I'm Grandfathered in, for now.

Or if you ever wanted to become Michaela, that is in there, too :-)

--
Regards, Joerg 

http://www.analogconsultants.com/

in the rates of colorectal cancer from state to state - more than between t he US average and the German and Canadian average, and that this doesn't co rrelate with the percentage of the affected population screened.

much of this depends on heritage and profession. For example where I grew up, it was mostly farmers. Tough guys who would never go to a doctor unless they were unconscious and somebody called an ambulance. No ten horses woul d get them into a CT machine for screening, regardless of whether it's free or not. What counts are the country-wide averages and that's where there i s a stark difference between the (former) US system and socialized medicine .

wrong conclusions.

known fact that cancer treatment success hinges largely on timely detectio n. That can only work with screening and such screening is clearly better i n the US.

But nowhere near as much better as you seem to be claiming. You started off claiming that UK's National Health Service didn't do mass screening at all ...

t. Beats me why. It's sad, I know a person whose cancer spread because of t hat and it does not look good right now.Also, they can't force you to do a colonoscopy. But they are pushy, for good reasons.

shtml

ay announced that HHC doctors performed more than 21,000 colonoscopies and removed pre-cancerous polyps in about 20 percent of the cases at the city p ublic hospitals last year". They even found 338 hardcore dangerous ones dur ing those. 20% is a lot. I believe one can safely assume that the remainde r of the US population and also that in Canada isn't all that much differen t from New Yorkers. We eat too much bacon, they eat too much poutine, both pretty bad for the health.

nada as a whole.

atistics/?region=on

n the New York State figure (which is after polyp-snipping on half the popu lation).

oblems, and different reactions to health advice. One of the tricky things about cancer is that every cancer is different - cancer cells only get to b e cancerous after their genotype has been extensively screwed up. The "six" crucial changes required to make them malignant happen in different ways i n different cells, and are only a small part of a much larger collection of mutations.

it is 45.4/31.8. Now how can this huge difference between two immediately adjacent countries with similar habits possibly be explained by anything o ther that preventative health care?

I was comparing New York State (not the whole of the US) with Canada.

The US colorectal cancer rate varies more between states. In theory, they a ll get the same protective health care.

ing simply because the individual cancers can be very different, as can the individula cancer cells within a cancer (which is why chemotherapy eventua lly stops working in a lot of cases).

essage that early detection efforts pay off.

Early detection does pay off, but if the US states are all equally good at early detection, why do they have markedly different colorectal cancer rate s?

them do, years or decades down the road. This is why early detection and removal are important, yet it is not done in many countries with socialized health care. Again, talk to a cancer specialist that knows about intestina l cancer.

bout socialised medicine that stops it doing FOCT tests or colon-snipping. ...

ively new technique, and there is still some discussion about exactly how c ost-effective it is, but I'm fairly confident it will be widely adopted - p robably even in the UK where they are already good on mammograms and Paps s mears.

But not faecal occult blood tests, and polyp-snipping.

ever developing colon cancer. Because it was caught at a very early stage w here you don't even know whether they would become malignant. But as the sa ying goes, an ounce of prevention ...

. Had they not been screened those people would most likely have died soon.

20 or 30 years from now. Ask the wife of your breast cancer specialist frie nd, she should know.

became widely popular, so she may not know. I'm already perfectly convince d that polyp-snipping has a substantial long-term benefit, but if you had p olyps now, there's every reason to suppose that you might develop new ones in a few years.

them would mean they and their doctors would never know about polyps.

if you've got them you probably got a lot more cells that aren't quite so f ar down the road. My guess is that polyps now are pretty reliable indicator or more polyps later.

he road the US doctor now knows that the person had polyps and can make sur e that this person comes in for follow-ups more often than folks where no p olyps were found. The UK, CA or Australia doctor does not know any of this because no colonoscopy had been performed.

Australian doctors do know about FOCT tests, colonoscopy and polyp-snipping . What on earth made you think that they didn't? Medical science is interna tional. Mass-screening programs are evaluated nation-by-nation and differen t nations have different ideas about what is cost-effective - particularly the US where malpractice suits get figured into the costing.

e closely and may be called in for more colon tests down the road than peop le with an uneventful screening. And that's the key:

ies with socialized health systems.

but if it looks cost effective, it does it - it certainly does mammograms and Pap smears and has for many years. And I got my cholestrol level checke d there by my GP in 1990.

every three years. As I said, that is considered way subpar in the US. _Th is_ is what good health care looks like:

Good but extravagant health care. The US system costs half as much again pe r head as German and French systems, and twice what the UK system costs.

And it's certainly not clear that the money is being spent where it would s ave most quality adjusted years of life.

er was detected that way were between 40-50. In the UK most of them they wo uld likely be dead now.

Manual examination works fine for but the faster-growing breast cancers, an d X-ray screening is too infrequent for the faster-growing cancers anyway.

ancer screening back, big time:

688720

Inn other words, the US medical experts are agreeing with the UK experts, a nd your newspaper has been moved to publish an emotional reaction. That's n ot Obamacare, that's efficient use of resources.

flat wrong. Luckily for me and my family we haven't (yet) been dumped into that morass and can keep our old pre-Obama plan for now.

Don't be stupid. Doctors aren't trained to make decisions about cost-effect iveness, and their emotional involvement with their patients makes them pro ne to make sub-optimal choices.

igher than the 40.9 to 43.6 per 100,000 shown on the map, outstripping Cana da and Germany even further, and again suggesting that US colorectal cancer is different breed of cat to the US/Canadian one - or rather a different r ange and distribution of of cancers to the range and distribution that the the Canadians and Germans have to cope with.

a vested interest in scaring patients into their consulting rooms

d female colorectal cancer rate. The 2013 "estimates" were 30% higher than the 2008 figures. Which would you believe?

2013 isn't over yet. The numbers have to be older than they claim, or extra polated. Either way, they aren't to be trusted.

go!

ick? I believe the Canadian Cancer Society who published this knows a thing or two about this.

They clearly don't, or they wouldn't have published "estimated" 2013 figure s.

ld. They are very meticulous and honest. There is no reason to believe that this is different in cancer research.

The one cardiac study that you've cited here may have been meticulous and h onest, but was just an assembly of clinical data - not a double blind study that might have told the world anything unambiguous about the treatments b eing compared. A double-blind study would probably have been unethical, and the clinical results were interesting, but not all that informative.

A lot of medical studies are equally uninformative. Doctors aren't trained to think like scientists - it's inappropriate in a clinical context. Some l earn how, and learn how to swap hats between making clinical judgements tha t can kill people, and making scientific judgements that can influence how groups are treated, but a lot of the medical literature is close to useless , and some is downright dangerous.

two about this.

I believe they knew a lot about scaring patients into their consulting room s, and very little about anything else. The sub-committee involved in conco cting the text doesn't seem to have been all that scientifically sophistica ted.

d in a timely manner because they are nearly all asymptomatic. Once symptom s set in it is usually too late.

ugh to go out and buy a FOCT test kit from my local chemist, but probably converted enough to talk to my GP about it next Monday during my regular ev ery-six-months appointment.

ays there will be a phone call. And another, and another

One of my remoter cousins got colon cancer and both my brothers promptly t ook themselves in to get checked. My younger brother was not enthusiastic a bout the procedure. By the time I got to hear about it, none of the relativ es scanned had come up positive, so I figured that it wasn't worth the trou ble.

that there's still discussion about it's cost effectiveness. US medicine i s more influenced by malpractice suit phobia, which is one of the reasons i t's half again more expensive per head than anybody else's even through it isn't universal.

eening because that goes along general guidelines. Malpractice cannot be cl aimed unless there were clear signs that a doctor or hospital negligently i gnored.

was after. I've now got a much clearer picture of what the US does in this area, and it's good. Your health system is still grossly over-priced for wh at it does, and only does it for the fully insured 70%, but at least it see ms to get colorectal cancer screening as close to right as is humanly pract ical.

