Preventive Health Care

As Robin has pointed out before, there isn’t a lot of evidence that so-called preventive health-care is worthwhile. A recent NY Times op-ed by Dartmouth professor H. Gilbert Welch, author of "Should I Be Tested for Cancer? Maybe Not and Here’s Why," is worth flagging:

In a presidential campaign that promises straight talk and no gimmicks, why do both candidates champion one of medical care’s most pervasive myths? The myth is that like magic, preventive medicine will simultaneously reduce costs and improve health. . . .

The term "preventive medicine" no longer means what it used to: keeping people well by promoting healthy habits, like exercising, eating a balanced diet and not smoking. To their credit, both candidates ardently support that approach. But the medical model for prevention has become less about health promotion and more about early diagnosis. Both candidates appear to have bought into it: Mr. Obama encourages annual checkups and screening, Mr. McCain early testing and screening.

It boils down to encouraging the well to have themselves tested to make sure they are not sick. And that approach doesn’t save money; it costs money.


Increasing the amount of testing for an ever-expanding list of problems always identifies many more people as having disease and still more as being "at risk." Screening for heart disease, problems in major blood vessels and a variety of cancers has led to millions of diagnoses of these diseases in people who would never have become sick. . . .

These interventions do prevent advanced illness in some patients, but relatively few. Any savings from preventing those cases is dwarfed by the cost of intervening early in millions of additional patients. No wonder pharmaceutical companies and medical centers see preventive medicine as a great way to turn people into patients — and paying customers.  . . .

Early screening is like the "check engine" light in your car. It can alert you to problems that need to be fixed, but too often it picks up trivial abnormalities that don’t affect performance, like one sensor’s recognizing that another sensor isn’t sensing. . . .

It’s hard to ignore a "check-engine" light. Some mechanics reset them and see if they come on again, but often they lead you to a repair. And you may have had the unfortunate experience that a repair makes matters worse.

If so, you have some feel for the problem of overdiagnosis. Almost everybody with a diagnosis undergoes treatment. And all of our treatments have some harms. From 1 to 5 percent of patients die after major surgery, and as we are all increasingly aware, prescription medicines carry real risks. Recent experiences with hormone replacement (breast cancer) and Vioxx (heart attacks) are potent reminders that our "best" new treatments may harbor unpleasant surprises.

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  • Bill Gardner

    I’d like to stress the “so-called” in “so-called preventive health care”. The term refers to a heterogeneous class of things. It’s a mistake to say that preventive health care does or doesn’t work, without specifying the specific intervention. PKU screening may be helpful, or not; tuberculosis vaccination may be helpful, or not; and PSA screening may be helpful for a particular age group of men, or not.

  • http://stuartbuck.blogspot.com Stuart Buck

    Sure, that makes sense. I see the “preventive care” issue as akin to the “prescription drugs” issue, which was so prevalent in a previous political campaign. Both sides assumed that there is this class of things called “prescription drugs” that are universally good and useful, and that the only question is how much money to give to people to buy more prescription drugs. In reality, of course, we spend billions of dollars on prescription drugs that are useless or even harmful (see, e.g., this).

  • http://drchip.wordpress.com/ retired urologist

    I recall reading, during my urology residency, an autopsy study of 80+ year-old males in which the entirety of the prostate glands were thoroughly examined microscopically. Cells classified as “cancerous” were found in almost every specimen. Prostate cancer was not the cause of death in any of the men, nor had it been diagnosed during their lives. There was an associated conclusion that in men over the age of 60, if every cell of the prostate could be examined, the incidence of cancer would be approximately the same as the age, that is, 60% in 60 year-olds, and so forth. (My apologies: I no longer subscribe to the Journal of Urology, and I cannot find the reference on the Internet). Fast-forward to 1986, when the first PSA test became commercially available. One of my first thoughts was: this test has the potential to bankrupt the Medicare system (men 65+), both through the cost of the test itself, and through all the corollary tests and treatments that will be generated. While prostate cancer is the second-leading cause of cancer death in males in the US, around 29,000 annually, there are many millions of men with the mutation. Most who die from it are metastatic when first diagnosed (there is no cure for metastatic prostate cancer); in my personal experience, it was 100%. In general, the outcomes are about the same if treatment is reserved for those with clinical manifestations. Now, 22 years later, the US Preventive Services Task Force has advised against any PSA screening for prostate cancer in 75+ year-olds, and questions the value at any age. Here’s the summary by the National Cancer Institute.

