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ObamaCare Tax Increases Are Double Original Estimate


By zzyzzx   Follow   Wed, 13 Mar 2013, 12:31am PDT   2,413 views   143 comments
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http://www.economicpolicyjournal.com/2013/03/tax-prof-obamacare-tax-increases-are.html

The Joint Committee on Taxation recently released a 96 page report on the tax provisions associated with Affordable Care Act. The report describes the 21 tax increases included in Obamacare, totaling $1.058 trillion – a steep increase from initial assessment, according to the Tax Prof Blog. The summer 2012 estimate is nearly twice the $569 billion estimate produced at the time of the passage of the law in March 2010.

Patrick's code won't let me paste in a table here.

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Meccos   Sun, 17 Mar 2013, 12:57pm PDT   Share   Quote   Permalink   Like   Dislike     Comment 104

MMR says

It comes back to what I said about intellectually dishonest debate tactics; you're in violation of the 'my resume is bigger than yours tactic.' Thanks for taking things out of context to the point that it misrepresents my original position.

MMR the biggest problem to your argument is that I never tried to trump anyone's argument based on my resume. I never used the prestige of my schooling/education, job, etc as the basis for my arguments as you suggest.
Rather it is you who boasts about your relatives in medicine, as if that has anything to do with you. You think having relatives in medicine gives you any credibility? Furthermore you try to overstate your position by saying "you are gunning for residency in 2015" rather than saying you are a second or third year medical student". Keep in mind, that I never stated what I did or what my background was, until curious asked me. So how could I possibly do what you accuse me of doing?

BTW, you'll learn about projection soon enough (yes now I am talking down on you).

Meccos   Sun, 17 Mar 2013, 12:57pm PDT   Share   Quote   Permalink   Like   Dislike     Comment 105

MMR says

Curious provides links unlike you, usually high quality.

If you think links to local newspapers with anecdotal evidence are high quality links , then you are a fool...

MMR   Sun, 17 Mar 2013, 12:59pm PDT   Share   Quote   Permalink   Like (1)   Dislike     Comment 106

What does one need to diagnose for obesity at the primary care level? It makes up for 40% of patient load in most offices. What kind of treatments would you recommend for these people. What is the 'standard of care' for pre-diabetes, diabetes and CVD? Drug therapy? How brilliant! Not telling patients the truth about their situations makes for repeat customers and future referrals to others in your referral network. Yeah, yeah, diet and exercise. How do patients do that? Telling patients that is next to worthless but most doctors stop there, knowing damn well it doesnt make a difference. Since you like anecdotes, because you are 'too good' to provide evidence/links, failure to adequately address obesity increases referrals to cardiologists and oncologists and probably psychiatrists as well. What benefit is there for cardiologists and oncologists who make money to provide advice on diet and exercise when most live off of medicare? Generally speaking, most doctors I know (over 100) only have other doctors in their referral network. Since you are a doctor who has familiarity with the billing codes, maybe you can enlighten us all about the benefit financially for cardiologists to provide detailed diet and exercise advice. Oh, that's right, most cardiologists don't do that because that doesn't put more money in their pockets than doing procedures; When the arteries become blocked due to incompetence/failure to tell patients unvarnished truth at the primary care level, the cardiologist intervenes with a balloon angioplasty; prior to that, the radiologist might determine the level of blockage. So yeah, since nothing was done for the obese person at the primary care level, the radiologist got make a diagnosis which then leads to treatment.

Not sure what kind of doctor you are, but based on your speaking style, your patients are most likely, unmitigated idiots if they put their trust in you.

Again not saying that radiology doesn't add value, but it is often questionable. Certainly not 4.4 billion dollars. Certainly helps you to cover your ass, though it might not put money in your pocket.

Meccos says

f you feel that making a diagnosis adds no value, then I could see your argument. However, most if not all, patients and clinicians would argue that diagnosis is the first step in any treatment.

Meccos   Sun, 17 Mar 2013, 1:01pm PDT   Share   Quote   Permalink   Like (1)   Dislike (1)     Comment 107

MMR says

I noticed that you make assertions without providing research, but use anecdotes to explain you position, but when others provide links, you just say they are wrong without providing alternate links.

Perhaps you should review the links I made... Ill give you an example of my links versus curious' links.

