Saturday, December 22, 2007

Class war over cancer

The article below says that poor people have worse disease outcomes -- with cancer particularly. But one of the most consistent findings we see when anyone looks at the social class basis of disease is that middle class people have better health -- even in countries with socialized medicine. So blaming the bad outcomes described below solely on lack of health insurance -- as is done below -- is disingenuous. There is no doubt that the quality of the health care accessed does make some difference but much of what is described below simply reflects the fact that middle-class people are healthier anyway -- for a variety of reasons.

People diagnosed with cancer who don't have health insurance are more likely to die because they are less likely to get screening tests and so are typically diagnosed with advanced disease, a new study from the American Cancer Society finds.

The finding proffers strong evidence that differences in cancer survival are directly related to lack of access to health care. "If you are uninsured, and you are diagnosed with cancer, you have a 60 percent greater chance of dying from cancer than if you were insured and diagnosed with cancer," said Dr. Otis Brawley, chief medical officer at the cancer society. "There is not a cohort of insured and a cohort of uninsured cancer patients that have the same five-year survival," Brawley added. "It's always the uninsured who do worse."

Part of the problem is that uninsured people don't have access to screenings, Brawley said. "But part of it is that uninsured people don't have access to the best doctors or have access to good doctors who are overwhelmed. The end result is the quality of care the poor folks get is not as good as the quality of care of the wealthier or the insured," he said. There are also people who are underinsured, Brawley said. While these people have access to care, high co-pays and deductibles make the care unaffordable, particularly high-priced chemotherapy drugs, he noted.

"Where it becomes frightening and morally reprehensible is people who have significant pain and can't get narcotics and other pain medications they need, because they can't afford them," Brawley said. People don't realize they are underinsured until after they have gotten sick, Brawley said. "There are a substantial number of Americans who don't realize they are a cancer diagnosis away from economic disaster," he noted.

The study, in the January/February issue of CA: A Cancer Journal for Clinicians, used data from the National Cancer Database, which is the only national registry that collects data on patient insurance. The report is an overview of systems of health insurance in the United States. It has data on the association between health insurance, screening, stage at diagnosis, and survival for breast and colorectal cancer.

The link between access to care and cancer outcomes is particularly striking for cancers that can be prevented or found early by screening and for which there are effective treatments, including breast and colorectal cancer. Only about 38.1 percent of uninsured women aged 40 to 64 have had a mammogram in the past two years, compared with 74.5 percent of insured women. In addition, 20 percent to 30 percent of uninsured women are diagnosed with late-stage breast cancer, compared with 10 percent to 15 percent of women with private insurance, according to the study.

Uninsured women are less likely to be diagnosed with early breast cancer than women who are privately insured. This disparity was greatest among white women, where almost 50 percent of those with private insurance were diagnosed with early-stage cancer, compared with fewer than 35 percent of uninsured white women. Moreover, 89 percent of insured white women were living five years after breast cancer diagnosis compared with 76 percent of uninsured white women. For black women, five-year survival rates are 81 percent for those with private insurance and 65 percent for uninsured women.

For men and women aged 50 to 64 who have private insurance, 48.3 percent were screened for colorectal cancer in the past 10 years compared with fewer than 18.8 percent of the uninsured. In addition, uninsured patients are more likely than those with private insurance to be diagnosed with stage IV colorectal cancer and less likely to be diagnosed with stage I colorectal cancer, the researchers found.

For whites, 66 percent of insured patients survive colorectal cancer for five years, compared with 50 percent of those without insurance. For blacks, five-year survival rates are 41 percent among the uninsured compared with 60 percent among privately insured patients.

Additional findings in the study include:

Uninsured women were less likely to have a Pap test in the past three years than insured women (68 percent vs. 87.9 percent). Among insured men, 37.1 percent had a prostate specific antigen test, compared with 14 percent of uninsured men. People aged 18 to 24 have the highest probability of being uninsured.

Lower-income people are more likely to be uninsured. Blacks, Hispanics, Asian American/Pacific Islanders, and American Indian/Alaska Natives are more likely to be uninsured than whites. Of those without insurance, 53.6 percent have no usual source of health care.

The uninsured are more likely to delay care, not receive care, and not obtain prescription drugs because of costs. Among people who saw a health-care provider, those without insurance were less likely to be advised to quit smoking or lose weight.

Brawley noted that while some of the uninsured qualify for Medicaid, coverage doesn't begin until the cancer has been diagnosed. "You have someone who is uninsured and poor -- gets none of the screenings, gets none of the early detection opportunities -- when they finally go to the doctor, it's because they are so sick, they can no longer go to work, or their family is forcing them to go to the emergency room," Brawley said. "What you have is someone who a year ago we could, relatively cheaply, fix, maybe even cure, but now that they have ignored their symptoms, it's no longer fixable, we are going to treat them, but the treatment is going to be very expensive."

The remedy to the problem is "making sure that everyone who wants health insurance can get affordable health insurance," Brawley said. "In this country, we need to have an open conversation about this issue." One expert thinks this study highlights the need for a health insurance program that covers everyone. "Sadly, many Americans must face the challenges of cancer with no insurance coverage, or with Medicaid, which is often grossly inadequate as coverage," said Dr. Steffie Woolhandler, an associate professor of medicine at Harvard Medical School and a co-founder of Physicians for a National Health Program. [Woolly Steffie would say that. She has even claimed repeatedly that socialized medicine would REDUCE bureaucracy! It might do so initially but over the years bureaucracy is like an ever-growing cancer] For these cancer patients, diagnosis is delayed and survival is shortened, Woolhandler said. "We need nonprofit national health insurance to be sure that everyone gets the health care they need, particularly people with cancer."


