To followup on my previous post: how do these panels come up with screening recommendations?
Factors that come into play in making these recommendations: rate of false positives, rate of incidence of whatever is being screened for, and how the benefits are measured.
Before I get into my stuff, let me link other coverage of this issue, and you can ignore all the stuff I have to say.
NPR’s coverage on cancer screening guidelines
Coverage from a Florida newspaper
Let me run a very simplified model. To simplify matters, I’m going to pretend that the rate of false negatives [i.e., you have the condition screened for but the test doesn't find it] is zero; this is not going to appreciably change the analysis below. If we have a test with a high false negative rate, then who is going to want to use the test? So let’s assume that the test we use will catch all actual incidences of the condition.
However, some conditions are more rare than others, and there is always some level of false positives – some growth found that isn’t cancer, but you still will have to followup and do a biopsy, say.
Let d = the percentage of people in a given population who have a disease, and p = the probability of false positive [i.e., probability that the test gives a positive result, given you don't actually have the condition]. We are going to test the population: in percentage terms, how many false positives, true positives, and true negatives are we going to get? [remember, we're saying false negatives are not occurring].
true positives = d
false positives = (1 – d) p
true negatives = (1 – d) (1 – p)
Probability you actually have the disease, given you test positive: d / [d + (1 - d) d]
So let’s try different combos of d and p, and see results
| d
disease incidence (percentage) |
p
false positive incidence (percentage) |
Prob you have disease given positive (percentage) |
| 10 | 1 |
92 |
| 1 | 1 |
50 |
| .1 | 1 |
9 |
| .01 | 1 |
1 |
| 10 | .1 |
99 |
| 1 | .1 |
91 |
| .1 | .1 |
50 |
| .01 | .1 |
9 |
So when the disease has low incidence in the population, even for a relatively accurate test, most of the positive results will be false. This is just one piece in the decision of recommending which groups [by age, family history, race] should get screenings. On the cost side, you can figure in the costs of the screening tests themselves, and then the costs of followup [for false positives and true positives alike.]. Sometimes the anguish of false positives is added into the cost equation, but I think that’s usually for the press releases and not necessarily for an official cost-benefit analysis. The costs are the followups. For those who are true positives, you need to wrap in the cost of treatment for the condition.
But what about the benefit side? While the costs are very easy to define, these benefits are harder to define. Forget about improved quality of life [which obviously has value to the individual] for treatment of a condition, let’s say we use are measuring stick as added years to life expectancy if true positive is treated. But what dollar value are you going to put on those extra years of life?
That’s where it gets murky and political.
I’m going to swerve into the personal for a moment. My father died of a heart attack at a rather young age, and my family sued a medical center and the head doctor for misdiagnosis and mistreatment [our lawyer? John Edwards. This was his pre-senatorial days, of course]. I was a party to the lawsuit, but only 19 when it was settled, so I don’t know all the details, but there is one thing I know — part of the number in the requested restitution was based on the fact that my dad was an engineer working for IBM, and there was a calculation for lost wages due to early death. This is quite common in medical malpractice cases [esp. when the person who died or is disabled had been in a high salary career before the medical incident].
Can you imagine if the official government screening advice were based on your salary? Yeah, that’s not going to fly.
So what usually happens is some dollar amount is put on extra years of life, not really paying attention to which years they are, and not treating the value of these years as infinite. Think about it – you do something similar in your own life, though probably more implicitly than the explicit calculation made here.
People aren’t perfectly rational, to be sure, but we’re making these cost/benefit tradeoffs in terms of risk all the time. We know that traveling outside the house is risky compared to staying at home, but most of us think the benefits outweigh the risks we take on. But we don’t all value benefits the same — some of us don’t think the benefit of sky diving, say, outweighs the extra mortality risk.
Back to governmental recommendations. They’ve got to use some number to determine the cutoff, and depending on how they value those lives. This is where it becomes political. The higher the dollar value you put on those extra years, the more screening you’re going to recommend even into those areas where there are lots of false positives; the lower the dollar value, the less screening will be recommended.
I have nothing against these recommendations being set. The problem is how they will be used, and how they will be adjusted over time. In a competitive market, those who put a higher dollar value on those extra years will pay more for more screenings and more treatment; they will see more false positives and costly followups, but will also catch more true positives than a group that puts a lower dollar value on those extra years of life.
In the private insurance marketplace, the insurers can and do make different decisions on screenings supported, and they go with two things: what their customers want and what is required by state insurance regulation [if it pertains. I'm not getting into insurance regulation right now.]