Mine:
http://archinte.jamanetwork.com/article.aspx?articleid=416067

Curious:
http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-the-cost-conundrum-redux.html

Yes, this survey of hundreds of physician is anecdotal... yet the new yorker article surveying a couple physicians is not anecdotal.

Meccos   Sun, 17 Mar 2013, 1:04pm PDT   Share   Quote   Permalink   Like   Dislike     Comment 108

MMR says

Other than JAMA, Annals of Int Med, and Archives of Int Med and NEJM, what else do you read to stay up-to-date?

What is the purpose of this question? MMR says

By the way, on an unrelated topic, why do you whine about people deleting your links? Since you're a physician who uses this site often, why are you too cheap to donate 5 bucks for a premium account to Patrick, who is running this site at a loss?

Again what is the purpose of this question? Whether I pay for a forum service or not, what is it to you? Perhaps I am cheap. so what? Regardless of whether I pay, do you think it is proper for any comment to be deleted?

MMR   Sun, 17 Mar 2013, 1:22pm PDT   Share   Quote   Permalink   Like   Dislike     Comment 109

Referencing the original quote, that's pretty much what you did. I've heard that a million times before so its possible that you weren't doing that, but based on experience, I'd say not likely

Meccos says

MMR the biggest problem to your argument is that I never tried to trump anyone's argument based on my resume. I never used the prestige of my schooling/education, job, etc as the basis for my arguments as you suggest.

Meccos says

Just so I know what your background is and where you get your info from, what do you do and where?

There is a lot more to read that what makes it into political circle jerk that medicine has become. Pretty sure you're not much of a reader of current research unless it makes it into the only books you trust

Meccos says

MMR says

Other than JAMA, Annals of Int Med, and Archives of Int Med and NEJM, what else do you read to stay up-to-date?

What is the purpose of this question?

That's not up to curious standards. He's done better in the past. I do agree that defensive medicine is real; it may well be that the fear of getting sued is greater than the actual reality and that some people use the confusion to game the system. On an anecdotal level, my cousin, a retired pediatrician, bills aggressively and 'sees what sticks'. He was never sued in his career of over 22 years.

Meccos says

Perhaps you should review the links I made... Ill give you an example of my links versus curious' links.

Mine:

http://archinte.jamanetwork.com/article.aspx?articleid=416067

Curious:

http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-the-cost-conundrum-redux.html

Yes, this survey of hundreds of physician is anecdotal... yet the new yorker article surveying a couple physicians is not anecdotal.

Meccos   Sun, 17 Mar 2013, 1:23pm PDT   Share   Quote   Permalink   Like   Dislike     Comment 110

MMR says

What does one need to diagnose for obesity at the primary care level? It makes up for 40% of patient load in most offices. What kind of treatments would you recommend for these people. What is the 'standard of care' for pre-diabetes, diabetes and CVD? Drug therapy? How brilliant! Not telling patients the truth about their situations makes for repeat customers and future referrals to others in your referral network. Yeah, yeah, diet and exercise. How do patients do that? Telling patients that is next to worthless but most doctors stop there, knowing damn well it doesnt make a difference.

You have no idea what I do, yet you continue in this moronic fashion and accuse me of things to which you have no idea...

MMR says

Not sure what kind of doctor you are, but based on your speaking style, your patients are most likely, unmitigated idiots if they put their trust in you.

Exactly you have no idea what I do.

MMR says

Again not saying that radiology doesn't add value

No this is exactly what you said...

MMR says

But radiologists sure do. It seems like they make the money they make not as a value-add, but just to help doctors practice CYA medicine. One estimate (can't remember where) was that it was about 4.4 billion dollars a year.

BTW, I like how you deleted the part where you said that these tests are done to "cover" our butts. THis is exactly what I have been saying. Why did you delete that post??? haha

Meccos   Sun, 17 Mar 2013, 1:27pm PDT   Share   Quote   Permalink   Like   Dislike     Comment 111

MMR says

Referencing the original quote, that's pretty much what you did. I've heard that a million times before so its possible that you weren't doing that, but based on experience, I'd say not likely

So cant prove I did that, but yeah I possibly did it? hahaah funny.

MMR says

There is a lot more to read that what makes it into political circle jerk that medicine has become. Pretty sure you're not much of a reader of current research unless it makes it into the only books you trust

Again, you have no idea but make assumptions... You will go far my boy.

MMR says

That's not up to curious standards. He's done better in the past

Perhaps he has done better in the past, but we arent talking about the past are we?