Ob/Gyn tests or the mammogram it's the same, they keep calling. Then there are regular blood sample tests for males and females. It's like at an airpo rt. You sign in, pick a number, a monitor shows when it's your turn and to which stall to go, you stretch out your arm, and it'll be done. At home you can go online and see the results trickle in as they come back from the va rious labs. At the end you receive a letter with all details summarized (bu t you can opt out and go paperless).

terol levels are, liver values, and so on. Kind of important to know, yet m ost people in countries with socialized medicine don't get that screened. They are tested for this only after an event. Which is sometimes too late.

0 - I can remember the date fairly exactly, because it immediately preceded a herniated intervertebral disk.

alised medicine was getting that right more than twenty years ago. They are more picky about less cost-effective mass screenings.

breast cancer in women every 3 years between the ages of 50 and 70".

So what. That goes on all the time.

involve a cancer-encouraging dose of X-rays). Breast cancer is a lot less frequent in younger women, so there aren't that many cancers available to b e detected, which does make early mammograms less cost-effective.

t it at an age much younger than 50, where countries with socialized health do not screen? Those were also the more aggressive kinds of cancer.

Mass screening is less useful for the more aggressive types of cancer. As t o why more of the people you know got breast cancer younger than 50, it mig ht be that you knew more younger women sufficiently well to hear if they go t breast cancer. People don't go around wearing a label saying "I've got br east cancer".

at is being done in Obamacare will not make anything less expensive, on the contrary. Since it adds a layer of bureaucracy it will make everything go up in cost.

in Germany, ...

e directly to the HMO and that sets your payment. Their tax authorities are never involved in this while here in the US they have hired scores of peop le for that. As a self-employed (which I was most of the time in Germany) y ou self-declare. Obamacare insists on formal agency verifications and AFAIK that's one of the bureauuratic procedures that got their web site unglued.

"Scores" isn't that many in the context of national program in country with a population of 300 million.

mind would trust them with the administration of this whole monster? I sur e don't. Most of our friends don't anymore either.

Tea Party Republicans don't trust government to do anything. It's one of th eir many lunacies.

evel. That and the Dutch system run via a number of private health insuranc e firms which operate under close government supervision, which is presumab ly where Obamacare would eventually end up, if the Tea Party doesn't end up in power.

financial cliff.

financial cliff, you do seem to be backing quite the wrong horse.

9 he said racking up more debt is irresponsible and he is against doing tha t. 2013, after having racked up the highest debt of any president ever in h istory, he told the house he will not negotiate about any of that and it's his way or the highway.

Obama had a choice - more debt or a rerun of the Great Depression. He didn' t opt for enough debt, so you got the Great Recession, but the economy neve

4r got as bad as it did in 1933, and is now recovering (if more slowly than more aggressive pump-priming would have allowed).

thur - are the financial equivalent of the flat earthism.

For running a small business, not a country. John Maynard Keynes spelled ou t why flat earth economics don't work for countries, and right-wing nitwits have refused to understand him ever since. It's pathetic, and dangerous.

ch, despite all the hype about it. Because the penalties are ridiculously l ow and youngsters rather plunk down their money towards a new Dodge Challen ger with mag wheels rather than seeing it being slurped up by health premiu ms. The vast majority of people without health care that I know have no hea lth care because they chose to spend all their money on fun stuff. Boats, t railers, electronics, sports gear, cars, you name it.

A big part of health care is preventing communicable diseases turning int o epidemics, and there's strong argument for making health insurance compul sory (as it is everywhere else).

at that will do to the morale of school kids?

No, they won't. The arguments for not being promiscuous will be just as str ong as they have always been, and the rebellious and the impulsive will ign ore them, just as they always have. The difference is that the rebellious a nd the impulsive will come to slightly less harm than they would have if th ey hadn't had access to contraceptives. Pregnancy and STD's aren't the only risks they run.

ny state.

Most of them don't, and you will be very unwilling to recognise that some o f them do.

". It'll also increase the spread of communicable> diseases.

regnant for a long time now. Making it happen less often would be a good th ing.

an just have at it. You honestly think they'd use condoms anymore?

The Dutch run regular ads to remind teenagers about the risks of STD's, and the advantages of condoms. They seem to work - not perfectly, since the wo rld has plenty of impulsive idiots - but the Dutch statistics are pretty go od by world. standards.

t the whole enchilada done in one visit for a fixed price of $199 or someth ing like that. We also have that for cardiac screening. A huge tractor-trai ler pulls up, after some whirring this that and the other things slide out and, whoopdidou, you have a doctor's office right in the parking lot of a c hurch, supermarket or big company. Then they start piping people through th ere. Therefore, sorry to say, it is not an excuse if you don't have insuran ce.

creen TV. And you do not need a $100/mo gym membership, I just got a full w orkout in the Pine Hill Preserve right here on my cheap mountain bike. Took it and myself to the limits. It's simply a matter of priorities.

verybody out for TB - which was epidemic back then. If you had it you got s hunted into the sanatorium where you wouldn't infect anybody else. Back the n streptomycin cured it in about a year or so, if it didn't kill you first.

me in a US sanatorium in 1937-38.

erlands. The advertising is built on making you unreasonably nervous, and t he tests offered aren't exactly cost-effective.

are streamlined for maximum patient through-put and optimized machine usage rates. No scare tactics. IMHO it is important to know about your risks of getting a particular disease, be it coronary issues or potential cancer. If it is caught early on, which it often is in those mass screenings, it can make all the difference for a family. They may avoid losing mom or dad.

f customers. The local news services exploit them from time to time in new health technology stories, and their reports suggest definite - if subtle - scare tactics, and a serious shortfall on cost-effectiveness.

It's not so much propaganda as science reporting - they aren't there primar ily to make moral judgements about the services they are exploiting, but th ey do like to add a little spice to what are basically information pieces.

You'd have to plow through a lot of information to get to the relevant comm ents, and I'm not going to bother.

--
Bill Sloman, Sydney

No, I said they are subpar in screening. Which is a fact.

[...]

You need to compare the whole country.

In practice they don't. Some I already explained, the areas where folks are like where I come from, you don't see a doc until it's really, really bad. Then there are states with high migration. Naturally, you catch less cases there because you can't get people to the screening.

See above. Aside from migration inside the country there's also immigration which greatly varies by state, including (or predominantly) the illegal kind. There you have people who never got screened for anything. Suddenly, blood is seen where there shouldn't be any.

[...]

Sure. I had an occult blood test in Germany in the 80's because of suspicion. Turned out that was because of some extreme bicycle riding during that time and the doc said he sees that a lot. Of course, these tests have improved in sensitivity over the years.

Polypectomy is also around at least since the early 80's. You probably don't know this because you've always lived in countries with socialized medicine. They get a lot of this much later, and for screeing often not at all.

Never said they didn't. Doctors in AUS, CA, UK and so on are just as good as ours. But most of them have a lesser arsenal of tools available. You said it yourself that in AUS you must buy your own occult blood test kit. Nothing wrong with that but the fact is that most people won't do it.

But the end result is that cancer survival rates there are worse than in the US. A friend of ours just gets cancer treatment, to the tune of

pre-Obamacare.

Well, let me put it that way: I do not want my wife to die from this stuff so I am glad we do not have an Obamacare policy, so we have this kind of screening. It's as simple as that.

You know what's extravagant "care"? What Obamacare does, where contraceptives and elective surgeries such as sex change operation are covered but women under 50 are left to fend for themselves with breast cancer detection. Meaning the affluent can get screened and the others don't. Just like in Canada. That happens when bureaucrats make decisions.