They do do these sorts of analyses, too, though they will look in terms of costs in a different way — if one doesn’t do the screening, what will treatment costs be if the condition is detected later on? It’s not so much cost/benefit analysis as cost/cost analysis – what will the costs be under two different screening set ups? Sometimes the insurance companies offer screenings as part of coverage, even without being asked by customers, because they know the ultimate costs will be less if problems are found early on. [Similarly, some employers will do stuff like free flu shots on site, because that cost is much less than the cost of sick days due to flu].
You cannot escape tradeoffs in costs and benefits, no matter who is doing the choosing. People are going to have an emotional reaction, because nobody wants to put an explicit dollar amount on their own life, and when these recommendations change, that calculus becomes more evident to all. The question becomes who gets to decide, and whether there will be one decision for all.
As it is now, there are many ultimate “deciders”. Will that continue under “health care reform” as envisioned by the current crop of politicians?
As you point out, we all make calculations of this kind, rather instinctively. Consider the victims of a Lifetime movie: what do they have in common that makes them calculate out as worthy of maximum compassion?
This is a very interesting study on how we might make such off-the-cuff calculations.
Meep, I have a huge problem with the guidelines; the chief reason is that they ignored (or suppressed) data that didn’t fit their desired outcome, real population studies available that do not support some of the conclusions drawn from their (less than robust) mathematical modeling. They also somewhat overplay the benefits to the patient (vs “the system”), saying that increased mortality of the few is outweighed by a reduction in “anxiety” or sparing of follow-up tests with minor risks and discomforts. Overdiagnosis (discovery of carcinomas that may never become clinically significant) may be real, but their predictions about that are not quantified well, and the fact remains that in any given patient, there is no way to determine if the DCIS will start to spread, even after biopsy. There is no way to know. But this uncertainty notwithstanding, some DO begin to spread if left alone. New biomarkers or predictive factors may be discovered to make better guesses, and there may be other ways to deal with these types of findings, such as a program of active surveillance. But right now the early detection is the best chance to prevent spread/recurrence and the panels own figures show a mortality benefit to women in the age range 40-49, and real population data (Swedish) points to a much larger benefit that the mathematical modeling of the panel.
My objection is not to “guidelines” per se, from some expert body, but that this body has a future role waiting for it; these “panels” are expected to gain power under current health care legislation. Not that there shouldn’t be any gathering of xperts reviewing data, or careful analyses of risks and benefits of screening – but that the current push towards or emphasis on comparative medicine is not the ivory tower agendaless “more perfect medicine” it’s advocates market it with. Behind the scenes, the issue is not limited to protecting health; the whole thing is contaminated by a cost and waste control message increasingly internalized by health providers. And make no mistake, the evidence-based medicine movement, at its core, is centered around limiting the obligations of public and third party payers to cover treatments.
I am bothered by the paternalistic view that patients cannot possibly be left with control over how much risk they will bear; most of all that women must be spares “uneccessary anxiety”. It’s like they think women are stupid. That their doctors are avaricious bullies who will somehow FORCE them into screening, and then to biopsies or treatments, that women can’t consider the evidence and their own situation and come to an individual plan, with advice from their physician expert, about how aggressive to be.
There is by the panels own findings, a mortality benefit to earlier, more frequent screening. This used to be the goal-poat for the utility of treatment. That’s moved now to “spare more cows in the herd overall from scares, even if some will die or face less effective, more grueling treatments” I
Individual factors such as menopause, race,
breast size, breast density, are relevant to the benefit/risk ratio- but consider a patient has PERSONAL factors that are important to her alone.
The costs generated by screening are real. But I get impatient with people who argue that cost has nothing to do with these guidelines out of one side of their mouth, while often in the same discussion or same breath will say ” we can’t allow patients and doctors access to anything they want”.
If the panel had considered or addressed the real population studies instead of hiding them, I think I’d be less convinced that the process was corrupted by agenda.
It has unfortunate similarities to the recent global-warming manipulations exposed.
I don’t disagree on this — I didn’t want to get into the obvious political maneuvering that occurs in these recommendations, when it goes to determine Medicaid and Medicare coverage.
There is no way to avoid politics on this sort of thing if this is the final decision as to whether screening occurs; as opposed to numbers set up to inform, whereby others will make their own decisions.
I was appalled by the spin on the “anguish” of false positives, which was played up more than the actual dollar costs. Beg pardon? That anguish is better than death. “Anguish” as a cost is as bogus as “happiness” measurements as a benefit [they don't include that in the analysis, do they?]. There’s no real number you can put on that stuff.