  • michael vassar

    One advantage of widespread early screening is that the medical industry can create the illusion of serious long-term progress against cancer by showing continually increasing 5-year survival rates after diagnosis even while the age adjusted death rate from most cancers stays roughly constant for 60 years, as has been the case.

  • http://www.mutualinformation.org/ luispedro

    When the NY Times declares dead an idea that had previously been held dear by the liberal elites, then the idea is normally dead within a couple of months.

  • Curt Adams

    Age-adjusted cancer rates have been anything but stable in recent years http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5729a6.htm In 79-91 they were stable for whites and increased rapidly for blacks. Since then they have declined rapidly in all groups, up to 28.4% in black males.

  • http://www.originalfaith.com/ Paul Maurice Martin

    I also have the impression that the phrase “preventive medicine” is quite consciously used by corporate health insurance industry spokespersons as a way to reassure the healthy general public, which is generally still pretty clueless about just how corrupt the health insurance corporations are, that nobody has a problem as long as they live right.

    Bad things only happen to bad people, so to speak.

    Yeah, right… I say this as someone very slowly and excruciatingly dying from a rare, long-term and incurable illness with no family history of any such thing and who never smoked, jogged in moderation all my adult life, ate healthy, never did drugs and barely drank alcohol at all.

  • ScentOfViolets

    Huh!?!?!? This sounds like complete partisan insanity. Polio vaccinations, measles vaccinations don’t save lives? Not immediately showering and using strong soap after suspected contact with poison ivy, that’s not preferable to a really nasty case of itching and supporting patches of skin that must be treated at a clinic? There plenty of conditions where an early diagnosis and treatment is much the better alternative.

    This sounds like more libertarian boilerplate.

  • Stuart Buck

    That comment doesn’t even make enough sense to be wrong; this article wasn’t about governmental regulation at all, but about the usefulness of a category of healthcare. And as I already said, preventive healthcare (like prescription drugs) is much too broad a category to be spoken of as “useful” — certain treatments are useful, but many are not. The moral is that people should discuss the issue with more precision.

  • ScentOfViolets

    Stuart, your comment makes absolutely no sense. Where is there any regulation discussed? I am, in fact, responding to your very first line: “As Robin has pointed out before, there isn’t a lot of evidence that so-called preventive health-care is worthwhile.” _That_ is what makes no sense – at best – given several obvious and easy examples.

    Do you wish to amend your statement?

  • http://profile.typekey.com/simon112/ simon

    Scent, you are defining the term “preventive health care” differently than everyone else. From the quote in the original post:

    The term “preventive medicine” no longer means what it used to: keeping people well by promoting healthy habits, like exercising, eating a balanced diet and not smoking. To their credit, both candidates ardently support that approach. But the medical model for prevention has become less about health promotion and more about early diagnosis.

    By assuming that other people are talking about vaccinations, or washing after touching poison ivy, you are arguning against a straw man.

  • ScentOfViolets

    Sigh. Let’s quote someone else you apparently had no problems agreeing with:

    I’d like to stress the “so-called” in “so-called preventive health care”. The term refers to a heterogeneous class of things. It’s a mistake to say that preventive health care does or doesn’t work, without specifying the specific intervention. PKU screening may be helpful, or not; tuberculosis vaccination may be helpful, or not; and PSA screening may be helpful for a particular age group of men, or not.

    Posted by: Bill Gardner

    Your response?

    Sure, that makes sense.

    You apparently have no problem with this statement, but you do mine? Why? I see little if any difference. If you want to talk about a specific procedure, say, screening for prostate cancer, or a general colonoscopy, fine. If you want to make a case about ‘preventative medicine’ being thought of as a certain set of procedures, fine – but then make your case, using cites, sources, quotes. Certainly what you say is the case in general is not true with respect to my families three regular physicians; in fact, it was my physician who told me I could wait another five more years for a prostate examination, given my families medical history, and that testing for cancer really wasn’t what the initial enthusiasm had built it up to be. As I said, this sort of wild over-generalization appears to be little more than your standard libertarian boilerplate.

    I am still waiting, btw, for an explanation as to how you read anything about regulation into my initial comment.

