It is not true that new and better treatments have changed the benefits of mammography screening. Screen-detected cancers and nonscreen-detected cancers have benefited equally of improved treatments (fig 4). https://www.bmj.com/content/381/bmj-2022-074684.long
Therefore, there is no new mammography trial to be performed.
The only question is why is there no reduction in breast cancer mortality after 12 years of mammography screening? This is perfectly explained by the occurrence of cancers caused by X-rays beginning 6 years after exposure. This has been confirmed by the fact that most excess breast cancers are delayed (Corcos D, bioRxiv, 2017 https://www.biorxiv.org/content/10.1101/238527v1.full; Corcos D & Bleyer A, NEJM, 2020).
Can't thank you enough, Daniel, for your research. I have known this truth for decades but to communicate with others, evidence is needed and this is a perfect study that you've published. Yes, censorship of such truths has been the norm as long as I've paid attention which has been decades. But that's all changing now. I look forward to your research being shared far and wide.
Excellent research and article that confirms my impression that breast cancer recurrence rates are decreasing, as was my general impression, anyway. It is particularly compelling, as I am a breast cancer survivor having been diagnosed and treated in 2014. Thank you, Dr. Corcos!
Thank you for being brave enough to speak out against the things that are so bad in medicine. I am a retired surgeon that quit early mostly out of frustration with system based on a profit margin rather than the truth.
Regarding med school fails—Certainly there is a lot that could or should be changed about medical education and the student’s experience. I have a hard time imagining the kind of person or persons who might do this, though, even given that they had a plan.
I graduated from medical school in 1978, and during my clinical rotations, I was very much a part of the team. Since my medical school used the university hospital and the VAH as its teaching hospitals, there simply weren’t the ancillary personnel available to do even some of the scut work, whether that was transport or specimen collection. So if the med students and the intern didn’t get those necessary things done, they wouldn’t have gotten done.
I remember getting the page on call days that we had a new admission in the ER. I’d find a gurney, trundle it to the ER, load the pt. on and draw the relevant labs. I’d also get him to pee in a cup. Then I’d get in the elevator and take him first to the lab to drop off the specimens and then on to X-ray to get a chest X-ray done. I’d place the film on the pts.’ stomach, get back on the elevator, and take him to his assigned bed on the ward. Then I’d help him off the gurney (sometimes with the assistance of other patients) and into his bed. I’d draw the curtain around the bed and would proceed to do a physical exam complete with a rectal exam thereby obtaining a specimen of stool that would be tested for the presence of blood.
I’d compile all my findings into a “medical student admission history and physical” note on the chart, then distill my findings down onto an index card that I would use on morning rounds to present the case to the team.
I felt integrated into the process because I was. Possibly it increased my empathy, to a point, given that I was so personally involved with the pt., but then again, I have always been an empathic person. However, too much of that close, responsible contact probably decreases empathy, in general, as the pt. begins to feel like just another burden in an already lengthy day filled with similar burdens.
I was surprised in listening to this, perhaps naively, about the problem of student fake sick call ins. I’m not sure that it would’ve even occurred to me to call in fake sick when I was a student (and thereafter), probably because I felt so integrated into the team. I would have (and did) arrive on time, day after day, despite coughs, sneezes and sniffles. I probably was febrile, too, on occasion. But then again, what are Tylenol and Sudafed for? Sure, I could have been an excessively duty-bound control freak, but if other students in my class were calling in “fake-sick” with any regularity, I was unaware of it.
By and large, I had a pretty horrible experience in med school, less from the work load, but more from very real financial woes as well as intermittent episodes of sexual harassment that I was treated to on the part of certain faculty members, resident/interns, and fellow medical students. It also didn’t help that my parents decided not to loan me any more money beginning in the second year of med school. I was not eligible for any student loans because that eligibility was based on parental income.
Relatively speaking, my parents made a lot of money, which they declined to share with me, at least until after 9 long months of near destitution, when an intervention by the dean of the school of medicine brought them to their senses. They then loaned me $12,000, interest deferred until completion of residency, and payable on demand at that time, if other prior terms had not been arranged. And sure enough, on the day after the completion of my residency, there arrived a letter from their attorney demanding payment in full. I scraped together the money from a faculty loan fund and a loan from my fiancé. After dispatching the money, I cut all ties that hadn’t been previously cut, and did not speak to them again. I did attend their funerals, however, possibly to assure myself that they were really dead and buried. Clearly, this was not an ideal parent child relationship, and with help, I have not repeated it in the raising of my own children, to everyone’s relief.