Kaiser is a large organization consisting almost exclusively of doctors. Tons of experience. They know better.

As I said, we know lots of women where it was caught in the mammogram well before age 50 and they all survived. With the new rule of no-scan below 50 most or all would have died.

Nonsense. The bureaucrats copy the UK system. They know nothing about this stuff. Doctors do.

Wrong. At Kaiser they have a medical and a business job, because the HMO is also the clinic. They base their decisions and also the policy coverage on hard clinical evidence. An organization this size has tons of such data because millions of patients pipe through there and they have their records fully computerized since a long time.

Head in the sand again.

Have you never heard how forecasting works? If you have more than half the year in the bank it's a piece of cake. Cancer trends do not change with the weather or the lottery numbers.

I know plenty of docs that think like scientists as well. We call them "luminaries", because those are the people who can truly bridge the gap between clinical and engineering worlds. Typically, several of them are involved in each large study. Believe it or not, but there are cardiologists who have a medical plus an EE degree.

Now you are veering towards propaganda.

[...]

Simple reason but you may not have heard of them: Prayer chains. People are very open in the US about this stuff. Which is good, because that way they not only find spiritual comfort but also new friends who have gone through similar ordeals before them.

It is a huge additional cost that was not there before. Who do you think pays for that?

No, they are proven right time and again. See the HHS web site debacle.

He has let welfare programs balloon beyond belief, then stifled business. Printing money like they do not does not help either because banks don't lend. It causes inflation.

Europe was in a similar situation and look what Angela Merkel did. That's what I call a successful leader of a country.

I do not respect Keynes much, never did.

Pregnancy is usually the #1 factor they are afraid of. Because it cannot be hidden and cannot be explained away. Plus it has consequences that last decades.

Then let those that don't keep their health plan as promised. Yet that was one of many promises this president broke. Most people I know will no longer trust him.

Yeah, I remember when they warned youngsters about hard drugs but that soft drugs were kind of ok. Then lots of effectively brain-dead

20-somethings could be seen in town and they found the son of my landlady floating in an Amsterdam canal, dead from an overdose of some stuff.

You can't give a link because there is none. Then I take it that it was propaganda.

--
Regards, Joerg 

http://www.analogconsultants.com/

off claiming that UK's National Health Service didn't do mass screening at all ...

That's not what I recall. But the claim that they are "subpar" depends on t he proposition that the US level of testing represents some kind of gold st andard, which isn't true.

The US over-tests, which is expensive - and given the inevitable false posi tives - not just financially but also in terms of damage to patients.

The worst example is the PSA test of prostate cancer, which finds many too many potential cancers to be worth the trouble. It's nice to be told - as I was - that my PSA was unusually low, but I'd consented to the test on the basis that I was going to be very selective in my reaction to any kind of p ositive result.

Not to make the point I was making.

ey all get the same protective health care.

re like where I come from, you don't see a doc until it's really, really ba d. Then there are states with high migration. Naturally, you catch less cas es there because you can't get people to the screening.

You are trying to dodge the point that primary colorectal cancer rates vary quite a lot from region to region by suggesting that the only thing going on is a variation in testing coverage - which only seems to vary between ab out 50% and 60% - and followup.

This might be true, but seems unlikely. You'd have to muster a lot more evi dence to exclude diet and exercise levels as sources of variation.

ading simply because the individual cancers can be very different, as can t he individual cancer cells within a cancer (which is why chemotherapy event ually stops working in a lot of cases).

e message that early detection efforts pay off.

at early detection, why do they have markedly different colorectal cancer rates?

Since the primary testing levels vary between 50% and 60%, and the cancer r ates vary rather more, your explanation is implausible.

atly varies by state, including (or predominantly) the illegal kind. There you have people who never got screened for anything. Suddenly, blood is see n where there shouldn't be any.

When the primary screening rate doesn't seem to get above 60%, that's going to happen everywhere. There aren't nearly enough migrants to fill up that

40% untested catagory.

ique, and there is still some discussion about exactly how cost-effective i t is, but I'm fairly confident it will be widely adopted - probably even in the UK where they are already good on mammograms and Paps smears.

ion. Turned out that was because of some extreme bicycle riding during that time and the doc said he sees that a lot. Of course, these tests have impr oved in sensitivity over the years.

n't know this because you've always lived in countries with socialized medi cine. They get a lot of this much later, and for screening often not at all .

I don't know when I learned about polyp-snipping - it was certainly a few y ears ago.

Medical sociology is interesting. I remember spelling it out to a bunch of senior management at EMI Central Research around 1978 - reprsing something I'd told the managing director when he'd been practising management by walk ing about.

Any new technique gets picked up by a particular specialist, who spends the next five years spouting about it at medical conferences, along with his t hree or four acolytes.

After five years, the rest of the profession starts applying it - if the co nference presentations were sufficiently persuasive - and after another fiv e years it can become SOP. A very rough generalisation.

EMI weren't plugged into this because the brain-scanner and body scanner ha d produced "obviously useful" text-book anatomy images from the word go. Th e brain scanner was a clinical break-through and got adopted very fast.

The body scanner was much less useful - at the time we used to say that it' s major use was proving that you had inoperable lymphoma - but it got adopt ed equally fast. Our ultrasound machines could do interesting stuff, but th ey didn't produce such seductive images ...

f ever developing colon cancer. Because it was caught at a very early stage where you don't even know whether they would become malignant. But as the saying goes, an ounce of prevention ...

ve. Had they not been screened those people would most likely have died soo n.

u 20 or 30 years from now. Ask the wife of your breast cancer specialist fr iend, she should know.

She ran the NSW cancer register for some years, before polyp-snipping becam e widely popular, so she may not know.

al long-term benefit, but if you had polyps now, there's every reason to su ppose that you might develop new ones in a few years.

g them would mean they and their doctors would never know about polyps.

d if you've got them you probably got a lot more cells that aren't quite so far down the road. My guess is that polyps now are pretty reliable indicat or or more polyps later.

n the road the US doctor now knows that the person had polyps and can make sure that this person comes in for follow-ups more often than folks where n o polyps were found. The UK, CA or Australia doctor does not know any of th is because no colonoscopy had been performed.

ping. What on earth made you think that they didn't?

good as ours. But most of them have a lesser arsenal of tools available. Yo u said it yourself that in AUS you must buy your own occult blood test kit. Nothing wrong with that but the fact is that most people won't do it.

That's not what I said. What I said was that I could buy such a kit at my l ocal chemist. One of the reasons I didn't do it was that I'm pretty certain that I can get my doctor to write me a prescription for one - an hypothesi s that I'm going to test tomorrow.

Your preconceptions about "socialised medicine" are shaping the way you rem ember what I wrote.

nation-by-nation and different nations have different ideas about what is cost-effective - particularly the US where malpractice suits get figured in to the costing.

the US. A friend of ours just gets cancer treatment, to the tune of

re.

Unlikely. The down-side of over-testing is the financial expense and the da mage done by the more invasive tests needed to rule out false positives. Th e PSA test for prostate cancer is the poster-child for that kind of over-te sting. My cancer specialist friend once famously said - on television, that he'd sue if someone ran a PSA test on his blood without his permission.

ore closely and may be called in for more colon tests down the road than pe ople with an uneventful screening. And that's the key: Prevention at an ear ly stage. It simply does not happen in many countries with socialized healt h systems.

screening, but if it looks cost effective, it does it - it certainly does m ammograms and Pap smears and has for many years. And I got my cholestrol le vel checked there by my GP in 1990.

nly every three years. As I said, that is considered way subpar in the US. _This_ is what good health care looks like:

n per head as German and French systems, and twice what the UK system costs .

f so I am glad we do not have an Obamacare policy, so we have this kind of screening. It's as simple as that.