  • Stuart Buck

    Scent (or Dwight): Another commenter has already explained that you’re arguing against a straw man. The op-ed to which I linked wasn’t about vaccinations or washing your hands. The op-ed was about the term “preventive healthcare” as it is currently used, i.e., to mean an assortment of early screenings that are not actually all useful or helpful.

    I am still waiting, btw, for an explanation as to how you read anything about regulation into my initial comment.

    You claimed, and still do, that this was a “libertarian” post. What was that supposed to mean? One might as well say that your belief in vaccinations is monarchist . . . it’s just a completely inapplicable term.

  • ScentOfViolets

    Sorry, just getting my morning coffee. But in any event, then, my original comment applies: why do you object to what I wrote, when Bill Gardner said essentially the same thing and you agree with him? That makes no sense.

    And no, I did not claim this was a ‘libertarian’ post. I said it sounded like libertarian boilerplate. As an example, I’ve also heard libertarians claim that preventative health care is more expensive because when it is practiced, people live longer and so have higher lifetime medical expenditures. Shrug. As I said, unless you are much, much more specific, this really is a sense-free post. You would have to talk about – as I mentioned above, screening for prostate cancer. Or you would have to actually define precisely what is meant, and provide some hard data, rather than simply refer to an editorial. It certainly doesn’t describe how any of our family doctors use the term, for example.

  • ScentOfViolets

    Looking through this editorial, one gets a sense of how little meat there is to it. For example, when claiming a ‘new’ definition that no longer means what it used to, the link goes to this list:

    Information

    The most important part of preventive health care is maintaining good health habits. This includes:

    * Daily exercise
    * Weight control
    * Proper nutrition
    * Avoidance of smoking and drug abuse
    * Abstinence from, or moderation of, alcohol use
    * Proper control of any diseases or disorders, such as high blood pressure, diabetes, or high levels of cholesterol in the blood

    In addition to these habits, some screening services may prove worthwhile in either preventing or at least minimizing disease.

    1. Periodic screening of adults for specific problems is important and recommended:

    * Pap smear
    * Breast self-examination
    * Mammography
    * Testicular self-examination
    * PSA test
    * Cholesterol screening
    * Colon cancer screening
    * CT scan to screen smokers for lung cancer
    * Abdominal aortic ultrasound
    * Blood pressure

    2. Many diseases can be effectively treated when detected early. See your primary health care provider right away if:

    * A lump or persistent lesion appears on your body.
    * You have unexplained weight loss.
    * You have a lasting fever.
    * You develop a chronic cough.
    * You notice continued body aches and pains.

    Have a plan for obtaining professional care before the need arises.

    3. Keep immunizations up-to-date. See: Immunizations – general overview

    Note the bolded qualifiers; iow, the terminology ‘preventative medicine’ seems to mean pretty much what it always meant. And of course, google is always your friend; it confirms what I had already thought I knew about various recommendations:

    Breast Cancer Screening:

    * Modality. Mammogram. Evidence is insufficient to recommend for or against clinical breast exam and breast self examination.
    * Initiate.
    o Average risk. Recommend screening mammography for women age 40 and older. Evidence for mortality reduction is strongest for women aged 50 and older [A]. Evidence is weaker and absolute benefit of mammography is smaller for women age 40 to 49.
    o High risk. Women at increased risk of breast cancer (see Table 1 in the original guideline document) may benefit from earlier screening and discussion of risk reduction strategies [D].
    * Frequency. Little evidence is available regarding frequency of screening. Most experts recommend mammography either annually or every 1 to 2 years [D].
    * Terminate. Consider screening depending on life expectancy (even for women over 69) [D].

    Or this:

    Colon Cancer Screening:

    * Modality. Recommended methods include: fecal occult-blood testing (FOBT), flexible sigmoidoscopy (FS), or colonoscopy. (Digital rectal exam is not effective in screening for colorectal cancer.)
    * Initiate. For average risk, asymptomatic patients, screening should begin at age 50.
    * Frequency.
    o Average risk. FOBT: annually [A]. FS: every 5 years [A]. FOBT/FS: annually/every 5 years [B]. Colonoscopy: every 10 years [B]. Air or double-contrast barium enema (acceptable modality, but not recommended): every 5 years [B]. The frequency of screening has not been adequately evaluated in clinical trials.
    o High risk. Patients at increased risk of colorectal cancer should undergo more aggressive screening; details of screening vary based upon the nature of the increased risk.
    * Terminate. No definite age cutoff exists for discontinuing screening.