In the event of reincarnation, I wouldn’t go near the field of medicine again. I did not encourage my children to pursue it, either, having found that there are other many eminently satisfying vocations to pursue. Many of these yield incomes equal to or greater than any income earned in the practice of medicine but without the aggravation.
I have found practice, fortunately, to be gratifying and interesting. A career in medicine is like having a ringside seat on life—a prospect that doesn’t thrill many—but which I sought with enthusiasm. I have always wanted to know “why?”
Still, life not being perfect, I was sexually harassed again 20 years into practice, by associated colleagues, which led to my early retirement as well as a lengthy depression.
I’m ok now and have shed most of the bitterness and anger I carried. I now think that the system of medical training, as I knew it, spawns some terrible abuses that are visited on most, if not all, students. What’s more these abuses are viewed as time honored traditions or necessary rites of passage. As such, dismantling or removing them will be a hard task.
How do you get students to care deeply about the process of their education and their future roles as doctors? Hopefully, most people applying to medical school would be those sorts of people to begin with. However, I have suggested many times in other forums that testing each applicant with a comprehensive “personality inventory” (such as the Minnesota Multiphasic Personality Inventory) would reveal not only acute psychiatric issues but also, and more importantly, reveal the underlying substratum of personality which would indicate whether the applicant had those traits which are more conducive to a life in medicine as opposed to those that are not. It would also highlight distressing degrees of sociopathy and narcissism so that these applicants might be excluded from the pool.
I have worked with physicians who had extreme narcissistic personality disorders as well as a few sociopathic ones. I would not count those experiences as among the most gratifying of my life. Probably no one would. Pts. also suffered, so these individuals should be left to pursue other pastimes.
A useful exercise would be to construct profiles that capture “the ideal physician.” This process would delineate those personality and educational attributes that go into making that sort of physician. Such parameters would be extremely useful to an admissions committee. Without these parameters, committees are forced to rely on their gut senses, which may be somewhat accurate, but not precise. The question to committee members might be, “Yes, while it may be all well and good that you have a ‘gut sense’ that this applicant will be a stellar doctor, perhaps knowing more about the specifics which enabled you to arrive at that conclusion would be edifying to other committee members.”
I put this under a different topic, but since Dr Mandrolla asked:
Just so everyone not in primary care is aware, these are the “quality metrics” for my company at present (which follow many HEIDIS and medicare metrics): —
Tobacco screening (with counseling if pos)
- BMI screening ( with counseling if > 30)
- anxiety screen
- depression screen (PHQ2, 9 if needed)
- HgA1C control < 8 for diabetics
- eye exam note in our chart for diabetics (not just the patient saying they had it)
- nephropathy screening, diabetics
- foot exam documented, diabetics
- hypertension control- <140/90 in diabetics and anyone with HTN diagnosis
-colon cancer screening (actual test in chart, not patient say so) starting age 45
- breast cancer screening (currently age 50-65, we’ll see if that changes)
- cervical cancer screening
- and an individual NPS score > 85 minimum and > 92 to get full credit
- notes closed/ locked within 72 hrs
————-
They hold back part of our pay unless meet certain % of these OR pay less and give “bonus” if meet them.
Another thing is insurance companies and various health websites give ratings on how well you do on these and can make you a nonpreferred provider/ make you look like a “bad” doctor if you do not meet them.
And another is if you work for a big system, it is a reason to be “let go”.
Many incentives to do many things that may or may not actually help individual patients.
(Reposted here so maybe more people see, not sure how much the non- primary care/ non medical folks are aware of this behind the scenes stuff)
Yes, and this also falls under things that have changed as most physicians are now employed. I don’t think some of the older private practice people understand that for most doctors and most patients, medicine looks like this now, when that was not true at the turn of the century.
