Morning in America: Butthurt Achieved

[CBStew]

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.

This discussion has changed from whether or not medical practitioners are attempting to discourage men from getting their PSA tested to whether there is good reason for doing so.  You assume that a man who learns that his PSA has gone from 2.0 to 6.0 in a year is going to demand a biopsy.  That is doubtful.  The next logical step is a DRE, not a biopsy.  All I am arguing is that we deserve to know if there is a potential issue that may involve cancer or some less serious condition, and to be given information to help us decide the best course of action.  That may also include "watchful waiting".  Cutting down on the number of PSA tests will surely lessen the number of biopsies, but it will increase the number of deaths from cancer.

[J. Walter Weatherman]

Looks like we have yet another reason to never have a practical discussion about gun violence in this country. Oh, well.

[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.

This discussion has changed from whether or not medical practitioners are attempting to discourage men from getting their PSA tested to whether there is good reason for doing so.

No. This thesis was merely insinuated in your original exhortation.

You assume that a man who learns that his PSA has gone from 2.0 to 6.0 in a year is going to demand a biopsy. That is doubtful.

This is a straw man of the first water.

The next logical step is a DRE, not a biopsy. All I am arguing is that we deserve to know if there is a potential issue that may involve cancer or some less serious condition, ...

The notion that PSA testing gets some sort of slipstream boost as a detection mechanism for prostatitis is similarly absurd.

... and to be given information to help us decide the best course of action. That may also include "watchful waiting". Cutting down on the number of PSA tests will surely lessen the number of biopsies, but it will increase the number of deaths from cancer.

"Deaths from cancer" is not the only endpoint. PSA testing has a low signal-to-noise ratio. You have singled out this "source of information" as more important than the information suggesting that, overall, the real-world harms that ensue directly from screening may well outweigh the risks. It is not reasonable to declare that the average patient will magically acquire the ability to evaluate this based  on nothing more than your own self-appraisal.

[CBStew]

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.

This discussion has changed from whether or not medical practitioners are attempting to discourage men from getting their PSA tested to whether there is good reason for doing so.

No. This thesis was merely insinuated in your original exhortation.

You assume that a man who learns that his PSA has gone from 2.0 to 6.0 in a year is going to demand a biopsy. That is doubtful.

This is a straw man of the first water.

The next logical step is a DRE, not a biopsy. All I am arguing is that we deserve to know if there is a potential issue that may involve cancer or some less serious condition, ...

The notion that PSA testing gets some sort of slipstream boost as a detection mechanism for prostatitis is similarly absurd.

... and to be given information to help us decide the best course of action. That may also include "watchful waiting". Cutting down on the number of PSA tests will surely lessen the number of biopsies, but it will increase the number of deaths from cancer.

"Deaths from cancer" is not the only endpoint. PSA testing has a low signal-to-noise ratio. You have singled out this "source of information" as more important than the information suggesting that, overall, the real-world harms that ensue directly from screening may well outweigh the risks. It is not reasonable to declare that the average patient will magically acquire the ability to evaluate this based  on nothing more than your own self-appraisal.

   Have you any close relatives who have had prostate cancer?  Have you ever had a PSA test?  If not, will you ever have one?

[Internet Apex]

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.

This discussion has changed from whether or not medical practitioners are attempting to discourage men from getting their PSA tested to whether there is good reason for doing so.

No. This thesis was merely insinuated in your original exhortation.

You assume that a man who learns that his PSA has gone from 2.0 to 6.0 in a year is going to demand a biopsy. That is doubtful.

This is a straw man of the first water.

The next logical step is a DRE, not a biopsy. All I am arguing is that we deserve to know if there is a potential issue that may involve cancer or some less serious condition, ...

The notion that PSA testing gets some sort of slipstream boost as a detection mechanism for prostatitis is similarly absurd.

... and to be given information to help us decide the best course of action. That may also include "watchful waiting". Cutting down on the number of PSA tests will surely lessen the number of biopsies, but it will increase the number of deaths from cancer.