It is funny you mention the global warming stat shenanigans, because I was thinking of writing something on that, in response to a couple things I read today:
http://www.powerlineblog.com/archives/2009/11/024995.php
http://www.nytimes.com/2009/11/22/opinion/22soll.html?_r=1&adxnnl=1&adxnnlx=1258890755-D9WFqMEWppmEDPXMnF+olw
Meep troll, who sits on the politically maneuvered death panels over at Aetna?
And, of course, the follow-up to that would be who politically maneuvers the gears in your very own head?
It’s not politically manuevered, but hired by a buisness concern to make decisions based on profit and loss. And, may I add, people can choose other insurers if they don’t like Aetna’s plan…
Which is all the more reason why the Rethugs! Ideas for allowing companies to sell across state lines makes more sense than the Obamacare Obama-nation…
It looks like the Meep troll has gone into desperate back-pedal mode from her earlier “death panel” tooting.
I must say this is like watching a undergrad review the additional arguments before discovering the more valid answer to a essay question they flunked on a mid-term.
Yeah, well I’ll stick to that characterization…
Until you can find a way to refute the reality that the FCCCR board was established as part of the spendulus with an eye towards the swift passage of Obamacare…
And, of course, until you can assure me that hacks like Tom Daschle or that goulish Eugenicist Zeke Emmanuel are not to be part of it…
I don’t want any government agency deciding what human lives are “worth”; other than the US Military which need to actually make decisions involving lives directly. Especially when there will be no recourse against the decisions of that panel, as there are against the insurance companies currently…
Perhaps meep has better things to do than argue with your trollish self!
Seems like she’s saying that these decisions on what’s cost-effective will be made by politically motivated hacks, using a calculus that, at least at the beginning, will resemble that developed by Rahm’s bro.
And who are the politically motivated hacks at Blue Cross, Dan?
Oh wait, I get it, as long as they’re invisible to you by rote of not putting their name on published studies then they’re not hacks, they’re jeeenyuses, like ‘em better-that-governemnt-hacks at AIG, which is a wisdom-filled insurance company last I checked.
That’s the glaring hole in the charade of your and Meep trolls’ argument(s), namely, that the gubbymints are teh ‘tooopuds, teh ebols while the alternative is any better, which, in fact, they’re not.
This gubbymint of ebols has spent way more than required and/or necessary on millions of Americans through Medicare and other ebol government programs meant to care for Americans.
You’re a liar if you state otherwise. Go live in another country if you think this county – the one the spends more money than all others on its citizens – is teh ebol.
Seriously – go find yourselves somewhere wif less ebol.
Once again, you miss the nuance that Blue Cross is a private company, and if people don’t like their coverage policies, they can do business with another company…
Even more choices if the Rethugs! idea of allowing companies to sell to nationwide pools would be adopted…
Of course, the Obamists couldn’t even consider free market solutions…
It has to be a boondoggle along the lines of medicare; I’ll remind you that critics at the time knew it would cost a pile of money and distort medical costs in the effin’ 60’s!
Ronnie Reagan, your better, talked of the ills of socialized medicine in the 60’s too; and his points still apply today.
All one need do is observe the UK’s system to see what’s coming. It’s the single biggest employer, and government budget expense in the UK; and the care system stuinks if you have something that needs attended to quickly-like most of those socialized medecine schemes…
Oh they look good, if the population is small and doesn’t mind high tax rates. But in America, where nearly half of Working age adults pay no income taxes, we’re already redistributing too much wealth to undertake this expense also…
That’s right thor-troll, this <iexpense…David Broder’s words, hardly coming from a bastion of wingnuttery!
http://www.washingtonpost.com/wp-dyn/content/article/2009/11/20/AR2009112002618.html
Just as medicare was never really “paid for”, the same is true for Obamacare. It’s aluxury we can’t afford as a society.
“Once again, you miss the nuance that Blue Cross is a private company, and if people don’t like their coverage policies, they can do business with another company…”
Hey Fantasy Islander, once you’re diagnosed with, say, cancer, you can’t not-likey Blue Cross and walk across the street to Aetna for satisfaction.
The real world don’t work like that. Aetna won’t cover your brand new pre-existing condition.
Real world, Bob, and less fantasy free-market bullshit you, in reality, know nothing about.
Portablility issues and pre-existing condition restrictions are a couple of the ways the government can be constructively involved; again these were suggestions the Rethugs! made, but since the Obamists couldn’t include anyone not in ideological lockstep with them in the debate…
Free market solutions always trump government ones; and have the advantage of being able to be shaped by regulation.