    Read the article; it’s quite typical. So it seems like the good doctor is mainly railing about how campaigning politicians in an election year are abusing the term. Politicians making ridiculous claims and silly promises?!?!?! Tell me it ain’t so, Joe.

  • Stuart Buck

    As an example, I’ve also heard libertarians claim that preventative health care is more expensive because when it is practiced, people live longer and so have higher lifetime medical expenditures.

    You’re getting opposites confused. You’re referring to the argument that precisely because preventive healthcare IS effective, it makes people live longer, and the healthcare system therefore spends more money over an individual’s lifespan. The op-ed to which I linked is, if anything, making the opposite point: That some forms of “prevention” aren’t effective, because they result in way too much over-diagnosis and over-treatment that itself harms people.

    why do you object to what I wrote, when Bill Gardner said essentially the same thing and you agree with him?

    Because Bill Gardner didn’t rely on straw-men (you seemed to think that someone had argued against hand-washing, and that such an argument would be “libertarian”).

  • ScentOfViolets

    Sigh. The point I was making in regards to the boilerplate, Stuart, is that it can often-times be true, but irrelevant and misleading. In the 1996 elections, there was an ad released – whose provenance could be traced back to CATO – that under Clinton, taxes had gone up something like twenty percent or thereabouts. Which seems absurd, until one reads that the justification for this was that around twenty percent more taxes had been collected at the state and local level than in the years immediately previous to the administration. Iow, yes, if someone gets a raise, their taxes do ‘go up’, but that’s really not the sense in which tax increases are being discussed; what’s really meant by tax increases are tax rates, and it is not really appropriate to slip in another definition.

    The same with both of these examples. Yes, the price of health care goes up when you live longer. So does the price of food. Or the amount of taxes one pays. Yes, needless procedures increase the overall cost of medical care without increasing the overall benefits. Almost by definition.

    As I said, boilerplate, and not really worthy of discussion, except to point out the nature of the claims.

    I will also point out that your claim about throwing up a strawman is factually false. Go to the actual essay and click on the link ‘preventative medicine’ that appears in this paragraph:

    The myth is that like magic, preventive medicine will simultaneously reduce costs and improve health.

    Note again that far from supporting the authors claims, the link mentions the importance of a good diet, exercise, keeping current on immunizations, etc. So no, none of my examples were strawmen.

    Now, did you have any specific procedures you wished to discuss? Or did you want to defend the author’s claims about what’s considered preventive medicine by someone besides politicians on the stump?

    Because if not, I think we’re done here.

  • Stuart Buck

    As I said, boilerplate, and not really worthy of discussion, except to point out the nature of the claims.

    Exactly. So why are you bringing it up? No one else did.

    Note again that far from supporting the authors claims, the link mentions the importance of a good diet, exercise, keeping current on immunizations, etc.

    Now this is just unbelievably confused. For one thing, the “link” precisely is to the “author’s” article. It makes no sense for you to claim that one doesn’t support the other . . . they are one and the same. In any event, the author of the NY Times op-ed specifically mentioned the importance of a good diet, exercise, etc. And then he clarified that by the term “preventive” healthcare, he was referring specifically to “early diagnosis.” This is precisely why it’s a strawman for you to suggest that anyone was talking about hand-washing rather than “early diagnosis.”

  • Stuart Buck

    Oh wait, I see what you meant by saying the “link,” i.e., the “link” that was in the NY Times article itself (which seemed to be one of those automatic links that the NY Times inserts to define certain terms). No matter though: The NY Times op-ed, as you can read for yourself, expressly went on to agree that “preventive” efforts like diet, exercise, and “healthy habits,” are good things. So yes, it was a strawman on your part to suggest that the op-ed intimated any opposition to “healthy habits” like immunizations or hand-washing.

  • ScentOfViolets

    Stuart, click on the link to the author’s article. Inside it are more links. One link is called ‘preventative medicine’, it’s up near the top, in the paragraph I’ve put cited in my last post (needless to say, I’ve already indicated this.) Click on the ‘preventative medicine’ link to open it up. Look at what is included.

    You _really_ didn’t understand this?