MMR   Sun, 17 Mar 2013, 1:30pm PDT   Share   Quote   Permalink   Like   Dislike     Comment 112

I said it's overvalued. Not that it adds NO value. By the way

Meccos says

MMR says

But radiologists sure do. It seems like they make the money they make not as a value-add, but just to help doctors practice CYA medicine. One estimate (can't remember where) was that it was about 4.4 billion dollars a year.

BTW, I like how you deleted the part where you said that these tests are done to "cover" our butts. THis is exactly what I have been saying. Why did you delete that post??? haha

Meccos says

MMR says

Again not saying that radiology doesn't add value

No this is exactly what you said...

Meccos says


943053">

When did I delete it. Pretty sure its still up there. I guess you're projecting again.

MMR says

But radiologists sure do. It seems like they make the money they make not as a value-add, but just to help doctors practice CYA medicine. One estimate (can't remember where) was that it was about 4.4 billion dollars a year.

BTW, I like how you deleted the part where you said that these tests are done to "cover" our butts. THis is exactly what I have been saying. Why did you delete that post??? haha

Meccos   Sun, 17 Mar 2013, 1:35pm PDT   Share   Quote   Permalink   Like   Dislike     Comment 113

MMR says

I said it's overvalued. Not that it adds NO value.

um.. no. you didnt say over valued.

MMR says

But radiologists sure do. It seems like they make the money they make not as a value-add, but just to help doctors practice CYA medicine. One estimate (can't remember where) was that it was about 4.4 billion dollars a year.

BTW, you claimed that you didnt delete a comment after you posted it, but we both know its false. In fact, there is a comment that I quoted you on in the post just prior to this one that has been deleted as well.

MMR   Sun, 17 Mar 2013, 1:38pm PDT   Share   Quote   Permalink   Like   Dislike     Comment 114

Whatever you say dean ornish. I think you are using a dean ornish argument strategy. 'We both' don't "know" anything. Anyway, gotta go to bed so I can study. toodles. In closing I don't need your lousy 'advice' on how to 'make it far' in medicine. Lots of sucking up (strategically) and telling people what they want to hear until I have the freedom to practice what I see fit. Being good looking/fit helps as well, since most people(attendings,interns) in the wards judge people so superficially.

In closing, you're patients are probably universally idiots if they think you could give them good advice on diet and lifestyle. I am not interested in YOUR focus, rather I'm giving you a perfect example of why Radiology is often of questionable value. At the same time, I'm telling you what I'm already good at. This is what most people really need help on since doing so would decrease incidence of diabetes and cardiovascular disease. Nope, I'm not going to be an insurance taking hack like you, even if it means I make 25K in my first year. I'm fortunate not to have loans. Truth be told, I'm not florence nightingale, I like to help but I'm no saint; money matters and if I had to take loans to do it, I wouldn't. Meccos says

BTW, you claimed that you didnt delete a comment after you posted it, but we both know its false. In fact, if you look on the previous posts, I cant even find the post I quoted you there

Meccos   Sun, 17 Mar 2013, 1:41pm PDT   Share   Quote   Permalink   Like   Dislike     Comment 115

MMR says

Whatever you say dean ornish. I think you are using a dean ornish argument strategy. We both don't know shit. Anyway, gotta go to bed so I can study. toodles.

I may not know a lot of shit, but you clearly do not know any shit. Good luck in medical school, I hope you do not turn out to be this guy:

MMR says

Telling patients that is next to worthless but most doctors stop there, knowing damn well it doesnt make a difference.

MMR   Sun, 17 Mar 2013, 1:49pm PDT   Share   Quote   Permalink   Like   Dislike     Comment 116

Clearly......as clear as a bowl of shit.Meccos says

MMR says

Whatever you say dean ornish. I think you are using a dean ornish argument strategy. We both don't know shit. Anyway, gotta go to bed so I can study. toodles.

I may not know a lot of shit, but you clearly do not know any shit. Good luck in medical school, I hope you do not turn out to be this guy:

MMR says

Telling patients that is next to worthless but most doctors stop there, knowing damn well it doesnt make a difference.

Rin   Sun, 17 Mar 2013, 1:57pm PDT   Share   Quote   Permalink   Like (2)   Dislike (1)     Comment 117

BTW, to those reading this thread... Homeboy has accused me and MMR of being the same person in an earlier thread regarding doctor's salaries.

