Potentially, equally pernicious to the motivated reasoning based on future financial benefit for a doctor from screenings is the knowledge that they've already been doing screenings for twenty years and want to believe they've been doing something good.
Thanks for this video, I've been skeptical about it being "super important" for me to get a colonoscopy just because I am in my late 40's. I'm not a medical expert, but I do know how to read a study and look at the statistics. I'm just not buying that the benfits outweigh the risks. Now if I have legit symptoms of a problem then I'm more open to the idea.
I feel pressured to get mammograms. An abnormality led me to have a half dozen tests, some invasive, and a lumpectomy. I feel traumatized and wonder if all of this was bad for me.
I am 50 years old, have never had a mammogram or colonoscopy mainly due to lack of health insurance. Low and behold, a few months ago, I had to seek medical care due to symptoms that were not resolving, and am now dying of a metastatic cancer that would not have been found by either of those screens. So I can really appreciate this cost benefit analysis even more than I ordinarily would have. Yesterday I ordered Vinay's book Malignant and look forward to reading it for any insight into how I can make the most logical decisions about what, if any, future treatment I receive.
Your response had me thinking. I'm not yet done, so I have nothing useful to say. It will probably live in my head for a while. I hear these podcasts, but it is so different hearing from the other side of the fence. Good luck. May you make wise choices. Whatever they are.
its immediately possible for hospitals to remove patients who opt out of screening from the denominator that goes into the PCPs report card for reimbursement
Thank you Russ for another exceptionally informative and significant podcast. Vinay, one of your many returning guests, is one of my favorite’s and I hope we will hear from him again soon.
Thanks for being here! The audio episodes through podcast apps are still much more popular than the video versions here. Each audio episode averages a few hundred thousand downloads a week. I think people like to listen to podcasts while they drive or do other things? But glad you are enjoying the video episodes! The video definitely adds to the experience.
Would love to hear Azra Raza, Peter Attia and ZDogg/Vinay talk about cancer screenings. For example, Peter suggests that we've made more progress in the last 10 years than the last 50 combined (mostly as a result of immunotherapy). On the PBD Townhall podcast (27m mark), Vivek Ramaswami talks about the problem with the pharmaceutical industry and homelessness. BTW, as long as I'm dreaming, would like to hear Vivek, Vinay and Rahm Emanuel talk politics.
one thing that stands out about screening is that effectiveness, accuracy, and safety is correlated with how often the practice does the screen, they need to have a lot of patients to screen to practice and improve their practice's quality, even if or especially if, most the patients would not have benefited from the screening. In other words, once a screening protocol is defined, it becomes obligatory for patients to subject themselves to the inconvenience and potential downsides of screening for the greater good of the practice being able to help the few that would benefit,
I love to hear that as well. 2 of the best podcasters. However, I don't agree with Peter's advice on PCa Gleason 3+3 and 3+4 because he recommends surgery. Most MDs would put the former on active surveillance, and sometimes 3+4 goes on AS too. I would be curious as to why Peter would use surgery so quick when the potential side effects (incontinence and impotence) are devastating to most men.
Please do a episode on the intersectionality of medical freedoms and human rights. Vinay Prasad and Dr. Stanton Hom should discuss that topic on EconTalk.