I'm glad you like it. I have done a lot of reading in the 70+ years since I learned how. Lots of fiction and non-fiction and never read or heard the term. It was especially surprising that I never encountered the term in extensive reading on economics where it would seem to apply most directly. The purpose of language is to facilitate communication and understanding. When addressing an audience that is somewhat diverse it is best to use clear and easily understandable language.
I would file it under jargon. I’ve heard it used extensively in medical ethics, but there are a lot of unusual Greek and Latin words you find in the medical vocabulary but nowhere else.
In general, I think Sensible Medicine is intelligible to a lay audience, but sometimes they don’t even realize that what they’re saying is not part of a normal person’s vocabulary.
I love words! They are little packets of emotion and/or centuries of human endeavor! English is such a malleable language which is a blessing and a curse. Some years ago, I took some French classes. In comparison, French is rigid and word bound.
Perhaps American English, anyway, reflects the lives of Americans—inventive, creative—not willing to accept the status quo.
I'm confused. Is it just the US Preventive Services Task Force that only now recommended mammograms starting at age 40? Because I remember having to delay my recommended initial mammography screening at age 40 because I had just given birth and was breastfeeding. I think I started at age 41. I'm now 72. I think the American Cancer Society and other professional groups have always recommended screening women in their 40s, haven't they?
Exactly. I was wondering what advice I should be giving to my 34 yo daughter regarding when she should get a mammogram. Obviously, she has her own physician who will advise her, but mothers have been known to weigh in.
It is not true that new and better treatments have changed the benefits of mammography screening. Screen-detected cancers and nonscreen-detected cancers have benefited equally of improved treatments (fig 4). https://www.bmj.com/content/381/bmj-2022-074684.long
Therefore, there is no new mammography trial to be performed.
The only question is why is there no reduction in breast cancer mortality after 12 years of mammography screening? This is perfectly explained by the occurrence of cancers caused by X-rays beginning 6 years after exposure. This has been confirmed by the fact that most excess breast cancers are delayed (Corcos D, bioRxiv, 2017 https://www.biorxiv.org/content/10.1101/238527v1.full; Corcos D & Bleyer A, NEJM, 2020).
Why this information is censored still amazes me.
https://danielcorcos.substack.com/p/radiation-the-other-conspiracy-of
Can't thank you enough, Daniel, for your research. I have known this truth for decades but to communicate with others, evidence is needed and this is a perfect study that you've published. Yes, censorship of such truths has been the norm as long as I've paid attention which has been decades. But that's all changing now. I look forward to your research being shared far and wide.
Thank you very much. What you are saying touches my heart deeply.
Oh, how glad I am that I can reflect back to you what you already know but that this upside-down world has made so difficult: the truth sets us free from the relentless propaganda that we see going unquestioned around us. But the longer we stand firm in truth, the more that will awaken, and the oppressive corruption must fall. Thank you for your vital puzzle piece in this big process! I am putting it together with PCR farce and looking for more pieces to refute the highly effective "early detection" and testing racket. I've done some decent summaries to make it easier to grab evidence on science/research fraud, medical corruption, etc, but more I'd like to get into organized summaries. Examples (free): https://birdseyeview.xyz/essays-summary/where-have-you-given-your-power-away-why-does-it-matter-how-can-you-reclaim-it/the-need-to-reclaim-our-power-how-researchers-in-the-name-of-science-betray-humanity/ and https://birdseyeview.xyz/essays-summary/where-have-you-given-your-power-away-why-does-it-matter-how-can-you-reclaim-it/the-need-to-reclaim-our-power-how-modern-medicine-has-betrayed-humanity/
Excellent research and article that confirms my impression that breast cancer recurrence rates are decreasing, as was my general impression, anyway. It is particularly compelling, as I am a breast cancer survivor having been diagnosed and treated in 2014. Thank you, Dr. Corcos!
Thank you for being brave enough to speak out against the things that are so bad in medicine. I am a retired surgeon that quit early mostly out of frustration with system based on a profit margin rather than the truth.
Such thoughtful and insightful conversations. I really love your discussions.
Regarding med school fails—Certainly there is a lot that could or should be changed about medical education and the student’s experience. I have a hard time imagining the kind of person or persons who might do this, though, even given that they had a plan.
