Morning in America: Butthurt Achieved

[PenPho]

You're all forgetting that guns are cool and make you look cool, and that you're all probably a bunch of gheys. Or women. Or ghey women. 'Cept ghey women could probably handle a weapon better than some twink like Thrill.

Guns, like giant spoilers on small cars indicate the owner is compensating for something, such as a tiny little dick. If you think chicks don't know this by now, you're getting blinded by your bangs again.

I feel like somebody in this conversation is quoting Fro Dog but I'm not sure who it is.

Probably Eli. 

[Internet Apex]

You're all forgetting that guns are cool and make you look cool, and that you're all probably a bunch of gheys. Or women. Or ghey women. 'Cept ghey women could probably handle a weapon better than some twink like Thrill.

Guns, like giant spoilers on small cars indicate the owner is compensating for something, such as a tiny little dick. If you think chicks don't know this by now, you're getting blinded by your bangs again.

I feel like somebody in this conversation is quoting Fro Dog but I'm not sure who it is.

Probably Eli. 

I knew SKO was joking.

[Richard Chuggar]

You're all forgetting that guns are cool and make you look cool, and that you're all probably a bunch of gheys. Or women. Or ghey women. 'Cept ghey women could probably handle a weapon better than some twink like Thrill.

Guns, like giant spoilers on small cars indicate the owner is compensating for something, such as a tiny little dick. If you think chicks don't know this by now, you're getting blinded by your bangs again.

I feel like somebody in this conversation is quoting Fro Dog but I'm not sure who it is.

Probably Eli. 

I knew SKO was joking.

I'd actually think that most of the huge black dudes that play professional sports and also carry guns have huge cocks.  What are they compensating for in that case?

[Internet Apex]

You're all forgetting that guns are cool and make you look cool, and that you're all probably a bunch of gheys. Or women. Or ghey women. 'Cept ghey women could probably handle a weapon better than some twink like Thrill.

Guns, like giant spoilers on small cars indicate the owner is compensating for something, such as a tiny little dick. If you think chicks don't know this by now, you're getting blinded by your bangs again.

I feel like somebody in this conversation is quoting Fro Dog but I'm not sure who it is.

Probably Eli. 

I knew SKO was joking.

I'd actually think that most of the huge black dudes that play professional sports and also carry guns have huge cocks.  What are they compensating for in that case?

STDs.

[Quality Start Machine]

You're all forgetting that guns are cool and make you look cool, and that you're all probably a bunch of gheys. Or women. Or ghey women. 'Cept ghey women could probably handle a weapon better than some twink like Thrill.

Guns, like giant spoilers on small cars indicate the owner is compensating for something, such as a tiny little dick. If you think chicks don't know this by now, you're getting blinded by your bangs again.

I feel like somebody in this conversation is quoting Fro Dog but I'm not sure who it is.

Probably Eli. 

I knew SKO was joking.

I'd actually think that most of the huge black dudes that play professional sports and also carry guns have huge cocks.  What are they compensating for in that case?

Unless they're Plaxico Burress, and they blew half their cock off.

[CBStew]

This is literally "Butthurt".


http://www.sfgate.com/news/article/Jerry-Brown-treated-for-prostate-cancer-4113018.php

Prostate cancer is a bitch.  Because we are living longer, more of us than in previous years are susceptible to developing it.  Hopefully, in Brown's case they are telling the truth about his prognosis.  GET YOUR CHECK UPS and don't be persuaded to forego PSA tests.

[Wheezer]

GET YOUR CHECK UPS and don't be persuaded to forego PSA tests.

I don't think anyone is trying to "persuade" anyone to skip PSA testing. The USPSTF guidelines that have caused so much fuss simply recommend informed consent over routine screening. It's not as bad as the situation with mammography (which the Komen Foundation vastly overrates by silent invocation of lead-time bias), as the test itself carries almost no risk. Biopsies, however, carry risk. Treatment carries serious risk and uncertain benefit. Harms from overdiagnosis are real, and this is something that it can be hard to convey to the general public.

[CBStew]

GET YOUR CHECK UPS and don't be persuaded to forego PSA tests.

I don't think anyone is trying to "persuade" anyone to skip PSA testing. The USPSTF guidelines that have caused so much fuss simply recommend informed consent over routine screening. It's not as bad as the situation with mammography (which the Komen Foundation vastly overrates by silent invocation of lead-time bias), as the test itself carries almost no risk. Biopsies, however, carry risk. Treatment carries serious risk and uncertain benefit. Harms from overdiagnosis are real, and this is something that it can be hard to convey to the general public.