It isn't. The US system goes in for "churning" it's patients. Each test cos ts money ,and a portion of that money turns into a profit for the people ru nning the system. Tests that produce loads of false positives earn even mor e money on the more extensive, expensive and dangerous tests that prove tha t it was a false positive.

ives and elective surgeries such as sex change operation are covered but wo men under 50 are left to fend for themselves with breast cancer detection. Meaning the affluent can get screened and the others don't. Just like in Ca nada. That happens when bureaucrats make decisions.

Obamacare does mean that some 50 million more Americans can get the mammogr ams at 50+ which pick up enough breat cancers to be worth the expense - bea ring in mind that each mammogram pushes enough X-rays into teh breat tissue to marginally raise the risk of breat cancer in later life ...

Meanwhile contraceptives are cheap, and barrier contraceptives pay off in l ower rates of sexually transmitted diseases. Sex change operations are expe nsive, but they are also very rare. They won't bankrupt your system. You ma y find them morally offensive, but your morals aren't shared by the rest of society, no matter how much you'd like them to be.

ld save most quality adjusted years of life.

Tons of experience. They know better.

Perhaps. Doctors aren't great at scientific thinking. There are exceptions, but medical training is focussed on making up your mind quickly, and not r eflecting about your mistakes - when your mistakes kill people, reflecting on past disasters can be life-threatening.

ancer was detected that way were between 40-50. In the UK most of them they would likely be dead now.

, and X-ray screening is too infrequent for the faster-growing cancers anyw ay.

l before age 50 and they all survived. With the new rule of no-scan below 5

0 most or all would have died.

Untestable hypothesis.

g cancer screening back, big time:

253688720

s, and your newspaper has been moved to publish an emotional reaction. That 's not Obamacare, that's efficient use of resources.

s stuff. Doctors do.

The bureaucrats know a lot about this stuff. I talked with a few of them wh en I was working at EMI. Their contempt for emotionally-driven medical opin ion was well-concealed, but detectable.

is flat wrong. Luckily for me and my family we haven't (yet) been dumped i nto that morass and can keep our old pre-Obama plan for now.

fectiveness, and their emotional involvement with their patients makes them prone to make sub-optimal choices.

is also the clinic. They base their decisions and also the policy coverage on hard clinical evidence. An organization this size has tons of such data because millions of patients pipe through there and they have their records fully computerized since a long time.

That doesn't make the evidence available all that helpful, and medical trai ning isn't aimed at getting economically useful information out of medical records.

higher than the 40.9 to 43.6 per 100,000 shown on the map, outstripping Ca nada and Germany even further, and again suggesting that US colorectal canc er is different breed of cat to the US/Canadian one - or rather a different range and distribution of of cancers to the range and distribution that th e the Canadians and Germans have to cope with.

th a vested interest in scaring patients into their consulting rooms

and female colorectal cancer rate. The 2013 "estimates" were 30% higher tha n the 2008 figures. Which would you believe?

I'm afraid that it's your head that's buried in the sand. You've posted obv iously unreliable data, and refuse to recognise that posting "2013" data be fore the end of 2013 has to be evidence of some kind of fraud.

s sick? I believe the Canadian Cancer Society who published this knows a th ing or two about this.

gures.

e year in the bank it's a piece of cake. Cancer trends do not change with t he weather or the lottery numbers.

Well, if your numbers are to be believed, they've changed 30% since 2008.

That's odd, and needs explanation. "Estimated" strikes me as fig-leaf for g uessing something more frightening than real evidence would support.

ield. They are very meticulous and honest. There is no reason to believe th at this is different in cancer research.

nd honest, but was just an assembly of clinical data - not a double blind s tudy that might have told the world anything unambiguous about the treatmen ts being compared. A double-blind study would probably have been unethical, and the clinical results were interesting, but not all that informative.

ned to think like scientists - it's inappropriate in a clinical context. So me learn how, and learn how to swap hats between making clinical judgements that can kill people, and making scientific judgements that can influence how groups are treated, but a lot of the medical literature is close to use less, and some is downright dangerous.

luminaries", because those are the people who can truly bridge the gap bet ween clinical and engineering worlds. Typically, several of them are invol ved in each large study. Believe it or not, but there are cardiologists who have a medical plus an EE degree.

And my cancer specialist friend has a real Ph.D. as well as a medical degre e. Such people are rare, and their output doesn't exactly dominate the medi cal literature (though their citation rates are better than average.

ety who published this knows a thing or two about this.

rooms, and very little about anything else. The sub-committee involved in c oncocting the text doesn't seem to have been all that scientifically sophis ticated.

An appropriate reaction to a URL that was propaganda designed to scare fee- paying patients into consulting rooms.

't involve a cancer-encouraging dose of X-rays). Breast cancer is a lot les s frequent in younger women, so there aren't that many cancers available to be detected, which does make early mammograms less cost-effective.

got it at an age much younger than 50, where countries with socialized hea lth do not screen? Those were also the more aggressive kinds of cancer.

As to why more of the people you know got breast cancer younger than 50, it might be that you knew more younger women sufficiently well to hear if the y got breast cancer. People don't go around wearing a label saying "I've go t breast cancer".

re very open in the US about this stuff. Which is good, because that way th ey not only find spiritual comfort but also new friends who have gone throu gh similar ordeals before them.

Then you have to figure in the susceptibility to magical thinking, which do es vary with year of birth.

What is being done in Obamacare will not make anything less expensive, on t he contrary. Since it adds a layer of bureaucracy it will make everything g o up in cost.

t in Germany, ...

ome directly to the HMO and that sets your payment. Their tax authorities a re never involved in this while here in the US they have hired scores of pe ople for that. As a self-employed (which I was most of the time in Germany) you self-declare. Obamacare insists on formal agency verifications and AFA IK that's one of the bureauuratic procedures that got their web site unglue d.

with a population of 300 million.

pays for that?

"Scores" isn't a huge additional cost. And since the current US system is a lready half-again more expensive than anybody else's, you are objecting to the mote in socialised medicine''s eye while ignoring the beam in US medici ne's eye.

ght mind would trust them with the administration of this whole monster? I sure don't. Most of our friends don't anymore either.

The US system is half again more expensive than anybody else's. Changing it - while not upsetting the insurance companies who are making lots of money out of the existing system, is tricky, and it's not all that surprising th at it isn't going well.

Canadian academic opinions about why the US system is so expensive vote for over-priced administration, and it's no great surprise that Obamacare's ad ministration is turning out to be expensive too - their local role model is n't exactly cheese-apring.

their many lunacies.

Not the first software debacle in US history. And similar disasters happen outside of government. The Tea Party has rather selective vision. They freq uently have been proven to be far-right. Their opinions line up with realit y from time to time, just as a stopped clock is right twice a day.

level. That and the Dutch system run via a number of private health insura nce firms which operate under close government supervision, which is presum ably where Obamacare would eventually end up, if the Tea Party doesn't end up in power.

ial cliff.

e financial cliff, you do seem to be backing quite the wrong horse.

009 he said racking up more debt is irresponsible and he is against doing t hat. 2013, after having racked up the highest debt of any president ever in history, he told the house he will not negotiate about any of that and it' s his way or the highway.

idn't opt for enough debt, so you got the Great Recession, but the economy never got as bad as it did in 1933, and is now recovering (if more slowly t han more aggressive pump-priming would have allowed).

Printing money like they do not does not help either because banks don't l end. It causes inflation.

It hasn't. Printing money causes inflation if the economy isn't in recessio n. If the economy is in recession, the extra money gets spent on under-util ised resources. They weren't being sold before, so this doesn't raise their price.

