It is not what you do not know that I get into trouble. That s what we know with certainty that it is not. - Mark Twain
Please, the next test. Which of these statements is incorrect?
1) annual review with your doctor are a useful and convenient to prevent disease
2) Early detection of cancer significantly reduces mortality
3) You can reduce cholesterol significantly from simple changes in diet
4) If HIV testing positive againvery likely that the disease
5) Members of Congress who voted for Obamacare read the bill.
You may not understand, this is a trick question. The fact is that none of the allegations are true, (with some mild controversy.) However, the continuing erroneous belief in the truth of these claims characterizes most understanding of American health care. More importantly, reformers have Obamacare sold to the American people, as if these misconceptions were true. Idiscussed in the previous blog because most of the interventions for obesity, alcohol abuse and snuff are not working. Try to reduce your cholesterol, changing your diet is possible, but almost never succeed without the help of drugs. With few exceptions, most of preventive medicine and the detection of cancer, saving lives and much less than advertised, and a very high cost.
To understand the problems of health screenings, I have to talk about something called "Bayes theorem.Reverend Bayes was an English mathematician and fans interested in the probability. Understand the implications of his theorem is crucial for doctors, which is useful for consumers, health, and very disappointing for those hoping Obamacare promises are made.
In simpler terms, Bayes' theorem says that the probability to find something you're looking for is greater when it happens more often. It 's easier for a doctor to find people with colds than people withxanthogranulomatous pyelonephritis, a rare type of kidney infection (I like the name.)
The enigma of the Bayes theorem appears when one tries to find something unusual, such as early-stage breast or lung cancer. Any test that can find a disease will have a certain error rate. Sometimes, this evidence shows that a disease is present, even when the person does not have the disease (called a false positive). If the disease is rare, even a very good test gives many false positiveswhich is the source of confusion and controversy, both in medicine.
A good example is the HIV test I mentioned above. The risk of HIV in the general population is so low that there are more false than true positive test positive test. Also in the group of positive tests, only 1 in 10 actually has the disease.
For a false positive for HIV, there is little downside, except for anxiety, and a more expensive test for confirmation. However, for something likebreast cancer or lung cancer, a false positive mammogram or CT scan can be costly in many more years of follow-up scans, invasive biopsies or at risk of complications. These tests add the largest cost of screening programs and reduce the potential of saving early diagnosis.
Important is also a controversy over whether to detect tumors earlier has a significant impact on the lives of patients. This is a complicated problem with many disagreements. The short answer is thatearly cancer detection saves lives, but not as many as you might think. Even more surprisingly, certain types of cancer does not develop, but remain dormant for long periods. The discovery of these types of cancer screening means that some cancers are treated, not be a problem if left alone.
The issue of detection, prevention and care that have touched me here is the source of intense debate in the medical literature. The crucial point is that the claims made by supporters of Obamacare arenot true. preventive care, more visits to family physicians, and coverage of screening would not save money, and can save many more lives. Sometimes the hopes and populist politics can not withstand the harsh reality.
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