What this means in actual practice is that doctors tell their patients that they do not advise routine screening, and that that a high PSA doesn't necessarily indicate cancer, and may even reflect lab error. Please believe me, doctors, including urologists, actively attempt to discourage patients from getting tested, and are not advising it for men in appropriate age groups, even those with a family history of prostate cancer. 
"We encourage clinicians to consider this evidence and not screen their patients with a PSA test unless the individual being screened understands what is known about PSA screening and makes the personal decision that even a small possibility of benefit outweighs the known risk of harms."

[Wheezer]

GET YOUR CHECK UPS and don't be persuaded to forego PSA tests.

I don't think anyone is trying to "persuade" anyone to skip PSA testing. The USPSTF guidelines that have caused so much fuss simply recommend informed consent over routine screening. It's not as bad as the situation with mammography (which the Komen Foundation vastly overrates by silent invocation of lead-time bias), as the test itself carries almost no risk. Biopsies, however, carry risk. Treatment carries serious risk and uncertain benefit. Harms from overdiagnosis are real, and this is something that it can be hard to convey to the general public.

What this means in actual practice is that doctors tell their patients that they do not advise routine screening, and that that a high PSA doesn't necessarily indicate cancer, and may even reflect lab error. Please believe me, doctors, including urologists, actively attempt to discourage patients from getting tested, and are not advising it for men in appropriate age groups, even those with a family history of prostate cancer. 
"We encourage clinicians to consider this evidence and not screen their patients with a PSA test unless the individual being screened understands what is known about PSA screening and makes the personal decision that even a small possibility of benefit outweighs the known risk of harms."

This doesn't, of itself, mean anything in actual practice. Moreover, a low PSA doesn't indicate absence of cancer, and at certain ages, you're going to find 80% prevalence on autopsy anyway. We're not talking about PSAs over 10 ng/ml here. Once again, overdiagnosis has harms. As with mammographic screening, when you actively look for something, you're quite likely to find a hell of a lot of it (e.g., ductal carcinoma in situ). This doesn't readily translate to outcomes.

[CBStew]

GET YOUR CHECK UPS and don't be persuaded to forego PSA tests.

I don't think anyone is trying to "persuade" anyone to skip PSA testing. The USPSTF guidelines that have caused so much fuss simply recommend informed consent over routine screening. It's not as bad as the situation with mammography (which the Komen Foundation vastly overrates by silent invocation of lead-time bias), as the test itself carries almost no risk. Biopsies, however, carry risk. Treatment carries serious risk and uncertain benefit. Harms from overdiagnosis are real, and this is something that it can be hard to convey to the general public.

What this means in actual practice is that doctors tell their patients that they do not advise routine screening, and that that a high PSA doesn't necessarily indicate cancer, and may even reflect lab error. Please believe me, doctors, including urologists, actively attempt to discourage patients from getting tested, and are not advising it for men in appropriate age groups, even those with a family history of prostate cancer. 
"We encourage clinicians to consider this evidence and not screen their patients with a PSA test unless the individual being screened understands what is known about PSA screening and makes the personal decision that even a small possibility of benefit outweighs the known risk of harms."

This doesn't, of itself, mean anything in actual practice. Moreover, a low PSA doesn't indicate absence of cancer, and at certain ages, you're going to find 80% prevalence on autopsy anyway. We're not talking about PSAs over 10 ng/ml here. Once again, overdiagnosis has harms. As with mammographic screening, when you actively look for something, you're quite likely to find a hell of a lot of it (e.g., ductal carcinoma in situ). This doesn't readily translate to outcomes.

Everything you say is correct, except that practitioners are in fact discouraging men from getting their PSA tested.  False negatives are not the issue here.  They are concerned with false positives leading to unnecessary treatment.  A high PSA isn't  tantamount to a diagnosis of prostate cancer.  There can be many reasons that one's PSA level is higher than "normal".  One of which is that the individual recently ejaculated.  Another reason is that the person has an infection.  Or that he has an enlarged prostate.  These last two are good things to know, because the man may want to have those things treated.  Enlarged prostates and prostate infections are more common than prostate cancer, and if one learns from a PSA test that he has elevated levels, additional exams are available to determine what is going on.  (DRE and white blood cell test, for example)  To me it is irresponsible for the medical profession to advocate keeping individuals in the dark about their health conditions.