Homeboy   Sun, 17 Mar 2013, 4:31pm PDT   Share   Quote   Permalink   Like   Dislike (1)     Comment 118

CaptainShuddup says

Fuck... Who says I advocate some fantasy made up entity that no one has managed to put a face to, but several have gone on record, to say..."Gosh I'm not one of them, and why I wish they would tax me more..."

YOU did, fucktard, to wit:

"Why don't you Liberals just strong arm rob every rich republican in this country, then give all of their money to the IRS.
Can you explain, how that will benefit people that are actually trying to earn a living? That would be "Oh happy days!" for the welfare class, but the rest of us, will be shit canned from our jobs because it is the RICH in this country that hires people. "

You are saying you don't want the rich to pay more taxes, because they are the ones that "hire people". Look, dude - you fucking wrote it. It's right there. Don't try to slink away from it now like a pussy.

CaptainShuddup says

But nobody has explained how that top 1% managed to get everyone's money, but there's not one company that has been tied to this fictitious 1% entity pile of Bullshit. How in the fuck are the 1% getting so much goddamn money, if they aren't anyone that you can point at. How are they employing everyone, if there is one to point a finger at. How are they getting customers, to go to their businesses, to spend money, so they can pay their employees nothing, while they make piles of money and give everyone else the shaft.

How is all of this even happening?

All of the "1%" fear mongering, and not one Liberal will provide one fucking name of a company associated with this fictitious lot. So everyone can boycott them and drive them out of business if they are so bad.

Are you kidding? You are so far in denial it's not even funny. Oh, I don't know, just for example... GOLDMAN FUCKING SACHS. Duh. Not one Liberal will provide the name of a company? That's ALL liberals ever do. Maybe you should turn off the Fox News for 5 minutes. What good would it do to boycott them? You are as naive as they come. They already would have gone out of business, but they were declared "too big to fail". Doesn't matter how bad their business model is, the government will keep handing over the middle class' wealth to them.

You don't believe the distribution of wealth is skewed in the U.S. Well you're not the only one. Watch this video, and see the difference between people's perception and reality:

http://www.youtube.com/watch?feature=player_embedded&v=QPKKQnijnsM

Then look at this chart, to see how the distribution of income has CHANGED over the last few decades:

Then awaken from your long slumber, my friend.

MMR   Mon, 18 Mar 2013, 12:30am PDT   Share   Quote   Permalink   Like (1)   Dislike     Comment 119

Well......one-third of cancers that were found via routine mammograms may not be life-threatening, raising once again the question about the value and benefits of traditional breast cancer screening. More than one million women could have been wrongly over-diagnosed with breast cancer, thereby exposing them needlessly to the angst that comes with the diagnosis, as well as the traditional healthcare treatments for the disease.

http://www.ncbi.nlm.nih.gov/pubmed/12903848

Meccos says

MMR says

Again not saying that radiology doesn't add value

No this is exactly what you said...

MMR   Mon, 18 Mar 2013, 12:34am PDT   Share   Quote   Permalink   Like (1)   Dislike     Comment 120

We found that the introduction of screening has been associated with about 1.5 million additional women receiving a diagnosis of early stage breast cancer," writes study co-author Dr. Gilbert Welch.

Now, at first, you might think that's a good thing. You might think, "Well, early detection saves lives, just like we've been told by Komen and the cancer non-profits."

But you'd be wrong. As Dr. Welch's team discovered, there was virtually no reduction in late-stage breast cancer from all this "early" diagnosis, meaning that most women who were told they had breast cancer after a mammogram were being lied to.

As he explains:

We found that there were only around 0.1 million fewer women with a diagnosis of late-stage breast cancer. This discrepancy means there was a lot of overdiagnosis: more than a million women who were told they had early stage cancer -- most of whom underwent surgery, chemotherapy or radiation -- for a "cancer" that was never going to make them sick. Although it's impossible to know which women these are, that's some pretty serious harm.

Yep, it is. In fact, if you do the math and calculate 0.1 million fewer women with advanced-stage cancer out of 1.5 million who were diagnosed, 93% of the "early detection" cancer cases studied were false positives, meaning that they would never have gone on to cause advanced-stage cancer anyway.

http://www.nejm.org/doi/full/10.1056/NEJMoa1206809?query=featured_home&

Dr. Welch, author of study in New York Times

Six years ago, a long-term follow-up of a randomized trial showed that about one-quarter of cancers detected by screening were overdiagnosed. And this study reflected mammograms as used in the 1980s. Newer digital mammograms detect a lot more abnormalities, and the estimates of overdiagnosis have risen commensurately: now somewhere between a third and half of screen-detected cancers.