    Now, look at the next paragraph:

    The term “preventive medicine” no longer means what it used to: keeping people well by promoting healthy habits, like exercising, eating a balanced diet and not smoking. To their credit, both candidates ardently support that approach. But the medical model for prevention has become less about health promotion and more about early diagnosis. Both candidates appear to have bought into it: Mr. Obama encourages annual checkups and screening, Mr. McCain early testing and screening.

    Look at what I have bolded, and look at what is on the list. So, for example, immunizations aren’t part of what “preventive medicine” ‘used to mean’, I guess. And that’s part of my larger point: the author is very fuzzy with his terms, and to the extent that he says what you claim he says, he doesn’t support his argument. His own list, for example, uses the very important qualifiers ‘some’ and ‘may’ when talking about early diagnostic procedures. He also does not cite any studies, recommendations, statistics, etc, but merely asserts his claim that this is so (assuming he means what you think he means.)

    And as I have already indicated, both by an easy cite, and by personal experience, there doesn’t seem to be much evidence to support the claim as you would have it worded.

  • Stuart Buck

    And as I have already indicated, both by an easy cite, and by personal experience, there doesn’t seem to be much evidence to support the claim as you would have it worded.

    The author is claiming that when “preventive medicine” is used to mean diet, exercise, etc., it’s good. But when “preventive medicine” is used to mean “early diagnosis,” it’s not always helpful. He then lists at least eight different diseases or conditions where “early diagnosis” has “led to millions of diagnoses of these diseases in people who would never have become sick,” and has instead potentially caused them to have unnecessary surgeries (dangerous) or to take unnecessary medication (which can also turn out to be dangerous).

    Now, do you have anything to say about that thesis, or not? It’s irelevant to claim that vaccinations are being questioned; the author begins the whole piece by saying that he’s not talking about traditional prevention. It’s also irrelevant to point out that your personal doctor didn’t recommend early diagnosis; the claim isn’t that 100% of doctors use too much early diagnosis, but that enough do to affect millions of people.

    If your only point is that you’d like to see more statistics and studies — more than were capable of being written up in an op-ed — then you might want to check out Dr. Welch’s Univ. of California Press book on cancer screening (linked in the first sentence of my post), or perhaps one of his many scholarly articles (see, e.g., this or this).

  • http://stuartbuck.blogspot.com Stuart Buck

    For more studies, an earlier NY Times piece by Welch — this one was a good bit longer — discussed several studies.

  • ScentOfViolets

    The author is claiming that when “preventive medicine” is used to mean diet, exercise, etc., it’s good. But when “preventive medicine” is used to mean “early diagnosis,” it’s not always helpful. He then lists at least eight different diseases or conditions where “early diagnosis” has “led to millions of diagnoses of these diseases in people who would never have become sick,” and has instead potentially caused them to have unnecessary surgeries (dangerous) or to take unnecessary medication (which can also turn out to be dangerous).

    Now, do you have anything to say about that thesis, or not? It’s irelevant to claim that vaccinations are being questioned; the author begins the whole piece by saying that he’s not talking about traditional prevention.

    Sigh. Stuart, this is going to have to be the last time I respond to you unless you can acknowledge the implications of the linked list. Are you finally going with the interpretation that the list is meant to be an example of ‘traditional’ preventive medicine? As I said many posts up above, this list already acknowledges that some diagnostic procedures may be helpful. So his point is already subsumed in the list of traditional preventive medicine. That is, if that’s his point, he’s said nothing new, nor terribly profound. Indeed, all he seems to be saying then is that this is what the Presidential candidates are agitating for in their stump speeches. Again, politicians making unlikely promises? That’s new, or needs to be commented upon?

    So the options are that he has said something incredibly trite and already well known, or that he is not being specific enough to make a point, nor showing that his point actually pertains to anything real.

    As I said, if you cannot follow this, or if you cannot acknowledge what that list means, I think we’re through here. I’ll watch for what you have to say, but don’t expect a response in return.

  • http://stuartbuck.blogspot.com Stuart Buck

    All of your verbiage notwithstanding, you haven’t laid a finger on Welch’s claim — supported by ample scholarly work that Welch has both written and described in more detail elsewhere — that many “early diagnosis” procedures are overused. Perhaps you think this point is “incredibly trite,” but people who are falsely diagnosed with cancer (to use one of Welch’s examples) and are thereby subjected to unnecessary treatment or surgery might differ.