Instead of the tyranny of the death panels and “complete lifers” Like Zeke Emmanuel…
Let’s just hope that people who subscribe to the “complete lives system” philosophy of Zeke Emmanuel will have limited access to seats on these panels should they be established (God forbid)…
If so, then you can be sure that all of the analysis will be complicated by having a changing value of human life based on age; a kind of “Logan’s Run” calculus…
One thing I’ll say though, the Democrats are certainly dedicated to an, “equality of outcome” ideology; not just with respect to material wealth but in terms of actual years lived too…
I guess they figure it’s a responsible way to approach the looming entitlement debt die to social security and medicare; won’t owe so much of folks would just die off like they are supposed to! Damn those advances in medical care and technology that have extended our lives! It’s a conspiracy against our good and benevolent government I tell ya!
Let’s just hope a complete and utter hypocrite, like Bob, doesn’t sit on any death panels, most especially his personal death panel.
Anyone too stupid to know that the VA system is a single-payer system – teh ebol Communist type! – and that a person who has had their lips pressed to the government’s money tit long enough to earn a lifetime of tit-money, a.k.a. military retirement, has no valid reason to publicly bitch like a loon about the same big-tittied ebol gubbymint should be waterboarded in a public square.
My personal experience is that private business is a lot more responsive than gubmint. YMMV. I also think it’s hilarious that you think that the permanent unelected bureaucracy that they’ll create to administer this is going to be more answerable than private businesses, especially considering government shields to liability.
You’re the one who’s being naive here, Thor.
No Sir, I understand that someone has to pay and someone somewhere has to make decisions.
I don’t believe in your false duality where government is unresponsive while the private sector is, I mean, I read Meep troll’s first-hand experience of having to go bent knee to dirty Commie John Edwards simply to extract a monetary sum of responsibility, err liability, err responsiveness-bility.
Our current system sucks on many levels. I say fix it. I also say send a hard backhand toward the so-called Americans who blame the generous American gubmint for all their self-serving victimhood needs.
Debate the facts without the black helicopter falsehoods, let’s try that.
Meep troll looks to be making an effort, and I commend her for that.
“…dirty Commie John Edwards…”
Congratulations, that’s the forst cogent characterization I’ve seen you make in a long time; you’re making progress!
“I say fix it. I also say send a hard backhand toward the so-called Americans who blame the generous American gubmint for all their self-serving victimhood needs.”
Who are you referring to here? Folks who wailed about the reation to Katrina? Or the Congressional Black Causus’ backhand to Obama in committee this week, because he, “hasn’t responded to the needs of the African-American community as he should have so far”..?
Let’s debate the facts without your red herrings, insults, or non-sequitors about Russian authors, or Cuban journalists, or the righteousness of Chavez, Castro, or any other America hating totalitarians; let’s try that…
So what should I call this ad hominem attack? The reverse chickenhawk? That you’re absolute moral authority, and my lack thereof, stems from my life of service to the nation?
Utter Poppycock!
And for the record, just as I didn’t avail myself of any identity group preferences during my life, I don’t avail myself of VA medical funds either; leaving them instead for my brethren who truly are in need. I have private insurance, thank you very much…
Here’s a clue-I don’t want anyone to sit on the death panels, and feel it was criminal of the Obamists to implement them at all…
When your private insurance caps out, Bob – and I hope it doesn’t, personally – you’ll be in line over at the VA with your broken brethren.
It’s not moral authority on my mountain top, it’s that there is no true authority. Yours is yet another delusion in your larger delusion cloud. Replacing your death panel delusion with a differing delusional death panel is all you’re doing, yet neither the gubmint’s nor Aetna’s death panel exist.
You’ll likely get more from the gubmint than Aetna because the gubmint is liberal with morality whereas Aetna will fuck you over a gold coin, that’s their business. Understand that.
Thanks you for the consideration, but my cap resets yearly. It’s excellent coverage, and I’m sure I’ll be taxed more due to it if Obamacare becomes law.
It always costs more for the government to provide any service than the private sector; that’s an inescapable fact. One that was recently underscored for me by some Nuns I know who went to Nawlins to helo rebuild houses for a couple of weeks. Catholic charities does each house for around 20k expense, but enjoys volunteer labor. That’s a lot less money than FEMA threw at folks down there; money they got swindled out of because the additional step wasn’t taken of registering contractors so that large scale rip-offs by shyster profiteers could be prevented…
That’s why the solution should have been shaped by removing restriction to private companies operating across state lines, tort reform, and medicare fraud crack-downs. These mechanisms, as well as government regulations regarding portability and pre-existing conditions, as well as a few other issues, would have allowed for a free market solution that wouldn’t cost the taxpayers a bundle; which this eventually will…
You lie!
How much did it cost us for those ebol gubmint soldiers to stir beans and feed their brethren troops in Vietnam versus the KBR-hired employees who man the Burger King in the green zone in Iraq?