I graduated from medical school in 1978, and during my clinical rotations, I was very much a part of the team. Since my medical school used the university hospital and the VAH as its teaching hospitals, there simply weren’t the ancillary personnel available to do even some of the scut work, whether that was transport or specimen collection. So if the med students and the intern didn’t get those necessary things done, they wouldn’t have gotten done.
I remember getting the page on call days that we had a new admission in the ER. I’d find a gurney, trundle it to the ER, load the pt. on and draw the relevant labs. I’d also get him to pee in a cup. Then I’d get in the elevator and take him first to the lab to drop off the specimens and then on to X-ray to get a chest X-ray done. I’d place the film on the pts.’ stomach, get back on the elevator, and take him to his assigned bed on the ward. Then I’d help him off the gurney (sometimes with the assistance of other patients) and into his bed. I’d draw the curtain around the bed and would proceed to do a physical exam complete with a rectal exam thereby obtaining a specimen of stool that would be tested for the presence of blood.
I’d compile all my findings into a “medical student admission history and physical” note on the chart, then distill my findings down onto an index card that I would use on morning rounds to present the case to the team.
I felt integrated into the process because I was. Possibly it increased my empathy, to a point, given that I was so personally involved with the pt., but then again, I have always been an empathic person. However, too much of that close, responsible contact probably decreases empathy, in general, as the pt. begins to feel like just another burden in an already lengthy day filled with similar burdens.
I was surprised in listening to this, perhaps naively, about the problem of student fake sick call ins. I’m not sure that it would’ve even occurred to me to call in fake sick when I was a student (and thereafter), probably because I felt so integrated into the team. I would have (and did) arrive on time, day after day, despite coughs, sneezes and sniffles. I probably was febrile, too, on occasion. But then again, what are Tylenol and Sudafed for? Sure, I could have been an excessively duty-bound control freak, but if other students in my class were calling in “fake-sick” with any regularity, I was unaware of it.
By and large, I had a pretty horrible experience in med school, less from the work load, but more from very real financial woes as well as intermittent episodes of sexual harassment that I was treated to on the part of certain faculty members, resident/interns, and fellow medical students. It also didn’t help that my parents decided not to loan me any more money beginning in the second year of med school. I was not eligible for any student loans because that eligibility was based on parental income.
Relatively speaking, my parents made a lot of money, which they declined to share with me, at least until after 9 long months of near destitution, when an intervention by the dean of the school of medicine brought them to their senses. They then loaned me $12,000, interest deferred until completion of residency, and payable on demand at that time, if other prior terms had not been arranged. And sure enough, on the day after the completion of my residency, there arrived a letter from their attorney demanding payment in full. I scraped together the money from a faculty loan fund and a loan from my fiancé. After dispatching the money, I cut all ties that hadn’t been previously cut, and did not speak to them again. I did attend their funerals, however, possibly to assure myself that they were really dead and buried. Clearly, this was not an ideal parent child relationship, and with help, I have not repeated it in the raising of my own children, to everyone’s relief.
In the event of reincarnation, I wouldn’t go near the field of medicine again. I did not encourage my children to pursue it, either, having found that there are other many eminently satisfying vocations to pursue. Many of these yield incomes equal to or greater than any income earned in the practice of medicine but without the aggravation.
I have found practice, fortunately, to be gratifying and interesting. A career in medicine is like having a ringside seat on life—a prospect that doesn’t thrill many—but which I sought with enthusiasm. I have always wanted to know “why?”
Still, life not being perfect, I was sexually harassed again 20 years into practice, by associated colleagues, which led to my early retirement as well as a lengthy depression.
I’m ok now and have shed most of the bitterness and anger I carried. I now think that the system of medical training, as I knew it, spawns some terrible abuses that are visited on most, if not all, students. What’s more these abuses are viewed as time honored traditions or necessary rites of passage. As such, dismantling or removing them will be a hard task.
How do you get students to care deeply about the process of their education and their future roles as doctors? Hopefully, most people applying to medical school would be those sorts of people to begin with. However, I have suggested many times in other forums that testing each applicant with a comprehensive “personality inventory” (such as the Minnesota Multiphasic Personality Inventory) would reveal not only acute psychiatric issues but also, and more importantly, reveal the underlying substratum of personality which would indicate whether the applicant had those traits which are more conducive to a life in medicine as opposed to those that are not. It would also highlight distressing degrees of sociopathy and narcissism so that these applicants might be excluded from the pool.
