Favorite Quotes
"For every complex problem, there is a solution that is simple, neat, and wrong." - HL Mencken
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"I hear and I forget. I see and I remember. I do and I understand." - Confucius
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"The good physician treats the disease; the great physician treats the patient who has the disease" - Sir William Osler
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" The best test of a person's character is how he or she treats those with less power." - Bob Sutton
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"Those are my principles, and if you don't like them - well, I have others." - Groucho Marx
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"The difference between genius and stupidity is that genius has its limits." - Albert Einstein
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"It is hard enough to remember my opinions, without also remembering my reasons for them" - Friedrich Nietzsche
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"Anyone can make the simple complicated. Creativity is making the complicated simple." - Charles Mingus
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"Not everything that can be counted counts, and not everything that counts can be counted." - Albert Einstein
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"A foolish consistency is the hobgoblin of little minds, adored by little statesman and philosophers and divines. With consistency a great soul has simply nothing to do." - Ralph Waldo Emerson
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"This ain't no party, this ain't no disco, this ain't no fooling around." - Talking Heads, Life During Wartime
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"What is hateful to you, do not do to your neighbour. This is the whole Torah; all the rest is commentary. Go and learn it." - Hillel, Talmud, Shabbath 31a
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"You will never understand bureaucracies until you understand that for bureaucrats procedure is everything and outcomes are nothing." - Thomas Sowell
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"An idealist is one who, on noticing that a rose smells better than a cabbage, concludes that it will also make better soup." - HL Mencken
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"If you only have a hammer, you tend to see every problem as a nail." - Abraham Maslow
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"A great teacher is one who realizes that he himself is also a student and whose goal is not to dictate the answers, but to stimulate his students creativity enough so that they go out and find the answers themselves." - Herbie Hancock
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"There are no facts, only interpretations." - Nietzsche
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"An education isn't how much you have committed to memory, or even how much you know. It's being able to differentiate between what you do know and what you don't." - Anatole France
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"In character, in manner, in style, in all things, the supreme excellence is simplicity." - Henry Wadsworth Longfellow ====
Nov - 15
Dec - 19
Jan - 21
Feb - 8
Mar -
My disappointment in Sebelius
19 Nov2009
Screening Policy Won’t Change, U.S. Officials Say
The White House disagrees with the USPHTF on political grounds. These new recommendations are based on careful scientific analysis.
Members of the group, Physician Data Query, expressed frustration with the politicization of the mammogram debate.
“It seems like the current public controversy is enormously out of proportion,” said Dr. David Ransohoff, professor of medicine at the University of North Carolina.
The group does not make recommendations for the National Cancer Institute, but the institute said on Monday that it would review the new guidelines and then issue a statement. Its current recommendations are for women to have mammograms every one to two years starting at age 40.
One member of Physician Data Query, Dr. Russell Harris, a former member of the Preventive Services Task Force, said one reason the new guidelines recommend that most women not have mammograms in their 40s is that researchers have become more aware of the problem of overdiagnosis: finding cancers that were better off not being found.
I happen to know both Dr. Ransohoff and Dr. Harris. They are careful thinkers who make decisions based on data, not based on political impact.
We cannot rationally make medical decisions when politics interfere. We lost our best guideline process (the old AHCPR) because spine surgeons did not like a guideline.
We challenge physicians to use the best data to treat patients. However, when an unbiased committee gives a result that politicians dislike, the process is rejected.
So, politicians must either ban guideline development or back off. We are cursed with value decisions in medicine. Sometimes the value is money, but sometimes the value is political. Most of the discussions over this issue leave the data and move to a religious belief that mammograms must do good. The critics are perverting the ongoing process of refining medical decision making. Shame on the politicians.
Related posts:
- Mammograms and cost containment
- Another performance measure challenged – BP goal
- Politics and mammograms – I am disgusted and disappointed
- Shaneyfelt and Centor on guidelines
- Dr. RW and the JAMA editorial
Related posts brought to you by Yet Another Related Posts Plugin.
- In: Medical Rants
6 Responses to My disappointment in Sebelius
Mark Friedman
November 19th, 2009 at 3:12 pm
So how can we decide whether the "guidelines" are for maximum health or "cost-containment?"
JPB
November 19th, 2009 at 8:50 pm
Bravo, db. Mammography has become a sacred cow. It is time for rational people to examine its effectiveness.
Dr. Bob (FP)
November 19th, 2009 at 10:22 pm
Well Mark, you could read what the USPSTF actually said on their website rather that listening to Fox, CNN, MSNBC, etc. They says exactly what their decicsions were based on along with supporting articles. The USPSTF doesn't use cost criteria, e.g., $ per QALY. They use net benefits & harms.
WaltMD
November 21st, 2009 at 5:55 am
Is there any information about the natural history of DCIS and if those cancers were included in the analysis?
Michael Kirsch, M.D.
November 22nd, 2009 at 10:29 am
Rob, I am more than disappointed with Sebelius, but I am angry at her decision. She was given solid data on comparative effectiveness research (CER) and rejected it for political reasons. The USPSTF, which she 'dissed' is under her own HHS agency! We learned last week that there may be no one willing to make the tough decisions that real health care reform would require. If our government is throwing it's own impartial and objective task force under the bus, then what hope do we have for real progress? More thoughts at my current post at http://www.MDWhistleblower.blogspot.com
Doc99
November 22nd, 2009 at 10:37 am
No oncologists on a panel formulating guidelines on … cancer? Curious.