Just thought I’d make my example something close to your Army worldview, hahaha.
Your facts are usually fiction, Bob. At least your consistent.
I know not of what you speak, but can only speculate that the presence of vile fast-food joints may have been to give the solodiers a taste of home; so yes it may have cost more than “stirring beans” but may have had more than simple nutrition at the root of the decision.
And please, I’m Navy-not Army, an important distinction to either party I assure you…
I generally deal in facts, not fictions; you might want to try it!
gubbymint and should be
All I’m saying is this is what happens in cost-benefit analysis. That’s all.
Yes, insurance companies do cost analyses [it's not the same as these govt recs, for the reason I mention in the post]. If they don’t charge premiums to support the benefits they have to pay out — guess what? They go bankrupt, and no more insurance company, and no more benefits paid.
Maybe I need to do a post explaining that insurance companies need to cover their costs or they go out of business.
And covering costs is eeeeeeeeeeevil.
Maybe you need to do some explaining on how when a insurance company does its cost benefit analysis that it’s brilliant b-school 101 analysis yet when the gubmint does it it’s a ebol death panel.
Do you read the WSJ? Thursdays lead editorial incorporates a strikingly similar metanarratvie to your bouncy-bouncy ebol gumbint screed.
The public option isn’t supposed to drive the insurance companies out of business. It’s designed to absorb those not covered or unable to get coverage and to help flatten the price curve. Jeez, how many times has this have to be stated.
Show me when and where Travelers and the other Prop and Casualty insurers went under from the ebol gubmint offering gap Prop insurance, flood insurance for example.
The reason your arguments melt like a castle made of ice cream is your metanarrative is, of course, a fraud.
Bye, bye weeethuglidums, so sorry you fell in line behind hucksters, magic tonic hawkers and carnival barkers.
Ronald Reagan – Bwahahahahaha!
“The public option isn’t supposed to drive the insurance companies out of business. It’s designed to absorb those not covered or unable to get coverage and to help flatten the price curve. Jeez, how many times has this have to be stated.”
Yes, but it will eventually drive them out of business all the same. Poor folks are already covered by medicare or medicaid. A sizeable percentage of the uninsured are young folks who are so by choice. And then of course, there are the illegal aliens…
Flood insurance is federally mandated, as the feds have taken control of much of the seashore area that is not directly under a state’s control anyway. Just a bad example; as is the one too which attempts to compare it to auto insurance…
Let me run it down for you one last time. The Constitution doesn’t state that it is a “right” in our society for one to have health insurance. No one is “entitled” to it, just as they aren’t entitled to a government provided place to live and foodstuffs. Private charitable orginazation have, and will, provide services and aid for thise in need, by people who choose to do so; they will always be able to do so cheaper than the bureaucracy.
Obamacare will bust the budget, regardless of the claptrap coming from Congress, or the CBO scored built in the lies they proffered about reducing medicare, etc. If they’d been truthful, CBO would have scored the bill as costing big bank for sure.
We can’t afford it, plain and simple. Enact free market reforms, and modest new regulations to prompt the companies to provide the level of service desired…
Free market solutions wirk better than budget busting government ones that will raise taxes on the 53% of us who actually pay the freight in this nation…
That is all
You know, the thing I don’t understand is why they let the mask slip on the inevitable rationing of health care *on this particular disease.* The folks behind promoting a cure for breast cancer are better organized and have more well developed media avenues than probably any other disease, and most certainly more than any other type of cancer. In fact, the breast cancer lobby is so well-organized and receives so much p.r. that it causes tension within the cancer fund-raising community.
The administration couldn’t have thought that given the existence of such a machine that even a hint at changing the insured age range was going to go unnoticed.
Stupid, crazy, or evil? Damned if I know.
The people on these panels tend to be semi-academic; they’re doctors, sure, but they’re teaching at medical school. They might not realize the political implications of what they’re announcing.
I bet you the Dems are not at all happy at the timing of those particular recommendations coming out. I bet they were thinking “Couldn’t it have waited til next summer?”
And yes, breast cancer is politicized beyond reason. But I understand the reaction.
Most women die of heart disease, just like men do [just at different age distributions].
I think the scary thing with breast cancer is you get much younger women dying from it than you get with heart disease [in terms of probability distributions].
People dying at ages considered too young are going to make a greater impact in appeals to emotions… people aren’t as moved to hear that an eighty-year-old died of congestive heart failure.
My Mom died of breast cancer. You could say I’m moved.