This is all Keynesianism 101. The Tea Party is too dim to understand it, or - as in James Arthur's case - has been brainwashed into not being able to take it seriously.

That's what I call a successful leader of a country.

And what do you think she did? Europe includes basket cases like Greece and Portugal, and places like Spain and Ireland that caught a bad cold as soon as the sub-prime mortgage crisis pulled the rug out from their over-levera ged but previously successful economies. Germany had got it's economy into fine shape before the sub-prime mortgage crisis hit, and did a whole lot be tter than anybody else in Europe in recovering from the crisis.

ll_2013-02-3.pdf

Arthur - are the financial equivalent of the flat earthism.

d out why flat earth economics don't work for countries, and right-wing nit wits have refused to understand him ever since. It's pathetic, and dangerou s.

I'll forgive you. Engineers don't need to know much about economics.

much, despite all the hype about it. Because the penalties are ridiculously low and youngsters rather plunk down their money towards a new Dodge Chall enger with mag wheels rather than seeing it being slurped up by health prem iums. The vast majority of people without health care that I know have no h ealth care because they chose to spend all their money on fun stuff. Boats, trailers, electronics, sports gear, cars, you name it.

d. A big part of health care is preventing communicable diseases turning i nto epidemics, and there's strong argument for making health insurance comp ulsory (as it is everywhere else).

what that will do to the morale of school kids?

strong as they have always been, and the rebellious and the impulsive will ignore them, just as they always have. The difference is that the rebellio us and the impulsive will come to slightly less harm than they would have i f they hadn't had access to contraceptives. Pregnancy and STD's aren't the only risks they run.

be hidden and cannot be explained away. Plus it has consequences that last decades.

Marrying the wrong person is worse.

nanny state.

me of them do.

s one of many promises this president broke. Most people I know will no lon ger trust him.

He's a politician. Nobody should have trusted him in the first place. You elect politicians who can work out compromises that more or less work f or everybody involved. This usually involves breaking promises that should never have been made in the first place.

on". It'll also increase the spread of communicable diseases.

pregnant for a long time now. Making it happen less often would be a good thing.

s can just have at it. You honestly think they'd use condoms anymore?

and the advantages of condoms. They seem to work - not perfectly, since th e world has plenty of impulsive idiots - but the Dutch statistics are prett y good by world standards.

ft drugs were kind of ok. Then lots of effectively brain-dead 20-somethings could be seen in town and they found the son of my landlady floating in an Amsterdam canal, dead from an overdose of some stuff.

Another winner of a Darwin award. Think of it as improving the breed. Your landlady won't have seen it that way, but that's how evolution is working o n the human genome at the moment.

get the whole enchilada done in one visit for a fixed price of $199 or some thing like that. We also have that for cardiac screening. A huge tractor-tr ailer pulls up, after some whirring this that and the other things slide ou t and, whoopdidou, you have a doctor's office right in the parking lot of a church, supermarket or big company. Then they start piping people through there. Therefore, sorry to say, it is not an excuse if you don't have insur ance.

-screen TV. And you do not need a $100/mo gym membership, I just got a full workout in the Pine Hill Preserve right here on my cheap mountain bike. To ok it and myself to the limits. It's simply a matter of priorities.

everybody out for TB - which was epidemic back then. If you had it you got shunted into the sanatorium where you wouldn't infect anybody else. Back th en streptomycin cured it in about a year or so, if it didn't kill you first .

time in a US sanatorium in 1937-38.

therlands. The advertising is built on making you unreasonably nervous, an d the tests offered aren't exactly cost-effective.

are streamlined for maximum patient through-put and optimized machine usag e rates. No scare tactics. IMHO it is important to know about your risks of getting a particular disease, be it coronary issues or potential cancer. I f it is caught early on, which it often is in those mass screenings, it can make all the difference for a family. They may avoid losing mom or dad.

of customers. The local news services exploit them from time to time in ne w health technology stories, and their reports suggest definite - if subtle - scare tactics, and a serious shortfall on cost-effectiveness.

imarily to make moral judgements about the services they are exploiting, bu t they do like to add a little spice to what are basically information piec es.

comments, and I'm not going to bother.

ropaganda.

Suit yourself. I'd have to provide a link to a TV program, which is not som ething this computer is set up to. I'm not that interested in TV, and spent my first ten years in the UK without a TV set. My wife's more of a fan, an d what we watch we watch primarily because it interests her - I watch most of it with her because it is something we can share.

--
Bill Sloman, Sydney

The vastly better incidence and survival rates speak the truth.

Sure it has false positives. But a friend of mine would be dead now. He didn't know he had quite serious prostate cancer until a PSA test. There were several others, with varying degree of severity.

Sorry, but then the point is meaningless to judge the effectiveness of a country's sereening system. That would be like saying "Oh, but on 56th street between K and L there were four cases out of 70 residents, so ...

The US and the UK may be different in their gene and population pool (although probably not very different). But Canada and the US aren't much different.

[...]

Sure there are. You probably have not been in the US for decades. AFAIK even a US citizen does not stay in one location more than 7 years on average.

While in countries like Germany you typically keep your HMO so there is consistent track recording, this is not the case in the US. Your new employer is likely to offer 2-3 health plans to pick from but they are not from the same HMO. When I moved here, to my surprise, they did not request my previous health records. The docs relied on the patients to tell them if some information was needed. That is (or was) one of the downsides here because there was also a lot of mistrust by patients. It is one of the few (very few) good points of Obamacare that this mistrust will diminsh.

Ok, but colonoscopy and polyp removal have gone through that phase when we were in school.

But the company then croaked ... happens a lot that there are good technical ideas and in the end it goes nowhere.

[...]

No, you just said it: You need to get a prescription from you doctor to get the kit for free (or for a modest co-pay). And you haven't got one. That means it is not standard practice in AUS to screen for colon cancer. And this is wrong, considering how cheap yet sensitive this kind of test is. So that part of your medical system is clearly worse than in the US.

Yes, I am sure the doc will write you a prescription. Especially if you would tell him about a concerning family history or maybe he does it just to appease you. But the fact is, _you_ must take action to get the test done. Your health system doesn't. This is not screening because it misses all the people who are more passive in the medical sense and I fully confess that I also belong to that group. They don't go to the doc until something hurts badly. So I am glad that the US system pushes me to do those tests and that the HMO really bugs me if the test isn't back in what they consider due time.

As I said, the PSA test has greatly benefited friends of mine. My HMO iis large and has its own clicnics, so they have tons of data:

A single PSA test may get it wrong and is of questionable value. But if you watch the PSA trend in your body over the years an aggressive prostate cancer has a higher chance of being detected. This is why they say, quote "Kaiser Permanente guidelines include a recommendation that men age 40 and older should discuss the PSA test and rectal exam with their physician".

No. It saves lifes and clinical evidence clearly shows that.

Wait for the numbers. Most of the uninsured will remain ... uninsured. There is a reason why they keep sign-up numbers under wraps.

I find it morally offensive when elective surgery is covered while life-saving screening is curtailed.

[...]

No, experience. The docs told them and docs generally know.

I don't care about their opinions, they are still just bureaucrats who lack the understanding of true practitioners. Just like the RoHS guys.

At this HMO it is. They have to run a business which solely consists of insurance premiums and co-pays as the revenue stream and delivering medical services at the other end. That's all they do. It is a non-profit company without government funding so they must at least break even.

[...]

Sorry, but you seem to have no clue of how to arrive a statistics and predictions. It's like not trusting SPICE.

[...]

But it does tend to dominate many clinical studies.

Wrong. Preventative care is usually free. So far we have not paid one dime for that. The reason is simple: The HMO assumes you stay with them for a while. They do not want you to become seriously sick and they know what can prevent that. Because if you do develop cancer due to lack of screening it's all going to come out of their pocket.

