Doing What You Were Not to Do

In a recent Healio piece they describe a study evaluating QALY on PCa. This was frankly expressly prohibited by the ACA for any service provided thereunder. But the cat is out of the bag. The study states:

Under selective therapy, men with lower Gleason scores (< 7) and clinical stage cancer ( T2a) would only receive treatment after clinical progression. All other cases underwent contemporary treatment practices. Key study endpoints included life-years (LY), quality-adjusted life-years (QALY), direct medical expenditures, and cost per LY and QALY gained. Researchers evaluated cost-effectiveness as willingness-to-pay thresholds ranging from $50,000 to $150,000 per QALY. When compared with no screening, all screening strategies increased LYs (range, 0.03-0.06) and costs (range, $263-$1,371). Costs ranged from $7,335 to $21,649 per LY gained.

 Not really clear what was concluded. Was the cost low compared to the benefit? They conclude:

“Our work adds to the growing consensus that highly conservative use of the PSA test and biopsy referral is necessary if PSA screening is to be cost-effective,” Roth and colleagues wrote. “Among the strategies considered, less frequent screening and more restrictive criteria for biopsy resulted in greater chances of PSA screening being cost-effective — particularly when combined with selective treatment strategies that do not immediately treat low-risk, screen-detected cases.”

 This of course is studying on the basis of past practises and having not a clue what causes or differentiates the disease.

The Cost of the ACA

The CBO has a report describing the anticipated costs of the ACA, exclusive of Medicare for those who have paid in and are over 65.

We depict this above. It will soon exceed $200B annually and that is for an increase of some 14-15 million people. That amounts to an insurance premium of some $15,000 per person enrolled! Now the Medicare participant over 65 has paid in some 50+ years worth at 3% of their gross income plus some $2,400 per year plus a Medigap plan and a Part D plan costing an additional $4,500, plus a deductible, at a total in excess of well above $7,500. That is in addition to what they paid for 50 years!

So who are these people. Read the report and moan!

Why People Buy Apple Computers

For the past few weeks, yes weeks, I have been struggling with a dying W7 computer. Each death is different. In this case it was a result of what we think is registryoma, a malignant condition in the Microsoft Registry. We all know that Microsoft has designed this devilish system to control its world but one small base pair mismatch and if you think melanoma is bad try this on for size. There is no immune therapy available and there is not way to block the pathways.

The first symptoms are insidious. Google desktop stops. It just disappears. It was akin to a small mole, just a small change, just a little sensitive. So you do a work around. Then Quick Books fails. The mole starts to bleed. Maybe I scratched it, denial. Another work around. I will do my books on another machine. No problem. Put another bandage on it, how bad can it be.

Then the web systems fail to connect. No problem I can use Filezilla, another work around. It is another mole popping up where there was none before. I do not see lungs becoming engorged with metastatic patches.

Then I try Skype. Dead. It will not even load. It has spread to the brain. The patient does not know it yet. But Office is not loading properly, it freezes up all the time. Firefox has to be loaded 2 or 3 times before it starts. The patient has a seizure.

At this point  I would say the patient is a goner! Well I got another machine. Started all over again. New patient, left the old one in the basement. Not totally dead but it is hospice care for the dying!

Microsoft has with its Registry invented a malignancy that makes cancer seen benign. It starts slowly and then spreads and infirm the "patient" and the user. There is no cure, just put the old guy in a hospice and let him die. Kind of like the ACA approach. Thanks Microsoft, you make cancer research looks trivial!

Spy vs Spy

Ad Blockers have become a common thing. I use Badger on Firefox. One can see masses of white space where the ads were before being blocked. I now see that Wired senses the ad blockers and then blocks the page. Cute game, but I just switch to somethi9ng else.

The worst of these techniques is the pop up video, silently I work, check out a headline on Feedly and then WHAM! Blasting video. Now stopped by Badger.

Do these people really think that if I accept the ads I will in any way be persuaded. Rather to the contrary.

How do I find things? Well look at Lookeen, I had an indexing problem. Most likely some Microsoft update on W7. Killed Google Desktop. So I searched Google for an alternative and got a better result. Did I ever see them in an ad? No. Would I have responded to an ad? No.

Marketing folks really do not understand the consumer dynamic. Pity!

Great Product!

I have never endorsed any products before but when my Google Desktop crashed and would not reboot I panicked since my life depends on indexing my some 300,000 files! So after a few tries I stumbled on Lookeen, a German company, and for about $50 you get a fantastic indexing system. It is one of those simple things that you find a better part each time you use it. It is what Google Desktop could have become.

Moreover their customer support is fantastic! Real people answering real questions to make the experience better. So for any of you who want a great indexing system for a PC I would strongly suggest you try them out! No disclosures to make here, just that when one relies on a good indexing system and the only one you had is no more it is a God send to get this one! Hope they do well.

How Stupid is the USPTF?

First they did away with mammograms. Women went ballistic. Then they did away with PSA tests. Men were silent. Now they are doing away with vision testing for the elderly. At least the JAMA folks complained.

The USPTF states as of today:

The U.S. Preventive Services Task Force released today a final recommendation statement on screening for impaired visual acuity in older adults. The Task Force concludes that the evidence is insufficient to make a recommendation for or against screening in older adults without reported vision problems within a primary care setting.

In contrast JAMA states:

In 2009, the US Preventive Services Task Force (USPSTF) concluded that there was insufficient evidence to warrant recommending visual acuity screening of older adults. A recent update, published in JAMA,¹ reaches the same conclusion. How (one might ask) can that be, especially as the USPSTF also concluded that impaired vision is common among elderly adults and that the major causes of impaired vision that the recommendation targets—refractive error, cataract, and age-related macular degeneration—are prevalent among elderly individuals and responsive (often dramatically) to clinical intervention? 

It appears that these medical wizards always come up with recommendations that impair health and reduce costs. Remember we said seven years ago that this would happen!

Have any of these brains heard of ARMD, dry or wet, it leads to blindness! Any second year medical student should recognize drusen on a retinal exam.  Did these folks ever do one in their life?