Two-bit actuaries pimping their analysis cred over – cough, cough – lowly academic doctors doesn’t move me much, impresses me even less. I know a lowly academic doctor in San Diego. He’s a brain surgeon whose performed many brain surgeries, that’s one of the reasons he teaches. I mean, you don’t really believe they let a guy whose never performed a surgery teach others how to do it, do ya? More ice cream castles, yummy.
Really? Because there are plenty of academics teaching various [insert victim group du jour here] studies programs that have never actually done anything in life. The same is true for economists and sociologist as well. Indeed, there are many in the ivory tower teaching our youth about the eeeeevollz fo AmeriKKKa, uninhibited by, you know, reminding them how much good we’ve done as well; teaching them just how great it would be if we had a communist economic system with the superlative social justice-just like Castro, Chavez, and the Soviets used to…
And finny how all these folks stink at history, just like your boy “the won!”, and can’t seem to keep it straight as to which system exactly collapsed under it’s own weight, while trying to keep up with Reagan’s defemse build up instead of providing for all as communism alleges it will, and which one was more successful-until of course the givernment essentially got into the business of mandating that loans be made to folks who couldn’t pay them back, and essentially overlevereged our entire economy…
Yes, that’s right, overleveraged; total public debt is nearly 4 times GDP, that’s overleveraged…
Brought to you by wizards of smart many of whom, like Marx, had never previously left the ivory towers…
Bob, if you ever attended a university it was The Timothy McViegh School For Ex-military Waterheads.
The Ronnie “The Retreater” Reagan debt? Are those the government mandated loans you’re referring to?
I sat on a plane today next to a 22-year-old Army boy. He was a foot soldier, a forward scout is how he described his primary duty. He’s Army. He fights, unlike you, who floats (far away from the shores of sanity, obviously).
Me and my young Army buddy had a riveting and lengthy conversation. It’s Me, Eddie rested on my lap as we spoke. I held much sway over this impressionable youth, this much I could tell. He’s headed out for his second 15-month tour, this time to Afghanistan shortly.
There is no victory. Afghanistan is a kitty litter box of turds and tanks mines. Sarah Palin is a slut. Fox News sucks. Islamo-monkeys deserve death for they’re even worse scum than Christian Taliban. Of these declarations and more our young man of U.S. military training agreed with all, or was quickly persuaded by my university trained rhetorical prowess.
A firm grip that young man and I shared as we parted. I only wished I had more time to share stories of Russian military greatness with him. Real trained killers always dig my Russian war stories. The floaters, not so much.
“The Timothy McViegh School For Ex-military Waterheads.”
That’s a pretty good one there, I’ll give you that!
But, combat tours are back down to 12 months thor; they were only pushed to 15 months in Iraq, around the time of the surge…
And while I will agree that Afghanistan is surely a pretty shitty place, I’m left scratching my head that you would find the one soldier in the volunteer army that would share your exact political opinion, Russian Fetishism, and particular taste in authors. Did he use the words, “Sarah Palin is a slut”, and,”Fox news sucks”, or just imply it? Or are you weaving another of your “instructive” parables for a poor little bitter-clinger like me…
Because many of the infantrymen I’ve met, who were visiting NYC with my nephew when they were on leave, all belong to this face-chimp-book group with a very clever name; “My combat infantryman’s badge beats your liberal bullshit any day”. Descriptive, no? Clever, no? Kind of revealing of a certain swagger, attitude, and, oh, je ne sais quoi-wouldn’t you say?
“I only wished I had more time to share stories of Russian military greatness with him. Real trained killers always dig my Russian war stories. The floaters, not so much.”
*sigh* Spare me thor. Not only is this the “tell” of an utter BS saga, but you know nothing of what I did in my service and I won’t go into it on this thread. But I will say that you are a fool to gainsay the Navy or our personnel.
You held much sway over him…Stories of Russian military greatness…
Indeed…
You could be right, Floatin’ Bob. Young Army didn’t mention his Afghan tour being 15-months, I just assumed it after he said he spent 15-months in Iraq.
Say, Bob, is our Navy still considered part of our military or are they considered supply and transit personnel for our fighting men?
Yeah, I suppose things have changed since you were putting in time, Floatin’ Bob, workin’ on accumulating retirement. These young ones, such as my Army buddy, they seem employable and curious about the world outside Buttholeville. Much of that has to do with the progressive nature of an ever changing world, and access to education.
“Sarah Palin is a media slut,” I should have quoted Young Army properly.
“Say, Bob, is our Navy still considered part of our military or are they considered supply and transit personnel for our fighting men?”