You'd be surprised. Even atheists find great relief in this one a major medical blow such as cancer has hit them.

Obamacare did absolutely nothing about malpractice, for obvious reasons, and that's a large part of the beam you are talking about.

It has the potential to turn into a disaster.

... while Canadians are dying on waiting lists.

They are realists. There are lots of similar web portals that work. But they were designed ... ... by private enterprises instead of some bureaucrat committees. We could have had a working web portal for well under $100M. But no, now we have p....d away almost 10x that amount and it still doesn't work. Typical big government inefficiency.

It has. The real inflation numbers are simply not acknowledged by the governent, so only people who live here know. Real inflation has surpassed 5% long since. One glance at utility bills speaks volumes. CPI leaves out many costs "because they are too volatile". Yeah, right.

Printing money causes inflation if the economy isn't in

Keynes didn't have much clue about this and you apparently don't.

A lot. For example, she kept taxes and other burdens on businesses in check. That alone saved much of the bacon for Germany. It came with some austerity pains but was necessary and the voters obviously were smart enough to recognize that. Else they would not have re-elected "mama" again, as she is often called over there.

Interesting that (finally!) someone else than me has the guts to say Krugman had it wrong :-)

They know more about it than others. I don't want to sound arrogant but it's a fact: Why is it that I predicted the real estate bubble and even the fed chairman and almost all others did not? Alan Greenspan said so himself. I still remember how a real estate guru laughed in my face. Then that very family lost their home in the wake of what I told them would happen.

[...]

Just like with other people, I prefer politicians who always speak the truth.

No, that's failed drug policies in the Netherlands. As a society we can't expect teenagers to be as smart as we are. They still learn.

[...]

--
Regards, Joerg 

http://www.analogconsultants.com/

Good engineers seem to generally understand the realities of economics. That's why they tend to own homes and have savings. We're in the dynamics systems business, after all.

We bought all of our property at the bottom of boom-bust cycles. It's pretty obvious how to do that, +- a few months: just watch the trends and do what everybody else is not doing.

Sloman is pathetic. He keeps telling us how smart he is and how dumb we are but hasn't been personally productive in decades. He's been trying to build a useless oscillator for 10 years or so now.

--

John Larkin                  Highland Technology Inc 
www.highlandtechnology.com   jlarkin at highlandtechnology dot com    

Precision electronic instrumentation 
Picosecond-resolution Digital Delay and Pulse generators 
Custom timing and laser controllers 
Photonics and fiberoptic TTL data links 
VME  analog, thermocouple, LVDT, synchro, tachometer 
Multichannel arbitrary waveform generators

ed off claiming that UK's National Health Service didn't do mass screening at all ...

on the proposition that the US level of testing represents some kind of gol d standard, which isn't true.

positives - not just financially but also in terms of damage to patients.

The somewhat better survival rates offer a compensating advantage. Objectiv e observers - in other health systems - don't seem to be persuaded.

too many potential cancers to be worth the trouble. It's nice to be told - as I was - that my PSA was unusually low, but I'd consented to the test on the basis that I was going to be very selective in my reaction to any kind of positive result.

idn't know he had quite serious prostate cancer until a PSA test.

His doctor should have been able to feel the cancer via routine manual test ing.

And no false positives? I'm afraid that you are under-reporting, probably b ecause nobody talks about their false positives.

country's sereening system. That would be like saying "Oh, but on 56th stre et between K and L there were four cases out of 70 residents, so ...

You miss the point - again. Variable incidence rates mean that the range of cancers actually being looked at and treated aren't the same, and the vari ation in the cancers can be affecting the survival rates, as well as the va riations in staging at detection and treatment. Faster growing cancers are always detected later, and treatment is less effective.

they all get the same protective health care.

s are like where I come from, you don't see a doc until it's really, really bad. Then there are states with high migration. Naturally, you catch less cases there because you can't get people to the screening.

vary quite a lot from region to region by suggesting that the only thing go ing on is a variation in testing coverage - which only seems to vary betwee n about 50% and 60% - and followup.

evidence to exclude diet and exercise levels as sources of variation.

hough probably not very different). But Canada and the US aren't much diffe rent.

Pull the other leg. The Canadian population has a much larger Scottish comp onent than the USA.

greatly varies by state, including (or predominantly) the illegal kind. Th ere you have people who never got screened for anything. Suddenly, blood is seen where there shouldn't be any.

oing to happen everywhere. There aren't nearly enough migrants to fill up t hat 40% untested catagory.

even a US citizen does not stay in one location more than 7 years on averag e.

onsistent track recording, this is not the case in the US. Your new employe r is likely to offer 2-3 health plans to pick from but they are not from th e same HMO. When I moved here, to my surprise, they did not request my prev ious health records. The docs relied on the patients to tell them if some i nformation was needed. That is (or was) one of the downsides here because t here was also a lot of mistrust by patients. It is one of the few (very few ) good points of Obamacare that this mistrust will diminish.

The result of a FOCT test will be same no matter which HMO is responsible f or getting it done.

hnique, and there is still some discussion about exactly how cost-effective it is, but I'm fairly confident it will be widely adopted - probably even in the UK where they are already good on mammograms and Paps smears.

picion. Turned out that was because of some extreme bicycle riding during t hat time and the doc said he sees that a lot. Of course, these tests have i mproved in sensitivity over the years.

don't know this because you've always lived in countries with socialized m edicine. They get a lot of this much later, and for screening often not at all.

ew years ago.

of senior management at EMI Central Research around 1978 - reprising somet hing I'd told the managing director when he'd been practising management by walking about.

the next five years spouting about it at medical conferences, along with h is three or four acolytes.

e conference presentations were sufficiently persuasive - and after another five years it can become SOP. As a very rough generalisation.

we were in school.

The lat time I was "in school" - even as a graduate student - was 1969.

scanner had produced "obviously useful" text-book anatomy images from the w ord go. The brain scanner was a clinical break-through and got adopted very fast. The body scanner was much less useful - at the time we used to say t hat it's major use was proving that you had inoperable lymphoma - but it go t adopted equally fast. Our ultrasound machines could do interesting stuff, but they didn't produce such seductive images ...

cal ideas and in the end it goes nowhere.

EMI croaked because their cash cow - the music business - stopped generatin g enough cash at the same moment that Jimmy Carter put a six month delay in to the process of buying in a body scanner.

EMI had warehouses full of body scanners in the US at the time - all waitin g on the software guys to get the last few bugs out of the patient registra tion and billing software - and the consequent cash-flow crisis bankrupted the company.

They had good product and a good business plan, but got hit by an unexpecte d conjunction of disasters.

own the road the US doctor now knows that the person had polyps and can mak e sure that this person comes in for follow-ups more often than folks where no polyps were found. The UK, CA or Australia doctor does not know any of this because no colonoscopy had been performed.

ipping. What on earth made you think that they didn't?

ood as ours. But most of them have a lesser arsenal of tools available. You said it yourself that in AUS you must buy your own occult blood test kit. Nothing wrong with that but the fact is that most people won't do it.

my local chemist. One of the reasons I didn't do it was that I'm pretty cer tain that I can get my doctor to write me a prescription for one - an hypot hesis that I'm going to test tomorrow.

remember what I wrote.

et the kit for free (or for a modest co-pay). And you haven't got one. That means it is not standard practice in AUS to screen for colon cancer. And t his is wrong, considering how cheap yet sensitive this kind of test is. So that part of your medical system is clearly worse than in the US.