Got that? Many cancer diagnoses from mammography are utterly false. But they are a great scare tactic for recruiting women into what can only be called a "cult of cancer" in which they are manipulated into poisoning themselves with chemicals. They are later called "cancer survivors" if the poison doesn't manage to kill them.

http://www.nytimes.com/2012/11/22/opinion/cancer-survivor-or-victim-of-overdiagnosis.html?_r=1&

MMR says

Meccos says

MMR says

Again not saying that radiology doesn't add value

No this is exactly what you said...

MMR   Mon, 18 Mar 2013, 12:38am PDT   Share   Quote   Permalink   Like (1)   Dislike     Comment 121

Ultrasound better than mammography for detection of invasive breast cancer

An analysis conducted by the Seattle Cancer Care Alliance (SCCA) reveals that, overall, ultrasounds have a 95.7 percent sensitivity rate in detecting malignant tumor cells while mammograms are only 60.9 percent sensitive, by comparison. Among 1,208 cases evaluated, ultrasounds also successfully detected about 57 percent more harmful breast cancers compared to mammograms.

Dr. Constance Lehman, M.D., Ph.D., Director of Radiology at SCCA and her colleagues observed that, particularly among women aged 30 to 39, ultrasounds are a safer and more effective alternative to mammograms as a breast cancer screening tool. Based on her and her team's findings, it now appears prudent to switch gears and perhaps ditch mammography altogether.

"In women under 40, ultrasound is better at evaluating breast lumps compared to mammography," said Lehman about the findings, which were published recently in the American Journal of Roentgenology. Though Lehman still recommends mammograms for women over age 40, her study's findings illustrate that they are an unnecessary risk.

http://www.seattlecca.org/press-release/ultrasound-is-better-detecting-cancer-in-women-under-40.cfm

http://www.ncbi.nlm.nih.gov/pubmed/15474430

MMR says

MMR says

Meccos says

MMR says

Again not saying that radiology doesn't add value

No this is exactly what you said...

MMR   Mon, 18 Mar 2013, 12:42am PDT   Share   Quote   Permalink   Like (1)   Dislike     Comment 122

When you really take an honest look at the data, it is clear that mammography is negligibly effective at reducing deaths from breast cancer, at best. The general, 10-year risk of a woman dying from breast cancer is about 0.53 percent, while the risk for a woman who gets mammograms is 0.46 percent. Mammograms, in other words, reduce this already low risk by a mere 0.07 percent, which could represent nothing more than a statistical margin of error.

Put another way, 53 women out of 10,000 will die from breast cancer in the next 10 years, and mammograms may potentially lower this number to 46 women out of 10,000. But in the meantime, as many as 50 percent of all the women receiving mammograms to detect such cancers will have at least one false positive, which will in turn result in needless biopsies, surgery, radiation, or chemotherapy.

Any potential benefit in terms of death reduction from breast cancer is essentially offset by the fact that regular mammography screenings are also linked to actually causing breast cancer. A study presented at the annual meeting of the Radiological Society of North America (RSNA) found that young, high-risk women who are screened using mammography are up to 250 percent more likely develop breast cancer as a result of the screening compared to those who are not screened.

http://www.cnn.com/2012/08/02/health/komen-mammograms/index.html

MMR says

Meccos says

MMR says

Again not saying that radiology doesn't add value

No this is exactly what you said...

MMR   Mon, 18 Mar 2013, 12:47am PDT   Share   Quote   Permalink   Like (1)   Dislike     Comment 123

More mammograms equals more mastectomies.......Due to overdiagnosis

http://www.bidmc.org/YourHealth/HealthInTheNews.aspx?ChunkID=657310

The study drew on data from Norway's national breast cancer screening program for 35,000 women aged 40 to 79 diagnosed with early or invasive breast cancers. Oslo researchers discovered a 31% increased risk of mastectomy among women invited to receive mammograms compared with a non-invited younger age group.

The research team found, in comparing rates of mastectomy before and after the institution of the national screening program, mastectomies increased by 9% among women invited to screenings. However mastectomy rates decreased by 17 percent during the same time period among non-invited women aged 40 to 49 and by 13 percent in non-invited women aged 70 to 79.