"Deaths from cancer" is not the only endpoint. PSA testing has a low signal-to-noise ratio. You have singled out this "source of information" as more important than the information suggesting that, overall, the real-world harms that ensue directly from screening may well outweigh the risks. It is not reasonable to declare that the average patient will magically acquire the ability to evaluate this based  on nothing more than your own self-appraisal.

   Have you any close relatives who have had prostate cancer?  Have you ever had a PSA test?  If not, will you ever have one?

Not a real one.

[Wheezer]

Have you any close relatives who have had prostate cancer? Have you ever had a PSA test? If not, will you ever have one?

1. No, not to my knowledge. My mother has HER2+ metastatic breast cancer (which, as these things go, could be worse), and I lost my best friend far too early, and before he was able even to see his second child, to metastatic colon cancer. I'm not trying to minimize things.

2. No, but I don't think I've reached the age bracket.

3. On the off chance that I manage to secure insurance rather than simply jumping off a bridge, if my physician suggests that it's warranted, sure.

Stew, the question is what is generalizable. In this case, the evidence for universal screening simply isn't good.

[Edit.--Oh, and there's a good, non-self-diagnosed, chance that I have Gardner syndrome, but a colonoscopy is out of the question at the moment. So goes anecdote, as immediate or distant as it may be.]

[World's #1 Astros Fan]

Damn I still love this place.

[flannj]

Damn I still love this place.

I've learned about things that I'm surprised I had that much interest in.

[CBStew]

Have you any close relatives who have had prostate cancer? Have you ever had a PSA test? If not, will you ever have one?

1. No, not to my knowledge. My mother has HER2+ metastatic breast cancer (which, as these things go, could be worse), and I lost my best friend far too early, and before he was able even to see his second child, to metastatic colon cancer. I'm not trying to minimize things.

2. No, but I don't think I've reached the age bracket.

3. On the off chance that I manage to secure insurance rather than simply jumping off a bridge, if my physician suggests that it's warranted, sure.

Stew, the question is what is generalizable. In this case, the evidence for universal screening simply isn't good.

[Edit.--Oh, and there's a good, non-self-diagnosed, chance that I have Gardner syndrome, but a colonoscopy is out of the question at the moment. So goes anecdote, as immediate or distant as it may be.]

I hate cancer.  Medical science has lengthened our lives to the point where it is one of the last things that can kill us.  From what I have seen it is a really shitty way to go.  I met a doctor years ago who drank like a fish, smoked like a chimney and ate all of the things that common sense tells us to avoid.  When I thought that I knew him well enough I asked him why, since he was a doctor, he chose a life style that was so unhealthy?  He said because he was a doctor.  He had seen enough suffering and when it was his turn he wanted to go out with a bang.  No lingering.  No suffering.  Just the big one and out.  And he was going to enjoy life on the way there.  But I am not that brave.  

[flannj]

From what I have seen it is a really shitty way to go.

This.

[Wheezer]

Have you any close relatives who have had prostate cancer? Have you ever had a PSA test? If not, will you ever have one?

1. No, not to my knowledge. My mother has HER2+ metastatic breast cancer (which, as these things go, could be worse), and I lost my best friend far too early, and before he was able even to see his second child, to metastatic colon cancer. I'm not trying to minimize things.

2. No, but I don't think I've reached the age bracket.

3. On the off chance that I manage to secure insurance rather than simply jumping off a bridge, if my physician suggests that it's warranted, sure.

Stew, the question is what is generalizable. In this case, the evidence for universal screening simply isn't good.

[Edit.--Oh, and there's a good, non-self-diagnosed, chance that I have Gardner syndrome, but a colonoscopy is out of the question at the moment. So goes anecdote, as immediate or distant as it may be.]