I haven't been offered it yet, which isn't quite the same thing. I'll know more after my appointment this afternoon.

ould tell him about a concerning family history or maybe he does it just to appease you. But the fact is, _you_ must take action to get the test done. Your health system doesn't. This is not screening because it misses all th e people who are more passive in the medical sense and I fully confess that I also belong to that group. They don't go to the doc until something hurt s badly. So I am glad that the US system pushes me to do those tests and th at the HMO really bugs me if the test isn't back in what they consider due time.

My suspicion is that you need to have more risk factors than I've got to sc ore a FOCT test. AS I said. I'll know more this afternoon - my doctor is im preessed herself on the attention of my cancer specialist friend a some yea rs ago as unusually competent, and she's done fine so far. I expect to get the full Cochrane Collaboration chapter and verse

ed nation-by-nation and different nations have different ideas about what i s cost-effective - particularly the US where malpractice suits get figured into the costing.

in the US. A friend of ours just gets cancer treatment, to the tune of 10k/ month. It's covered. He may have lucked out that he got it pre-Obamacare.

e damage done by the more invasive tests needed to rule out false> positive s. The PSA test for prostate cancer is the poster-child for that kind of ov er-testing. My cancer specialist friend once famouslysaid - on television, that he'd sue if someone ran a PSA test on his blood without his permission .

large and has its own clicnics, so they have tons of data:

ou watch the PSA trend in your body over the years an aggressive prostate c ancer has a higher chance of being detected. This is why they say, quote "K aiser Permanente guidelines include a recommendation that men age 40 and ol der should discuss the PSA test and rectal exam with their physician".

Rectal examinations make sense. PSA tests catch too many potential cancers to be much use, except to clinics who get paid for the initial tests and th e more expensive follow-ups to clear the - numerous - false positives

d more closely and may be called in for more colon tests down the road than people with an uneventful screening. And that's the key: Prevention at an early stage. It simply does not happen in many countries with socialized he alth systems.

ing, but if it looks cost effective, it does it - it certainly does mammogr ams and Pap smears and has for many years. And I got my cholestrol level ch ecked there by my GP in 1990.

only every three years. As I said, that is considered way subpar in the US . _This_ is what good health care looks like:

ain per head as German and French systems, and twice what the UK system cos ts.

uff so I am glad we do not have an Obamacare policy, so we have this kind o f screening. It's as simple as that.

The clinical evidence doesn't talk about the extra breast cancers caused by the extra radiation dose from earlier mammograms, and the general nasty si de effects of over-testing and subsequent extra testing to follow up the nu merous false positives.

fit for the people running the system. Tests that produce loads of false po sitives earn even more money on the more extensive, expensive and dangerous tests that prove that it was a false positive.

eptives and elective surgeries such as sex change operation are covered but women under 50 are left to fend for themselves with breast cancer detectio n. Meaning the affluent can get screened and the others don't. Just like in Canada. That happens when bureaucrats make decisions.

mammograms at 50+ which pick up enough breat cancers to be worth the expen se - bearing in mind that each mammogram pushes enough X-rays into the brea st tissue to marginally raise the risk of breast cancer in later life ...

ere is a reason why they keep sign-up numbers under wraps.

If the Tea Party counter-propaganda as rampant in the US media as it is her e, I can see that the take up might be slow.

in lower rates of sexually transmitted diseases. Sex change operations are expensive, but they are also very rare. They won't bankrupt your system. Yo u may find them morally offensive, but your morals aren't shared by the res t of society, no matter how much you'd like them to be.

aving screening is curtailed.

Except that the "life-saving" screening that has been curtailed doesn't sav e all that many lives, and is rather expensive in terms of quality-adjusted years of life saved per dollar spent.

well before age 50 and they all survived. With the new rule of no-scan belo w 50 most or all would have died.

Technically speaking hearsay, not experience. And the docs told them what t he docs thought would make them happy. It often doesn't have much to do wit h reality.

ing cancer screening back, big time:

21253688720

rts, and your newspaper has been moved to publish an emotional reaction. Th at's not Obamacare, that's efficient use of resources.

this stuff. Doctors do.

m when I was working at EMI. Their contempt for emotionally-driven medical opinion was well-concealed, but detectable.

ck the understanding of true practitioners. Just like the RoHS guys.

The "understanding" of true practitioners is of a kind that lets them estab lish a raport with their patients. It's not the kind of understanding that leads to a rational deployment of resources.

at is flat wrong. Luckily for me and my family we haven't (yet) been dumped into that morass and can keep our old pre-Obama plan for now.

effectiveness, and their emotional involvement with their patients makes th em prone to make sub-optimal choices.

MO is also the clinic. They base their decisions and also the policy covera ge on hard clinical evidence. An organization this size has tons of such da ta because millions of patients pipe through there and they have their reco rds fully computerized since a long time.

training isn't aimed at getting economically useful information out of medi cal records.

insurance premiums and co-pays as the revenue stream and delivering medical services at the other end. That's all they do. It is a non-profit c ompany without government funding so they must at least break even.

And pay their staff wages - which have to be high enough to attract compete nt staff ... It doesn't make them inclined to under-test, or even to be par ticularly economical about testing.

e and female colorectal cancer rate. The 2013 "estimates" were 30% higher t han the 2008 figures. Which would you believe?

extrapolated. Either way, they aren't to be trusted.

obviously unreliable data, and refuse to recognise that posting "2013" dat a before the end of 2013 has to be evidence of some kind of fraud.

dictions. It's like not trusting SPICE.

I don't trust Spice. And I got an undergraduate course on statistics and pr ediction when I did "Theory of Computation 1" back in 1966. One comment fro m that course sticks in my mind, which was that interpolation can be more o r less reliable, but extrapolation is a bitch.

"luminaries", because those are the people who can truly bridge the gap between clinical and engineering worlds. Typically, several of them are in volved in each large study. Believe it or not, but there are cardiologists who have a medical plus an EE degree.

egree. Such people are rare, and their output doesn't exactly dominate the medical literature (though their citation rates are better than average.

"Dominate"?

ciety who published this knows a thing or two about this.

g rooms, and very little about anything else. The sub-committee involved in concocting the text doesn't seem to have been all that scientifically soph isticated.

fee-paying patients into consulting rooms.

e for that. The reason is simple: The HMO assumes you stay with them for a while. They do not want you to become seriously sick and they know what can prevent that. Because if you do develop cancer due to lack of screening it 's all going to come out of their pocket.

The Canadian Cancer Society isn't offering regualr screening - it's an asso ciation of specialists, and if you go an talk to them you start off by payi ng their consulting fee plus the costs of any tests they prescribe.

Mostly, they are relying on general-practitioner inspired screening to gene rate their referrals, but a bit of anxiety-making propaganda never goes ami ss.

EM

cancer is a lot less frequent in younger women, so there aren't that many cancers available to be detected, which does make early mammograms less cos t-effective.

ow got it at an age much younger than 50, where countries with socialized h ealth do not screen? Those were also the more aggressive kinds of cancer.

. As to why more of the people you know got breast cancer younger than 50, it might be that you knew more younger women sufficiently well to hear if t hey got breast cancer. People don't go around wearing a label saying "I've got breast cancer".

e are very open in the US about this stuff. Which is good, because that way they not only find spiritual comfort but also new friends who have gone th rough similar ordeals before them.

h does vary with year of birth.

medical blow such as cancer has hit them.

It happens, but much less often than the god-botherers like to claim.

. What is being done in Obamacare will not make anything less expensive, on the contrary. Since it adds a layer of bureaucracy it will make everything go up in cost.

got in Germany, ...

come directly to the HMO and that sets your payment. Their tax authorities are never involved in this while here in the US they have hired scores of p eople for that. As a self-employed (which I was most of the time in Germany ) you self-declare. Obamacare insists on formal agency verifications and AF AIK that's one of the bureaucratic procedures that got their web site unglu ed.

y with a population of 300 million.

nk pays for that?

is already half-again more expensive than anybody else's, you are objecting to the mote in socialised medicine''s eye while ignoring the beam in US me dicine's eye.

and that's a large part of the beam you are talking about.