Study author Pal Suhrke observed that "these results are surprising and disappointing because one might suspect that due to earlier detection of tumors, the number of women needing mastectomies would decrease."

MMR says

Meccos says

MMR says

Again not saying that radiology doesn't add value

No this is exactly what you said...

MMR   Mon, 18 Mar 2013, 12:50am PDT   Share   Quote   Permalink   Like (1)   Dislike     Comment 124

Mammograms deliver overwhelmingly more false positive results than true positives in women under the age of 40, according to a new study conducted by researchers from the University of North Carolina-Chapel Hill and published in the Journal of the National Cancer Institute.

In a false positive result, a mammogram detects signs of a tumor that turns out to be non-cancerous or otherwise not dangerous to a woman's health.

"In a theoretical population of 10,000 women aged 35 to 39 years, 1,266 women who are screened will receive further workup, with 16 cancers detected and 1,250 women receiving a false-positive result," the researchers wrote.

"Harms need to be considered, including radiation exposure, because such exposure is more harmful in young women; the anxiety associated with false-positive findings on the initial examination; and costs associated with additional imaging."

The researchers examined the medical records of more than 117,000 U.S. women who got their first mammograms between the ages of 18 and 39. In the ensuing year, not a single woman under the age of 25 was diagnosed with breast cancer. For women between 35 and 39, 12.7 percent were called back for further tests but only 0.16 percent actually had cancer.

Because breast cancer rates in young women are so low, screening them is like "looking for a needle in a haystack," lead researcher Bonnie Yankaskas said.

http://thechart.blogs.cnn.com/2010/05/03/mammograms-in-your-30s-%E2%80%98a-needle-in-a-haystack%E2%80%99/

MMR says

Meccos says

MMR says

Again not saying that radiology doesn't add value

No this is exactly what you said...

MMR   Mon, 18 Mar 2013, 12:55am PDT   Share   Quote   Permalink   Like (1)   Dislike     Comment 125

550
0

(NaturalNews) In my experience, it's not often that pro-mammogram literature or textbooks tell the truth about the limitations of mammography so imagine my surprise when I came across this section in the 1,100 page textbook I'm studying called Breast Imaging by Dr. Daniel B. Kopans.

"Because screening does not detect all cancers and does not detect all cancers sufficiently early to permit cure, screening should not be thought of as a method to reassure someone she does not have cancer. Emphasis was added by the book's author.

"Screening is purely a chance to detect some cancers early in their development, at a time when intervention may be able to alter the course of the disease. It should be understood that, given the present state of the art, screening does not detect all cancers or save all women, and there is still not a test or combination of tests that can guarantee a women does not have breast cancer. Screening is not the solution to the breast cancer problems, but until universal cure is developed or safe methods of prevention are discovered, screening with mammography can save many lives." (Kopans, pg. 146)

This is a revelation all women should understand: A normal mammogram does not mean a storm is not just over the horizon. Most women who receive a report that their mammogram is normal breathe a sigh of relief. For some, they have been lulled into a false sense of security. It can take up to nine years for the fastest growing cancers to be detected by mammography. What if your scan is normal and it's year eight?

I've heard women say, "I have to get my mammogram so I don't get cancer." They've said it with the same perky voice I've heard them announce, "I have to get my flu shot so I don't get sick!" Why is a flu shot viewed as something that provides health, like it's a shot of B12, instead of understanding a flu shot for what it is: an injection of a toxic substance? The same idea applies to a mammogram. It's not prevention. It's a dose of radiation, a toxic substance, promoted as something good for your health.

Dr. Kopans clearly states that a mammogram is "simply a measuring tool to assess if you have cancer" - yet. But women have a different perception of their annual exams. In fact, a 1999 study revealed that 44 percent of women believe screening mammography had a sensitivity of 100 percent, meaning, they believe that mammograms find every breast cancer (http://jech.bmj.com/content/53/11/716.abstract). This is not only untrue, it is an unrealistic expectation of any medical test. In fact, the Breast Cancer Detection Demonstration Project, a large epidemiological study first done in the 1970s, found that a combination of mammography and clinical breast exam failed to detect at least 20 percent of cancers. (Kaplan, p148). This statistic has remained fairly constant to the present day.