I have worked with physicians who had extreme narcissistic personality disorders as well as a few sociopathic ones. I would not count those experiences as among the most gratifying of my life. Probably no one would. Pts. also suffered, so these individuals should be left to pursue other pastimes.
A useful exercise would be to construct profiles that capture “the ideal physician.” This process would delineate those personality and educational attributes that go into making that sort of physician. Such parameters would be extremely useful to an admissions committee. Without these parameters, committees are forced to rely on their gut senses, which may be somewhat accurate, but not precise. The question to committee members might be, “Yes, while it may be all well and good that you have a ‘gut sense’ that this applicant will be a stellar doctor, perhaps knowing more about the specifics which enabled you to arrive at that conclusion would be edifying to other committee members.”
I put this under a different topic, but since Dr Mandrolla asked:
Just so everyone not in primary care is aware, these are the “quality metrics” for my company at present (which follow many HEIDIS and medicare metrics): —
Tobacco screening (with counseling if pos)
- BMI screening ( with counseling if > 30)
- anxiety screen
- depression screen (PHQ2, 9 if needed)
- HgA1C control < 8 for diabetics
- eye exam note in our chart for diabetics (not just the patient saying they had it)
- nephropathy screening, diabetics
- foot exam documented, diabetics
- hypertension control- <140/90 in diabetics and anyone with HTN diagnosis
-colon cancer screening (actual test in chart, not patient say so) starting age 45
- breast cancer screening (currently age 50-65, we’ll see if that changes)
- cervical cancer screening
- and an individual NPS score > 85 minimum and > 92 to get full credit
- notes closed/ locked within 72 hrs
————-
They hold back part of our pay unless meet certain % of these OR pay less and give “bonus” if meet them.
Another thing is insurance companies and various health websites give ratings on how well you do on these and can make you a nonpreferred provider/ make you look like a “bad” doctor if you do not meet them.
And another is if you work for a big system, it is a reason to be “let go”.
Many incentives to do many things that may or may not actually help individual patients.
(Reposted here so maybe more people see, not sure how much the non- primary care/ non medical folks are aware of this behind the scenes stuff)
Yes, and this also falls under things that have changed as most physicians are now employed. I don’t think some of the older private practice people understand that for most doctors and most patients, medicine looks like this now, when that was not true at the turn of the century.
Never heard the word equipoise before. Hope I never hear it again.
Equipoise—“balance of forces and interests effecting outcome.”
Sounds like a mighty fine word to me.
I'm glad you like it. I have done a lot of reading in the 70+ years since I learned how. Lots of fiction and non-fiction and never read or heard the term. It was especially surprising that I never encountered the term in extensive reading on economics where it would seem to apply most directly. The purpose of language is to facilitate communication and understanding. When addressing an audience that is somewhat diverse it is best to use clear and easily understandable language.
I would file it under jargon. I’ve heard it used extensively in medical ethics, but there are a lot of unusual Greek and Latin words you find in the medical vocabulary but nowhere else.
In general, I think Sensible Medicine is intelligible to a lay audience, but sometimes they don’t even realize that what they’re saying is not part of a normal person’s vocabulary.
I love words! They are little packets of emotion and/or centuries of human endeavor! English is such a malleable language which is a blessing and a curse. Some years ago, I took some French classes. In comparison, French is rigid and word bound.
Perhaps American English, anyway, reflects the lives of Americans—inventive, creative—not willing to accept the status quo.
I'm confused. Is it just the US Preventive Services Task Force that only now recommended mammograms starting at age 40? Because I remember having to delay my recommended initial mammography screening at age 40 because I had just given birth and was breastfeeding. I think I started at age 41. I'm now 72. I think the American Cancer Society and other professional groups have always recommended screening women in their 40s, haven't they?
Exactly. I was wondering what advice I should be giving to my 34 yo daughter regarding when she should get a mammogram. Obviously, she has her own physician who will advise her, but mothers have been known to weigh in.