  • ScentOfViolets

    Well, Stuart, I’m gone. Is this how you normally comport yourself? That’s an honest question. You seem to be rather combative on what seem to me to be a rather obvious point.

  • http://hanson.gmu.edu Robin Hanson

    Scent, please don’t use boldface if you can’t remember to close it before comment end.

  • ScentOfViolets

    Gee, Robin, do you always wear your resentment on your sleeve like that? A much better way to phrase what you wrote, one which would not be indicative of such a thin skin, would be something like: “If you use html tags, please be sure to preview your posts so that you can spot any you have not closed.”

    See? Wasn’t that much more nicely phrased?

    Oh, and by the way, it’s ScentOfViolets (the physics problem), or if you must abbreviate, SOV.

  • http://stuartbuck.blogspot.com Stuart Buck

    Scent: My previous point still stands.

  • ScentOfViolets

    Stuart, until you address the points I have made – repeatedly made, I might add – there really is nothing more that I can contribute.

  • http://stuartbuck.blogspot.com Stuart Buck

    Well, that was clear from your first comment. If you think of a genuine objection to something Welch actually said, do let it be known.

  • ScentOfViolets

    Shrug. You don’t get to decide what is genuine. And not addressing the points because they are ‘not genuine’, rather than explaining what, precisely, invalidates them indicates that they are actually quite salient.

    So, as I said, and you attempted to evade – again – the ball is in your court. It is most certainly not in mine. Not until you actually attempt some sort of argument.

  • http://stuartbuck.blogspot.com Stuart Buck

    About what?

  • http://profile.typekey.com/simon112/ simon

    Arguments over definitions tend to be extremely annoying, especially when one side seems not to acknowledge the nature of the dispute and accuses the other of arguing in bad faith.

    SOV, it has been made clear that for the purposes of this comment thread when we talk about “preventive health care” we are referring mainly to early screening, not to everything that might be called “preventive health care”.

    Now, you may think that this use of terminology unfairly maligns useful things also generally categorized as “preventive health care”. A fair enough point perhaps, although you could have pointed this out in one sentence without the ridiculous drama. But while logically speaking “preventive health care” does include such things as vaccinations, in a political context it makes sense to restrict terminology to the actual policy differences that it represents as a slogan. It is not like any plausible hypothetical anti-”preventive health care” politician would actually be opposing vaccination.

  • ScentOfViolets

    Simon, bite me. Read the list. What does the list say. Hint: it says, among other things that some diagnostic procedures may be helpful. It most certainly does not say that more is better. Now, what is the para-paraphrased comment saying? That some diagnostic procedures may be helpful. Now, just what is the difference between the two? Here’s some more help, from Stuart:

    The author is claiming that when “preventive medicine” is used to mean diet, exercise, etc., it’s good. But when “preventive medicine” is used to mean “early diagnosis,” it’s not always helpful.

    Gee, you mean like the link to preventive medicine implied?

    So, just what, precisely, is your problem? Or Stuart’s?

    I suspect – and suspect strongly, now that I recall who Stuart is – that what’s really got your knickers in a twist is the phrase ‘libertarian boilerplate’. Which this article is.

    So stop with the sloganeering, Simon. And actually respond to the point. Rather than accuse others of ‘drama’, or mutate the talking points yet again.

  • http://profile.typekey.com/simon112/ simon

    I’m having a hard time wrapping my mind around what your problem is. You seem to be saying that the article is not saying anything particularly controversial … in which case what is your problem? As far as I can tell, you are complaining that it is unfair to characterize all of “preventive medicine” broadly defined as bad.

    But, that’s not what was actually meant by the post. The article, as quoted, pointed out that the actual policies that the term “preventive medicine” stood for in practice were early screening. Most other commenters followed this restricted definition, but you argued as if everyone was using the broad definition.

    Now what makes it hard for me to conclude that I have correctly characterized what your problem is that it would seem that the reasonable thing to do when pointed out that you are defining your terms differently than other people in the thread is to simply acknowledge the difference, and, if you still have a point of disagreement, make clear arguments based on terms that all parties can agree on. You have not done so.

    So, if I have incorrectly characterized your views, please try to clarify them.

    P.S. I’m not sloganeering, the politicians are – when a politician makes a slogan calling for “preventive medicine”, one should judge this on the merits of the actual policy differences that the slogan represents. If electing the politician will lead to policy changes A, B, and C, one should judge the merits of those policies, not the merits of uncontroversial policies that the politician attempts to connect to policies A, B and C using a broad term like “preventive medicine”.