Well, there were literally thousands aboard the Theodore Roosevelt, a couple of thousand in CVW-8 alone! All part of a proud team that could unleash a frightful can of whup-ass on America’s enemies, anytime, anywhere; something you need to remember and respect son…
Nobody was ever just “putting in time” as a slacker like yourself would characterize it; maybe you’re not aware of the fact that an aircraft carrier is like a city at sea, and that in addition to it’s gargantuan size, it is always teeming with activity, 24-7. It’s sole purpose was to put our wing in a position to ptoject military power as deemed neccesary by command, and I always felt humble that so many were working so hard to support the mission of my squadron.
Respect the Navy mister, we’ve saved your bacon and traveled in harm’s way more than you’ll ever realize…
Oh, and I call BS on that complete story, so give up on the permutations of it already; remember the first rule of holes…
speaking of emotional reactions [and I see it's not just women getting emotionally worked up here]:
http://disgrasian.com/2009/11/how-to-piss-off-dr-sanjay-gupta-lazy-mammogram-guidelines/
Cost-benefit analysis doesn’t go down easy for most people, esp. if it’s themselves or their loved ones on the line. And it doesn’t matter who is doing the analysis.
Looks like Meep is the fraud I pegged her to be. Tsk, tsk.
Poor thing, she thought the internet was full of Sarah and Trigs. If you regurgitate a mix of the WSJ editorial page with a dash of Sean Hannity stooge speak and then sprinkle some first week of Bus. Stat. homework assignment looking drivel, you can expect to be called out.
Cite the WSJ, quote Sean Hannity and dolly up your screed with something more than sample groups, and for God’s sake, actually read the fuckin’ study if you want to attempt to debunk it. Tsk, tsk.
BSE, cost analysis, Mame? Chirp, chirp.
Work for a insurance company, Mame? Chirp, chirp.
Lowly academic doctors? You’re not qualified to change a bed pan, Mame.
Cheap propaganda fail.
You have no room accusing others of fraud thor…
Yu call out people all the time for crap you can’t back up, and then sling the same lame, “Hannity!, Limbaugh!, Palin”, references around.
So what if the WSJ informed meep’s opinion? It’s a well respected publication and sells more copy daily than the NY Times, and get’s more judicious eye-ball exposure than the times or WaPost! It informs a lot of people’s opinions…
You know, folks read stuff, from many sources, and form opinions based on the facts and evidence…Hmmmmm?
We don’t all embrace the OFA talking points daily or the gospels of Saint Rahm-bo and
GoebblesAxelrod, and finish our daily devotion with a hearty, mmmmmmmm, mmmmmmm, mmmmmmmm!Your boy’s teflon shield has ablated son, you all have sown the wind, now get ready to weap the whirlwind!
Meep troll is a fraud. That’s why she picked up her skirt, kicked up her heels and ran away.
Note how she started out by trying to pimp the low-IQ death panel BS then moderated to cost benefit analysis and then further moderated to simple cowardly personal attacks against those who signed off on that study. Note that I disagreed with the study’s recommendation but read the thing fully and learned a thing or two, and neither did I laughably pretending to know more than the doctors on the task force, unlike our low-wage slave cubicle Queen, which is typical of r-wing loudmouthers.
I think what we have here is a insurance company employee (whore, if you will) [or should I use brackets to keep in Meep troll style] performing a little game of three card monty.
Is that how the cartoon ran in your head? Because those of us in the reality based community didn’t see anything like what you described…
1) Death panels are an accurate characterization when it’s the government making those decision, thereby leaving people with no other choice in the matter. Palin was right, and so was meep-get over it…
2) Her cost benefit analysis was merely an example-an illustrative exercise for people not skilled in statistical methods…
3) I saw no cowardly personal attacks on her part over the course of this thread. Seems to me that you are tossing about all of the ad homs…
Why are you so intent on trying to bully meep?
On all three points, you lie.
Meep troll started off with her feathered chicken suit on spewing political-hack bullshit. I would bet she didn’t even read the reports she was commenting on, merely hoping to be a r-wing cool girl, note her links to hotair and Sarah “Queef Nuts” Palin.
Then she got knocked to the ground and tried a cost benefit analysis take, never addressing that a cost benefit can’t be done on self-exams for they have no cost. The costs are, obviously, the trauma and follow-up care for false positives.
Meep troll impugns the motives and credentials of the doctors involved in the research and, frankly, all research physicians with her wittle implied “there only academic doctors,” you know, not the ones who actually know anything. Too bad for Meep troll that it’s easy to Google to background of the doctors involved in the AHRQ. Many own breasts [tooters!] and graduated and practiced in the finest medical facilities in America.
Hers is typical of overly political know-nothings and right-wing nutjobs, namely, they’re loudmouth blowhards quick to declare themselves teh jeeenyus, use Wush Wimbuagh as prototype.