That's not the opinion of the Canadian economists who've looked at the reas ons why US medicine is over-priced. They point to administrative costs.

right mind would trust them with the administration of this whole monster? I sure don't. Most of our friends don't anymore either.

g it - while not upsetting the insurance companies who are making lots of m oney out of the existing system, is tricky, and it's not all that surprisin g that it isn't going well.

You've already got a disaster. There's no evidence that Obamacare is going to make it perceptibly more disastrous.

for over-priced administration, and it's no great surprise that Obamacare' s administration is turning out to be expensive too - their local role mode l isn't exactly cheese-paring.

That's universal - if there's any kind of waiting list, people on it are go ing to die, and reporters are going to make a fuss about every last one of them, even if they've been hit by a meteorite.

one of their many lunacies.

.

pen outside of government. The Tea Party has rather selective vision. They frequently have been proven to be far-right. Their opinions line up with re ality from time to time, just as a stopped clock is right twice a day.

With a very restricted view of reality. If they can't touch it, it doesn't exist.

. ... by private enterprises instead of some bureaucrat committ ees. We could have had a working web portal for well under $100M. But no, n ow we have p....d away almost 10x that amount and it still doesn't work. Ty pical big government inefficiency.

Private enterprise can match it. Some projects come in on time and under bu dget. Many don't.

US level. That and the Dutch system run via a number of private health insu rance firms which operate under close government supervision, which is pres umably where Obamacare would eventually end up, if the Tea Party doesn't en d up in power.

the financial cliff.

the financial cliff, you do seem to be backing quite the wrong horse.

2009 he said racking up more debt is irresponsible and he is against doing that. 2013, after having racked up the highest debt of any president ever in history, he told the house he will not negotiate about any of that and i t's his way or the highway.

didn't opt for enough debt, so you got the Great Recession, but the econom y never got as bad as it did in 1933, and is now recovering (if more slowly than more aggressive pump-priming would have allowed).

ss. Printing money like they do not does not help either because banks don' t lend. It causes inflation.

ernent, so only people who live here know. Real inflation has surpassed 5% long since. One glance at utility bills speaks volumes. CPI leaves out many costs "because they are too volatile". Yeah, right.

The real economy has between 2% and 3% inflation per year. I don't know why , but 5% inflation since Obama came to power would be surprisingly low.

One side effect of the Great Depression was 30% deflation. If the Great Rec ession has held inflation down to 5% over five years, it's because the econ omy hasn't been e\well enough protected against the ravages of the GFC.

he economy is in recession, the extra money gets spent on under-utilised re sources. They weren't being sold before, so this doesn't raise their price.

, or - as in James Arthur's case - has been brainwashed into not being able to take it seriously.

Not an opinion widely shared by economists.

t's what I call a successful leader of a country.

ck. That alone saved much of the bacon for Germany. It came with some auste rity pains but was necessary and the voters obviously were smart enough to recognize that. Else they would not have re-elected "mama"again, as she is often called over there.

Being in charge of a thriving economy does make you look good. I do like An gela Merkel, but she's no miracle worker.

like Spain and Ireland that caught a bad cold as soon as the sub-prime mort gage crisis pulled the rug out from their over-leveraged but previously suc cessful economies. Germany had got it's economy into fine shape before the sub-prime mortgage crisis hit, and did a whole lot better than anybody else in Europe in recov ering from the crisis.

n_bull_2013-02-3.pdf

man had it wrong :-)

Krugman's prescriptions weren't necessary in Germany.

Arthur - are the financial equivalent of the flat earthism.

led out why flat earth economics don't work for countries, and right-wing n itwits have refused to understand him ever since. It's pathetic, and danger ous.

t's a fact: Why is it that I predicted the real estate bubble and even the fed chairman and almost all others did not? Alan Greenspan said so himself. I still remember how a real estate guru laughed in my face. Then that very family lost their home in the wake of what I told them would happen.

It's easy enough to detect when a bubble is about to burst - everybody star ts telling you that you ought invest in whatever it is whose price is being blown up by the bubble.

That doesn't need enough economic insight to realise that Adam Smith - let alone Keynes - was onto something.

You elect politicians who can work out compromises that more or less work f or everybody involved. This usually involves breaking promises that should never have been made in the first place.

truth.

And I want a 100% reliable investment that pays out 30% dividends. Back in the real world you have more limited choices.

tion". It'll also increase the spread of communicable diseases.

g pregnant for a long time now. Making it happen less often would be a good thing.

oy...

The evidence goes rather the other way.

--
Bill Sloman, Sydney

:

re but hasn't been personally productive in decades. He's been trying to bu ild a useless oscillator for 10 years or so now.

I've not worked since 2003, so I've not been all that productive for one de cade, not decades, and the useless oscillator really is useless - in the se nse that I don't have any immediate application for it - but I started work ing on it around the 14th February 2012, which is eighteen months ago, not ten years.

Larkin's grip on reality is tenuous. Just as well - he'd have trouble maint aining his inflated ideas about his own competence if he had better underst anding of the outside world. It would probably drive him into a lethal depr ession, and put his employees out of work. Some delusions can be useful.

--
Bill Sloman, Sydney

BS > I've not worked since 2003, so I've not BS > been all that productive for one decade, So it's easy for you to promote outright socialism.

I'm 70 and retired. I'd love to be productive, but it's difficult to arrang e.

I was a "socialist" long before I found myself retired - I was an active me mber of the British Labour Party in Cambridge UK (mainly because I was prep ared to mange my ward's membership list on my computer, and printed out a b unch of address labels every month) back when I was very productively emplo yed.

My political opinions haven't changed significantly since then - I was firm ly middle-of-the-road Labour then, and wouldn't have voted for the Dutch so cialist Party if I'd had a vote in the Netherlands national elections. I di d vote for the Dutch Labour Party - Partij van de Arbeid - in the municipal elections where we did have a vote.

Your own ideas about "socialism" are a little hazy, and one wonders what yo u might think meant by "outright socialism".

--
Bill Sloman, Sydney

So, why do so many Canadians come to the US for MRI screening? I hear the US has 35 MRI machines per million while Canada has only 6 or so. Is this a case of the US over-testing people with hypochondria?

-Bill

I've told this story here before, but again. I herniated a disc and was going to see a surgeon, I went shopping for an MRI. I called a couple places and while on an errand about 1:30 in the afternoon I stopped to get a quote and they said $382, I said that's good when can we do it. They ask me if I could come back at 9pm. I got the MRI 7 and 1/2 hrs after I ask for it. Turned out I had two herniated discs. I suffered for over 3 years. 3 and 1/2 years later I have little back pain with occasional bouts of minor sciatica. I never had the surgery. Mikek

Enough of this rubbush!

I'm no fan of Bill Sloman. He can be a bit of an old woman at times and a tad scathing when he points out the obvious deficiencies in American society.

But when it comes to credibility he wins hands down for two main reasons.

1. He is always well informed. You aren't
2. You are a rabid right wing septic. Bill isn't.

1. He is always well informed. You aren't Herein read "well indoctrinated"
2. You are a rabid right wing septic. Bill isn't. Anything right of Karl Marx is to you then. Septic? LOL

On Mon, 11 Nov 2013 13:06:01 +0000, Pomegranate Bastard Gave us:

The pomegranate ingrate RETARD fires off a post!

Run along Nymbeclile, you irritating little tick. Can't you find some bogs to clean?

Sloman is like Obama's version of Baghdad Bob.