  • ScentOfViolets

    Sigh. No Simon. I’m saying that this is false:

    The term “preventive medicine” no longer means what it used to: keeping people well by promoting healthy habits, like exercising, eating a balanced diet and not smoking.

    “preventive medicine” – by your own admission, mind you – already says exactly what he is claiming(In fact, as I said earlier, it’s either vacuously true or waaaay off base, depending upon your interpretation of the list.) Nothing has changed, and this is not some woo-woo weird new risk that few people know about. At best, as you yourself said earlier, it’s pointing out that a few politicians are talking about things that they have no particular expertise in, in which case, well, what else is new?

    So, _now_ what is your problem with what I said? Is this a case of you don’t know what, but you’re sure I’m wrong about something? Or will you finally admit that maybe I might have a point?

    Really, this is no different than if Dr. Welch had written about the ‘new’ threat of over-prescribing antibiotics and the dangers of antibiotic resistance in disease organisms. Are you saying I’d be wrong to point out that this just ain’t so?

  • http://zbooks.blogspot.com Zubon

    After how many posts of “I am not going to respond” is it only proper to enforce that claim?

  • ScentOfViolets

    This is where I get to accuse you of poor reading comprehension, right? Here’s what I originally said:

    As I said, if you cannot follow this, or if you cannot acknowledge what that list means, I think we’re through here. I’ll watch for what you have to say, but don’t expect a response in return.

    Posted by: ScentOfViolets

    Iow, I was talking to Stuart(I don’t know if it’s the same person, but he sounds an awful lot like another guy who argued that if a theory said A->B, and B was observed, then A was confirmed. He also believed that ‘statistical significance’ was equivalent to ‘significance’) who seems to have a problem with, ironically enough, overcoming bias.

    Not to anyone else, though Simon is actually, unlike Stuart, actually responding to the article’s definition of “preventive medicine”.

    I’m guessing this is also the part where you refuse to admit that your comment was out of line, but refuse to give any pertinent reasons why it was not.

  • http://stuartbuck.blogspot.com Stuart Buck

    Dwight Thieme:

    1. The fact that you are still claiming that the NY Times article is “libertarian” is enough to discredit you entirely. As has already been explained to you, the article has nothing whatsoever to do with anyone’s theory of government. Indeed, even the hoariest communist might like to know whether, due to unduly sensitive early screening methods, he is being advised to undergo needless and possibly dangerous treatments. That is what the article is about: the fact that millions of people are improperly diagnosed with diseases and conditions that pose no real threat to them, due to early screening methods that are too sensitive.

    Again, you have never even laid a finger on this central claim, except to say that it isn’t new (no one ever claimed that it is a “new” point, and I even linked to earlier essays in which Welch made the same point).

    2. It still isn’t clear what significance you purport to find in the Times’ generic webpage about “preventive” healthcare. (You do realize that the Times has a habit of inserting lots of links into its articles, which is why there are about a dozen links in Welch’s op-ed that merely lead to other generic Times webpages about, say, “John McCain.”)

    3. As for this: he sounds an awful lot like another guy who argued that [1] if a theory said A->B, and B was observed, then A was confirmed. [2] He also believed that ‘statistical significance’ was equivalent to ‘significance’

    [2] is a flatout lie. [1] also shows that you never even understood the terms of the conversation. In our earlier encounter, I said that “acting white” exists, which equates to the fact that smart black children tend to be less popular. I pointed to a Harvard study confirming empirically that smart black children do tend to be less popular. This confirms that smart black children tend to be less popular. In other words, an empirical finding of A confirms the existence of A. There was no “B,” and hence no improper logical inference from B back to A. It’s surprising that you would bring up a past instance of your inability to comprehend such an elementary point.

    4. Robin — I would recommend banning ScentofViolets, or Dwight Thieme, or whatever nom de plume he chooses. He is a classic troll.

  • Adam Greenwood

    Why waste time arguing with a guy who starts every comment with a sigh or a shrug. Classic troll.

  • random site surfer

    Wow! You guys should all be embarrassed! That was just like reading an ‘intellectual’ Coronation Street screenplay! What fun, childish drama! An incredibly thrilling read.

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