Again, I think the AHRQ’s final recommendation is flawed, but I read every page of their report as well as the disclaimer [Disclaimer: Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.]
Nothing here leads me to believe the motives of those involved in the recommendation were politically motivated. Only those who lie due to their lying nature [you, Bob] and/or two-bit wage-slave hacks who likely work directly for some shitty insurance company would consider it so, not forgetting all the other pink-tutu wearing, anti-American dithering, right-wingy losers!
[Ppppp!]
[And yes, I'm using brackets so as to be coolee r-wingy just like Meep troll]
As always, you are quick to call others a liar; and in doing so, you lie!
You are soputing occurances from an alternate level of reality or some other fictional reality.
She never resorted to political hackery. She did a cost-benefit example for illustrative purposes, noting a priori that she was using made-up-values in a simplified model. And she never “impugned” any doctors or other panel memebers, but rightly questioned their motivations; especially in light of the far greater number of physicians who questioned their professional acumen in doing so, orders of magnitude greater than those on the panel…
You’re just upset because of the inconvenient timing of this ridiculous reccomendation; and how it will become part of Obama’s healthcare Waterloo…
Suck it up! Your boy screwed the pooch! Get used to it, he’s gonna do it a lot more; because he’s a loooooooser! like Jimmy Carter-weak as effin’ water, full of bad ideas to boot…
Stop taking your frustation out on others; stop the lies!
Everything meep said was measured and reasonable. You can’t point to any specifics, just the usual snark; so I reject your cartoonish objection…
Sorry, Blowhard Bob, Meep troll is a fraud.
Just like you ran cover for racist Carin and racist Duuuuh-Dar, now you’re runnning cover for this wingered twin-tootered clown.
She furiously back-pedaled because I pounded her rabid wingered snout to the point she, in effect, said that both gov’t and insurance co.s approach health care on a cost benefit basis.
Again, you don’t read.
You’re a hopelessly manipulated tool, and a coward, frankly. Nobody wants to cheat the mothers, sisters, daughters out of necessary breast cancer treatment – not Barack Obama, not anyone in the government, not anyone anywhere.
Medicare paid my Mom’s bills and so did Unum. I’d have to physically make you pay a price if to my face you went on lying that Medicare didn’t or that her and her doctor didn’t have ever option made available to them by Medicare. You’re a liar. You’re a cheap ungrateful scumbag. You don’t deserve this country.
As always, you’re a legend in your own mind, and in the cartoon reality you are operating in right now.
I read the links, and many more doctors are questioning the decision of the panel than are members of the same body.
And I wouldn’t dream of challenging the facts of your own mother’s treatment, only point out that it all occurred before this panels pronouncement. Sadly, others may not recieve the same level of care she did; especially if Obamacare becomes the law of the land…
You’re not seeing the forest for the trees, Podnuh; and I’m less running covr than trying to get you to step outside of your own frame and see the greater picture…
The AHRQ’s recommendation has not been accepted. Got that? It will not effect anything.
One thing it does do, seeing how you didn’t read it, is highlight the number of false positives in all forms of testing.
The AHRQ report doesn’t address cancer treatment, it addresses testing, knuckle head. And Medicare covers all women, much like the goal of Health Care Reform. This seems to be lost on big thinkers like Meep Troll and you – all women, as in every woman is a mother, daughter, sister of someone and they deserve to be tested and treated equally.
There is no market price for treatment when it’s your Mom, and there should be no gold-digging insurance companies differentiating treatment based on how many gold coins one has in there pocket. I’m pretty sure Meep Troll hasn’t seen any other country’s health care system – I wage she lied. She’s read about them – from Rush Limbaugh.com!
Meep Tool might be impressed with the quality of care in, oh, say, Canada, Sweden, Israel, if she actually saw it firsthand and/or had been treated by doctors from those – SOCIALIST-COMMUNIST-EVoOoL!!! – countries, but she’s a fraud, a tool, a liar.
Death Panels – whoever parrots that instantly gives away the fact they’re a slobbering waterhead.
Wow, what a bizarre comment thread. The notion that meep is just repeating crap from the WSJ, while not unfathomable I suppose, certainly appears baseless at this point.
Anyway, it seems that individually tailored screening regimens might be most appropriate. So a general recommendation for those without any risk factors ie. first full term pregnancy by age 20, and breast fed and no family history of cancer, and no birth control pill use, no abortions etc. and then let doctors adjust the recommendation for earlier and more frequent screenings as risk factors increase.
Since breast cancer is increasing generally, many are trying to track the importance of certain risk factors at the population level. http://www.the-actuary.org.uk/698029
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