole region.

Hopefully just one.

[Xan]

4. Hopefully everyone already knows that prostate cancer screening has been declared useless.

I only remember Ben Stiller urging men to get tested. I just reviewed that after reading your post. Hmm.
https://www.healthnewsreview.org/2016/1 ... te-cancer/

All I know about prostates is they're up in your butthole region. Of course, I didn't know you should not get it checked out, but it's welcome info.

Well, hang on... WiseOne is questioning the utility of PSA tests, but that isn't the same as the doctor sticking a finger up there to see how it's doing. Is that old-fashioned test better than a PSA, WiseOne?

And thanks very much for sharing your wisdom here!

[Maddy]

Here's a question (albeit a little tangential) that I've just been dying to ask:

Are there any studies that compare the outcome of cancer patients who go through the standard treatment protocols and those who do nothing? I'm guessing that the data is limited due to the fact that you can't very well create a "control" group of non-treated cancer patients. But I'm also guessing that there's a growing number of self-styled controls out there. WiseOne?

[WiseOne]

Gee, I guess I need to answer these questions...

Rectal exams used to be mostly about checking for occult blood in the stool, which is (or rather was) a very useful and inexpensive colon cancer screening test. Plus you get an instant answer. JCAHO however has effectively banned the practice, I guess because the test was maddeningly simple and didn't make money from an administrator's point of view (sarcasm). Honestly I have zero idea why that was done.

It is also a way of doing prostate cancer screening, which is not useful no matter how you do it, or to check for an enlarged prostate or altered rectal tone to investigate causes of urinary issues. Thus, there's no longer any reason for screening rectal exams. You guys can now rejoice.

Maddy, I'm not sure what you're intending with your question exactly? What you said is definitely true for a cancer that manifests due to clinical symptoms, and I doubt that would ever get IRB approval as it would violate equipoise. Cancers caught on screening tests, though, are a different issue. A randomized trial might just get past an IRB board, but I suspect it might be hard to recruit for it plus you'll likely get pilloried by the press, patient advocate organizations etc.

So you have to try alternative approaches. One is to study the correlation of survival with lesion size at detection. This is a useful assessment of the value of screening because lesions do tend to be caught when they are smaller, but you have to be careful to limit to specific pathologies to avoid biasing the results by comparing fundamentally different types of cancers (which is a problem with nearly all studies of breast cancer screening outcomes). I'm aware of one study limited to aggressive breast cancers that did this well, and that's the one that found that lesion size (and thus screening) had no effect on survival. Another approach is to compare all-cause mortality in a sufficiently large study of patients randomized to receive screening vs. not. There have been 3 such studies of breast cancer screening. Two of them (in Canada and Finland) found no difference between groups. One of them did (New York) but the study was flawed because the two groups showed the difference BEFORE they started screening. Naturally, the screening recommendations were put in place using the New York study as the justification, ignoring the other two.

Anyway...it's so much fun when you start REALLY looking at the data that support preventive medicine recommendations. At best, primary prevention provides tiny benefits or exchanges one set of problems for another. At worst, it's downright damaging. A decision to screw the whole scene and just live your life is perfectly justifiable, and probably good for your mental health as well!

[amdda01]

WiseOne,

Curious about your opinion of "heart scans":

https://www.amitahealth.org/heartscan/? ... gJK4PD_BwE

Thanks!

[WiseOne]

No idea what the heart scan is...doesn't even say if it's an MRI or CT or plain X ray. Unlikely to be one of the first two given the price.

If it's just an Xray, it's mainly able to detect an enlarged heart, which I guess is not bad to know about. Just be aware that enlarged hearts can be normal for some people especially athletes. Also for men, active heart disease is not something you'd miss...women on the other hand can have heart attack symptoms that get overlooked (including by doctors). So I'm not really sure why a man would need one of these. Also, for either sex an EKG is going to be at least as informative, and doesn't involve any radiation.

This is sort of like going to a used car salesman. They're trying to sell you something, and it's not necessarily something you need. But then, almost any medical encounter now is not too different from that.

[WiseOne]

A CT scan for $50? Sounds fishy. That's less than 10% of a typical chest CT charge.

This has "stay away" written all over it.

[amdda01]

Seems to be in the ballpark for Chicago.

Here's another one for $75:

https://www.dupagemedicalgroup.com/heal ... e-ct-scan/

[Xan]

It may be that these are "loss-leaders". Give the scan away for (basically) free, and some percentage of people scanned will need hospital services. It's very likely they'll get those services at the same hospital.

I don't know whether that's good or bad: they're delivering on their promise to give you peace of mind, if nothing turns up.

[Mountaineer]

Seems to be in the ballpark for Chicago.

Here's another one for $75:

https://www.dupagemedicalgroup.com/heal ... e-ct-scan/

This is what caught my eye in the link:
The amount of calcium may not closely correlate with the degree of narrowing in the coronary arteries. The clinical implications of any CAS result should be determined by a physician in conjunction with risk factors for coronary artery disease, possible symptoms, medical history, physical findings and may be influenced by many factors, including age, gender, location and number of calcifications and arteries involved. This screeningtool is not for purposes of evaluation or diagnosis of any conditions of the chest and we will not bill insurance for this screening. Payment is expected at the time of service.

Why even bother to get the test? Would you really have peace of mind?

[jacksonM]

I've been working on my medical degree lately by watching youtube videos by Peter Attia.

Here's an article of his discussing this very thing and others when it comes to what we actually know about heart disease (or maybe it's more accurate to say it's about what we know that isn't true).

It's written mostly for doctors but I think he's pretty good at making these things understandable for laymen.

https://peterattiamd.com/heart-disease- ... revention/

Seems to be in the ballpark for Chicago.

Here's another one for $75:

https://www.dupagemedicalgroup.com/heal ... e-ct-scan/

This is what caught my eye in the link:
The amount of calcium may not closely correlate with the degree of narrowing in the coronary arteries. The clinical implications of any CAS result should be determined by a physician in conjunction with risk factors for coronary artery disease, possible symptoms, medical history, physical findings and may be influenced by many factors, including age, gender, location and number of calcifications and arteries involved. This screeningtool is not for purposes of evaluation or diagnosis of any conditions of the chest and we will not bill insurance for this screening. Payment is expected at the time of service.

Why even bother to get the test? Would you really have peace of mind?

[WiseOne]

They're looking for arterial calcification with that test?

Wow, that's hilarious. You can't see coronary arteries with that degree of precision on a CT scan. They're too small! Plus there's a lot of uncertainty about the basic technique even if you're looking for something sufficiently big (like an aortic aneurysm). That's why the standard of care is an angiogram (injecting dye directly into blood vessels). Which obviously is invasive so you only do that when you have good reason to.

I'd say the chances of finding any useful information from this test is close to zero. Other than how easy it is for someone to hawk $50 services to the unsuspecting public.

[dualstow]

Read or listen to the bill of the month and enjoy. This one's a doozy.
https://www.npr.org/tags/585747919/bill-of-the-month