[Wheezer]

Everything you say is correct, except that practitioners are in fact discouraging men from getting their PSA tested. False negatives are not the issue here. They are concerned with false positives leading to unnecessary treatment. A high PSA isn't tantamount to a diagnosis of prostate cancer. There can be many reasons that one's PSA level is higher than "normal". One of which is that the individual recently ejaculated. Another reason is that the person has an infection. Or that he has an enlarged prostate.  These last two are good things to know, because the man may want to have those things treated.  Enlarged prostates and prostate infections are more common than prostate cancer, and if one learns from a PSA test that he has elevated levels, additional exams are available to determine what is going on. (DRE and white blood cell test, for example) To me it is irresponsible for the medical profession to advocate keeping individuals in the dark about their health conditions.

It's not even false positives. Once an actual cancer is found, the "compulsion to treat" kicks in. One is stuck with the fact that most patients are completely unable to competently evaluate the evidence on the subject. Clinical guidelines are based on overall outcomes. If you have to screen 1068 and treat 48, with significant individual risk associated with the treatment, to prevent a single death due to prostate cancer (here), what do you imagine the guidelines for practice would be? All medical interventions hinge on a risk-benefit analysis. PSA numbers do not shine a great deal of light, particularly as received by most individuals.

[CBStew]

Everything you say is correct, except that practitioners are in fact discouraging men from getting their PSA tested. False negatives are not the issue here. They are concerned with false positives leading to unnecessary treatment. A high PSA isn't tantamount to a diagnosis of prostate cancer. There can be many reasons that one's PSA level is higher than "normal". One of which is that the individual recently ejaculated. Another reason is that the person has an infection. Or that he has an enlarged prostate.  These last two are good things to know, because the man may want to have those things treated.  Enlarged prostates and prostate infections are more common than prostate cancer, and if one learns from a PSA test that he has elevated levels, additional exams are available to determine what is going on. (DRE and white blood cell test, for example) To me it is irresponsible for the medical profession to advocate keeping individuals in the dark about their health conditions.

It's not even false positives. Once an actual cancer is found, the "compulsion to treat" kicks in. One is stuck with the fact that most patients are completely unable to competently evaluate the evidence on the subject. Clinical guidelines are based on overall outcomes. If you have to screen 1068 and treat 48, with significant individual risk associated with the treatment, to prevent a single death due to prostate cancer (here), what do you imagine the guidelines for practice would be? All medical interventions hinge on a risk-benefit analysis. PSA numbers do not shine a great deal of light, particularly as received by most individuals.

There is a certain familiar ring to that, but that ain't the way I heard it.   "If they'd rather die, then they had better do it and decrease the surplus population"

[Wheezer]

Everything you say is correct, except that practitioners are in fact discouraging men from getting their PSA tested. False negatives are not the issue here. They are concerned with false positives leading to unnecessary treatment. A high PSA isn't tantamount to a diagnosis of prostate cancer. There can be many reasons that one's PSA level is higher than "normal". One of which is that the individual recently ejaculated. Another reason is that the person has an infection. Or that he has an enlarged prostate.  These last two are good things to know, because the man may want to have those things treated.  Enlarged prostates and prostate infections are more common than prostate cancer, and if one learns from a PSA test that he has elevated levels, additional exams are available to determine what is going on. (DRE and white blood cell test, for example) To me it is irresponsible for the medical profession to advocate keeping individuals in the dark about their health conditions.

It's not even false positives. Once an actual cancer is found, the "compulsion to treat" kicks in. One is stuck with the fact that most patients are completely unable to competently evaluate the evidence on the subject. Clinical guidelines are based on overall outcomes. If you have to screen 1068 and treat 48, with significant individual risk associated with the treatment, to prevent a single death due to prostate cancer (here), what do you imagine the guidelines for practice would be? All medical interventions hinge on a risk-benefit analysis. PSA numbers do not shine a great deal of light, particularly as received by most individuals.

There is a certain familiar ring to that, but that ain't the way I heard it. "If they'd rather die, then they had better do it and decrease the surplus population"

No, Stew. I repeat: All medical interventions hinge on a risk-benefit analysis. It is impossible to sensibly establish clinical guidelines regarding a screening protocol without asking whether the screening in fact may cause more overall harm than benefit. It is indeed impersonal, aside from the identification of clear risk factors. If you're going to advocate for universal PSA screening, then you also have to figure out a way to universally bang a large amount of highly technical information into people's heads. Testing itself is not a viable choke point.

[J. Walter Weatherman]

We get it, Wheezer. You want to kill off Stew and the rest of his age cohort and burn their bones to heat your coke ovens.

[Wheezer]

We get it, Wheezer. You want to kill off Stew and the rest of his age cohort and burn their bones to heat your coke ovens.

Given the racial disparity in serious complications following prostate biopsy, you tell me who's targeting whom.

More screenings mean more biopsies mean more complications. This is not sensibly in dispute.