I hate cancer. Medical science has lengthened our lives to the point where it is one of the last things that can kill us. From what I have seen it is a really shitty way to go. I met a doctor years ago who drank like a fish, smoked like a chimney and ate all of the things that common sense tells us to avoid. When I thought that I knew him well enough I asked him why, since he was a doctor, he chose a life style that was so unhealthy? He said because he was a doctor. He had seen enough suffering and when it was his turn he wanted to go out with a bang. No lingering. No suffering. Just the big one and out. And he was going to enjoy life on the way there. But I am not that brave.  

Stew, this is either simply contradictory or an argument for assisted suicide. We're talking about the risk-benefit balance in PSA testing, right? This doesn't cause prostate cancer to happen or not to happen. It is certainly true that cancers, as derangements of cellular reproduction, cone hand-in-hand with longevity. But if you're going to invoke QALYs, quality-adjusted life-years, it's back to square one. One can't glibly bank on (or, really, target) "the big one," because Moby Dick might turn out to be a debilitating but nowhere near fatal stroke.

[J. Walter Weatherman]

I hate cancer.  Medical science has lengthened our lives to the point where it is one of the last things that can kill us.

Cancer is the classic disease of longevity, right? I mean, each cell division is a little roll of the the dice. The longer you live, the more likely you are to eventually come up snake eyes with a nasty malignant mutation.

From what I have seen it is a really shitty way to go.  I met a doctor years ago who drank like a fish, smoked like a chimney and ate all of the things that common sense tells us to avoid.  When I thought that I knew him well enough I asked him why, since he was a doctor, he chose a life style that was so unhealthy?  He said because he was a doctor.  He had seen enough suffering and when it was his turn he wanted to go out with a bang.  No lingering.  No suffering.  Just the big one and out.  And he was going to enjoy life on the way there.  But I am not that brave.  

Incidentally, I happened to read this just the other day:

http://www.zocalopublicsquare.org/2011/11/30/how-doctors-die/ideas/nexus/

Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient's five-year-survival odds–from 5 percent to 15 percent–albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn't spend much on him.

It's not a frequent topic of discussion, but doctors die, too. And they don't die like the rest of us. What's unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.

Of course, doctors don't want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain, and dying alone. They've talked about this with their families. They want to be sure, when the time comes, that no heroic measures will happen–that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that's what happens if CPR is done right).

Almost all medical professionals have seen what we call "futile care" being performed on people. That's when doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs. All of this occurs in the Intensive Care Unit at a cost of tens of thousands of dollars a day. What it buys is misery we would not inflict on a terrorist. I cannot count the number of times fellow physicians have told me, in words that vary only slightly, "Promise me if you find me like this that you'll kill me." They mean it. Some medical personnel wear medallions stamped "NO CODE" to tell physicians not to perform CPR on them. I have even seen it as a tattoo.

Brief follow-up here:

http://www.zocalopublicsquare.org/2012/07/23/doctors-really-do-die-differently/ideas/nexus/

[Wheezer]

Cancer is the classic disease of longevity, right? I mean, each cell division is a little roll of the the dice. The longer you live, the more likely you are to eventually come up snake eyes with a nasty malignant mutation.

It's complicated. It is horribly complicated. It is not one disease. I was once young and naive and proud enough to think that the biological sciences paled in comparison to the physical sciences and, oho!, look at this Riemannian manifold! I was dead fucking wrong. Cellular mutations accumulate; there's no snake eyes. There is a mitochondrial clock, and a roundabout of checkpoints. What might be a survival benefit in normal metabolism may be a turnkey to destruction later on. Malignancies adapt to evade cytotoxic chemotherapy. The search for therapies is a painstaking hunt for ways to sabotage saboteurs. And once childhood leukemia was death sentence, and now it is not, and HER2+ breast cancer was once a bad actor, and now it is subject to significant immunological attack.

I suppose I'm just rambling. But given the massed assault of human endeavor in this regard, I'm not willing to dismiss the considered opinion on screening, and not just prostate, in favor of some sort of "informed consumer" routine any more than I would engage in the drastically simpler activity of pro se representation.

[Oleg]

Prostate cancer: Butthurt, LITERALLY, achieved?

[CT III]

This is literally "Butthurt".

FACE