False positive and false negative mammograms

While radiologists use a strict set of criteria for interpreting the films, the interpretation of a breast x-ray is challenging. A mammogram looks like white blobs and scratches across a black board. If you've never seen one, ask your doctor to see your films the next time you have a mammogram. It's an educational moment worth having and can explain why mammograms do not - and cannot - detect every cancer, especially at its smallest, earliest stage.

A false-positive mammogram means that something appears abnormal on the film, but then turns out to be a false alarm. Over a 10-year period, approximately 24 percent of women who have an annual mammogram will have at least one false-positive mammogram

Suspicious findings require a woman to be called back for "extra views" and more radiation exposure. An inconclusive mammogram can lead to an ultrasound, and most likely a biopsy, where eight of 10 are found to be normal.

In 2006, the Cochrane Review published a meta-analysis of mammograms performed on 500,000 women throughout the US, Canada, Scotland and Sweden. The review concluded that for every 2,000 women who received mammograms over a 10-year period, 10 women have extra, unnecessary and potentially harmful treatments and the number of mastectomies increased by 20 percent

http://www.ncbi.nlm.nih.gov/pubmed/17054145

A false-negative x-ray, on the other hand, means cancer is present but not detected by the mammogram or is overlooked the radiologist who did the interpretation. In 1982, the false-negative rate for screening mammography was found to be eight to 10 percent

(http://caonline.amcancersoc.org/cgi/content/abstract/32/4/194).

A decade later, some authors have suggested the false-negative rate was as high as 25 percent

http://radiology.rsna.org/content/184/3/613.short

Dense breast tissue can compromise the ability of a mammogram to detect a mass, and lesions located near the sternum (breast bone) or near the chest wall can be difficult to visualize. A false-negative test can explain why one year the report is normal and the very next year, cancer is diagnosed.

MMR says

Meccos says

MMR says

Again not saying that radiology doesn't add value

No this is exactly what you said...

MMR   Mon, 18 Mar 2013, 12:58am PDT   Share   Quote   Permalink   Like (1)   Dislike     Comment 126

Radiologists vary in their ability to accurately interpret mammograms and the overall range of accuracy is troublesome. In 2005, a disturbing study published by U.S. Army Medical Research for its "Era of Hope Project," radiologists (on average) accurately identified only 77 percent of cancers. For individual radiologists, the detection rate ranged from 29 percent to 97 percent, meaning that some physicians only found about 30 percent of tumors on sample mammograms, an extraordinarily high false negative rate. Interestingly, this reference seems to be no longer available for review.

At the other end of the scale, a meta-analysis of 117 studies published in Annals of Internal Medicine (2007) reported that false-positive results on mammograms range from 20 percent to 56 percent in women 40 to 49 years of age

http://annals.org/article.aspx?articleid=733981

In Radiology, researchers found that radiologists who interpret fewer scans generate more false positive reports. The minimum number of mammograms required of radiologists practicing in the U.S. is currently 960 mammograms every two years - or about 10 per week. The researchers estimate that increasing the number of required scan interpretations to 1,000 per year, or about 20 per week, would result in 43,629 fewer women being recalled for extra studies, reducing the cost of false-positive tests by $21.8 million per year. On average, for every cancer detected, 22.3 women were called back for more testing

http://www.emaxhealth.com/1024/radiologist-who-read-more-diagnostic-mammograms-do-it-better

MMR says

Meccos says

MMR says

Again not saying that radiology doesn't add value

No this is exactly what you said...

MMR   Mon, 18 Mar 2013, 1:05am PDT   Share   Quote   Permalink   Like   Dislike     Comment 127

Radiology might add net value, but I doubt it. It's highest value is to help insurance mill owners/hospital employed MDs to practice CYA medicine. I'd venture to say that a significant driver for 'defensive medicine' is whether or not a patient is self-pay vs insured. Translation, self-pay patients are less likely to be overbilled since they are paying out of pocket. Of course that makes up a small percentage of people visiting insurance mills.

One thing I am adamant about though: Radiologists should make a good living, but should not be the highest paid by any stretch, while Pathologists are near the bottom of the barrel. It's a lot harder for a pathologist to make a million dollars per year than for a radiologist. Based on value, that's unjust.

I gotta study for step I so have a good one dude.

MMR says

MMR says

Meccos says

MMR says

Again not saying that radiology doesn't add value

No this is exactly what you said...

zzyzzx   Mon, 18 Mar 2013, 1:51am PDT   Share   Quote