Farewell. The Flying Pig Has Left The Building.

Steve Hynd, August 16, 2012

After four years on the Typepad site, eight years total blogging, Newshoggers is closing it's doors today. We've been coasting the last year or so, with many of us moving on to bigger projects (Hey, Eric!) or simply running out of blogging enthusiasm, and it's time to give the old flying pig a rest.

We've done okay over those eight years, although never being quite PC enough to gain wider acceptance from the partisan "party right or wrong" crowds. We like to think we moved political conversations a little, on the ever-present wish to rush to war with Iran, on the need for a real Left that isn't licking corporatist Dem boots every cycle, on America's foreign misadventures in Afghanistan and Iraq. We like to think we made a small difference while writing under that flying pig banner. We did pretty good for a bunch with no ties to big-party apparatuses or think tanks.

Those eight years of blogging will still exist. Because we're ending this typepad account, we've been archiving the typepad blog here. And the original blogger archive is still here. There will still be new content from the old 'hoggers crew too. Ron writes for The Moderate Voice, I post at The Agonist and Eric Martin's lucid foreign policy thoughts can be read at Democracy Arsenal.

I'd like to thank all our regular commenters, readers and the other bloggers who regularly linked to our posts over the years to agree or disagree. You all made writing for 'hoggers an amazingly fun and stimulating experience.

Thank you very much.

Note: This is an archive copy of Newshoggers. Most of the pictures are gone but the words are all here. There may be some occasional new content, John may do some posts and Ron will cross post some of his contributions to The Moderate Voice so check back.


Friday, February 10, 2012

HCR -- Diagnostic vs Screening, Know the Difference

By John Ballard

As new guidelines and recommendations continue to be issued by a variety of experts everyone has more personal responsibility to stay up to date and well-informed. The current Komen vs Planned Parenthood brouhaha underscores the point. While most observers follow the narrative of the conflict and get pulled into the politics or public relations angles, it is easy to overlook a pox on both their houses.

Maggie Mahar tweets 

Planned Parenthood, like Komen, misleads young
women about breast cancer screening: hides
risks,hypes benefits  http://bit.ly/wblorq

The short (PDF, 9 pages) Cancer Letter to which she links has important information about the importance of screening, but balances the risks with the benefits. 

�All screening programmes do harm; some do good as well.� �Sir Muir Gray, chief knowledge officer of the UK National Health Service.


There are many disquieting aspects of the recent brouhaha regarding Komen for the Cure deciding to stop funding Planned Parenthood. First and foremost is the infusion of politics into issues of health policy. But there are others.

A story on the Planned Parenthood website is related by a 27-year old woman who �had no family history� of cancer and who discovered a lump in her breast. She �remembered Planned Parenthood.�

Clearly, having access to mammographic and eventually surgical and pathological assessment of her lump was a good thing. But in view of her symptoms the mammogram she got at Planned Parenthood was diagnostic and not screening. Every woman should have access to diagnostic mammograms, but whether Planned Parenthood is the appropriate place to offer them is less clear.

Regarding screening mammography, women in their twenties and thirties have never been shown to benefit. Indeed, the incidence of breast cancer is so low in this group�with or without screening�that millions and perhaps tens of millions of women would have to be randomized and followed up for extended periods to have any hope of showing a reduction in mortality�if there is one.

A 2009 USPSTF publication indicated that the �number needed to invite for screening to extend one woman�s life [is] 1,904 for women aged 40 to 49 years and 1,339 for women aged 50 to 59 years.�

Of course there is no abrupt change at age 50 and so these numbers are not constant over their respective intervals. The figure above interpolates within these intervals and extrapolates outside the intervals based on breast cancer incidence in the U.S.

?The takeaway to remember is the difference between diagnostic versus screening tests. This is not only true of x-rays but a raft of popular (uh, did I mention expensive?) tests in the modern medical toolbox. 

Aside from the expense, the less measurable effects of false positives, unneeded invasive procedures and the increased risk of plain old mistakes is part of the fallout. Previous posts here about PSA tests, MRI and CT Scans, colonoscopies and the whole crazy idea that more is better have become a recurrent theme for me. But every time I write another post I remember people I have known whose addiction to pill-pushing doctors and TV induced designer drugs have resulted in more harm and anxiety than benefits. Just a few days ago I posted something to Facebook about the overuse of statins and received a comment from a friend who had passed it to her Dad, saying she had told him for years that she thought he was over-medicating himself. He had all the side effects of long-term use, and of course his cholesterol numbers were good, but there is some question as to whether or not he would have received a bad diagnosis without it. 

They say being fat is bad but I can assure the reader as someone who has seen a lot of old people that there are still a lot of fat old people. Smoking is known to be bad for you and I quit smoking decades ago because I didn't like the odds. But odds is exactly what is at stake, not certainty. My family came from Kentucky where tobacco was an important cash crop and they both smoked unfiltered Lucky Strikes for forty years. Neither developed COPD or asthma, my father died in his seventies of a stroke and my mother lived past ninety. Yes, it was a lung tumor. It took seven decades to appear. Both of them played the odds and dodged the bullet. 

One more story. As a medical corpsman in Korea in the Sixties I saw civilians seeking access to GI medicine, especially pain killers and antibiotics. We were amused when they took them in advance, by the handful, to prevent pain and infection, but in many ways Americans have fallen into the same ignorant habits.

I'm not advocating ignoring screening tests. I am saying use good judgement. A screening test is diagnostic if there are signs or symptoms. And the "signs" may be nothing more than a family history. But absent any good reasons, routine screening can cost more than it's worth. 


  1. Your Korea anecdote struck a chord with my experiences over 15 years here in Japan. Doctors are abyssmal (UK Spl.) here. Nothing more than candy dispensers. Cold? Antibiotics. Skin infection? Antibiotics. Not sure? Antibiotics. Going to China? Hmm... antibiotics. Except one doctor. He recommended (after a visual inspection from 3 feet away) an operation! for the skin infection on my shins. I nearly hit him. But then I wouldn't have gotten any of those sweet, sweet antibiotics..

  2. Come to think of it, I took the family along on a business trip to Acapulco years ago and we were concerned about Montezuma's revenge from eating in Mexico. my wife was working in a dental practice at the time and the dentist said "Don't worry. I'll write a prescription for erythromycin, enough for everybody. Take one every morning, starting one day before you leave, and continue daily until the day after you return. No problems."
    He was correct. I know because the food looked and tasted so good (we were in a five-star place and nobody looked sick) that I left off taking my pill the day before we left for home. Sure enough, the day back when I reported to work I got an embarrassing case of the squirts. Thank goodness we had a few pills left.
    As I said above we Americans really do have those bad habits and they are hard to break. When I checked the spelling of erythromycin just now the first item on the list was an advertisement that Walmart sells a 30-day supply for $4.00.

  3. John-- Thanks for highlighting the Tweet and the Cancer Letter piece. As you say, if you don't have symptoms you don't need screening (unless you are at very high risk).
    I would add that if you don't have symptoms, you probably don't need to see a doctor. There are exceptions: annual dental checks (don't wait until you have a toothache), vision checks. . .