Cannabis smoke 'has more toxins'

It has always seemed likely that if tobacco smoke is bad for you, cannabis smoke would be too -- depending in part on what it had in it. The report below details just what that is

Inhaled cannabis smoke has more harmful toxins than tobacco, scientists have discovered. The Canadian government research found 20 times as much ammonia, a chemical linked to cancer, New Scientist said. The Health Canada team also found five times as much hydrogen cyanide and nitrogen oxides, which are linked to heart and lung damage respectively. But tobacco smoke contained more of a toxin linked to infertility. Experts said users must be aware of the risks.

About a quarter of the population in the UK smokes tobacco products, while a sixth of 15 to 34-year-olds have tried cannabis in the past year, making it the most commonly used drug.

Previous research has shown cannabis smoke is more harmful to lungs than tobacco as it is inhaled more deeply and held in the lungs for a longer period. However, it has also been acknowledged that the average tobacco user smokes more than a cannabis user.

Researchers from Health Canada, the government's health research department, used a smoking machine to analyse the composition of the inhaled smoke for nearly 20 harmful chemicals. They also looked at the sidestream smoke, given off from the burning tip of the product and responsible for 85% of the smoked inhaled through passive smoking.

In most cases, the comparison on sidestream smoke broadly mirrored that of inhaled smoke. However, in the case of polycyclic aromatic hydrocarbons, the toxin linked to infertility, the researchers found concentrations were actually higher in cigarette smoke. The study also showed little difference in the concentrations of a range of chemicals, including chromium, nickel, arsenic and selenium.

Lead researcher David Moir said: "The consumption of marijuana through smoking remains a reality and among the young seems to be increasing. "The confirmation of the presence of known carcinogens and other chemical is important information for public health."

Dr Richard Russell, a specialist at the Windsor Chest Clinic, said: "The health impact of cannabis is often over-looked amid the legal debate. "Evidence shows it is multiplied when it is cannabis compared to tobacco. "Tobacco from manufacturers has been enhanced and cleaned whereas cannabis is relatively unprocessed and therefore is a much dirtier product. "These findings do not surprise me. The toxins from cannabis smoke cause lung inflammation, lung damage and cancer."

Stephen Spiro, of the British Lung Foundation, added the findings were "a great worry".



Just some problems with the "Obesity" war:

1). It tries to impose behavior change on everybody -- when most of those targeted are not obese and hence have no reason to change their behaviour. It is a form of punishing the innocent and the guilty alike. (It is also typical of Leftist thinking: Scorning the individual and capable of dealing with large groups only).

2). The longevity research all leads to the conclusion that it is people of MIDDLING weight who live longest -- not slim people. So the "epidemic" of obesity is in fact largely an "epidemic" of living longer.

3). It is total calorie intake that makes you fat -- not where you get your calories. Policies that attack only the source of the calories (e.g. "junk food") without addressing total calorie intake are hence pissing into the wind. People involuntarily deprived of their preferred calorie intake from one source are highly likely to seek and find their calories elsewhere.

4). So-called junk food is perfectly nutritious. A big Mac meal comprises meat, bread, salad and potatoes -- which is a mainstream Western diet. If that is bad then we are all in big trouble.

5). Food warriors demonize salt and fat. But we need a daily salt intake to counter salt-loss through perspiration and the research shows that people on salt-restricted diets die SOONER. And Eskimos eat huge amounts of fat with no apparent ill-effects. And the average home-cooked roast dinner has LOTS of fat. Will we ban roast dinners?

6). The foods restricted are often no more calorific than those permitted -- such as milk and fruit-juice drinks.

7). Tendency to weight is mostly genetic and is therefore not readily susceptible to voluntary behaviour change.

8). And when are we going to ban cheese? Cheese is a concentrated calorie bomb and has lots of that wicked animal fat in it too. Wouldn't we all be better off without it? And what about butter and margarine? They are just about pure fat. Surely they should be treated as contraband in kids' lunchboxes! [/sarcasm].

9). And how odd it is that we never hear of the huge American study which showed that women who eat lots of veggies have an INCREASED risk of stomach cancer? So the official recommendation to eat five lots of veggies every day might just be creating lots of cancer for the future! It's as plausible (i.e. not very) as all the other dietary "wisdom" we read about fat etc.

10). And will "this generation of Western children be the first in history to lead shorter lives than their parents did"? This is another anti-fat scare that emanates from a much-cited editorial in a prominent medical journal that said so. Yet this editorial offered no statistical basis for its opinion -- an opinion that flies directly in the face of the available evidence.

Even statistical correlations far stronger than anything found in medical research may disappear if more data is used. A remarkable example from Sociology:
"The modern literature on hate crimes began with a remarkable 1933 book by Arthur Raper titled The Tragedy of Lynching. Raper assembled data on the number of lynchings each year in the South and on the price of an acre's yield of cotton. He calculated the correlation coefficient between the two series at -0.532. In other words, when the economy was doing well, the number of lynchings was lower.... In 2001, Donald Green, Laurence McFalls, and Jennifer Smith published a paper that demolished the alleged connection between economic conditions and lynchings in Raper's data. Raper had the misfortune of stopping his analysis in 1929. After the Great Depression hit, the price of cotton plummeted and economic conditions deteriorated, yet lynchings continued to fall. The correlation disappeared altogether when more years of data were added."
So we must be sure to base our conclusions on ALL the data. But in medical research, data selectivity and the "overlooking" of discordant research findings is epidemic.


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