Showing posts with label when. Show all posts
Showing posts with label when. Show all posts
When It Comes to Cancer Hope at the Margins of Success is Medically Necessary
Wednesday, April 9, 2014
Disease Management Care Blog readers saw it here first.
Months ago, the DMCB presciently argued that cancer patients appetite for high expense and low yield treatments was based on more than desperation. It said it was also based on doctors and patients quite rational realization that these treatments could rarely result in meaningful life prolongation. In other words, while an "average" life expectancy from a particular treatment might be reported to be "only" six months, knowing that some persons make it to 12 or more months while others died immediately (zero months) could prompt a reasonable cancer patient to choose a shot at getting the twelve months.
The prestigious medical journal Health Affairs has finally caught up the the DMCB. In the latest issue, Darius Lakdawalla and colleagues surveyed 150 persons with either breast cancer (N=47, 20 of whom had advanced disease), melanoma (N=20) or other types of cancer (N=83).
There were two surveys dealing with breast cancer and melanoma that presented two nominally equal chemotherapy treatment scenarios. One used a "hypothetical" survival outcome based on the usual kind of "average survival" statistics. The other presented a "hopeful" survival outcome that reported a "spread" of survival statistics that included the small number of persons with shortened as well as prolonged lifespans. The surveys were conducted face-to-face using interviews on representative patients drawn from multiple cancer treatment centers nationwide.
According to the authors, the survey was designed to test the appetite for risk among cancer patients. Behavioral economists have long known that persons generally per the "sure bets" ($100 now) over equivalently valued "hopeful gambles" (a coin flip to win $200 or lose it all).
Its also known that persons who are not well-off have a greater appetite for the hopeful gamble. Betting a relatively small amount with a large upside explains the luster of low odds state lotteries for socioeconomically disadvantaged persons. It could also account for the willingness of very sick cancer patients - who have little to lose - to demand long shot treatments, even if theyre toxic and experimental.
The results showed that 77% of the survey participants perred the hopeful gamble scenario. 71% of the patients with the melanoma scenario were prepared to "bet" two years of life in return for a 20% chance of living 4½ years. Among the patients with the breast cancer scenario, 83% were willing to bet 1½ years for a 10% chance of living 4 years.
These perences were also accompanied by a willingness to spend a lot of money to access the bet. On average, the melanoma patients were willing to pay at least $45,000, while the breast cancer scenario patients were willing to pay at least $90,000. Persons with higher income levels were willing to pay even more.
While the authors correctly note that more research is needed, the DMCB suspects this could explain the decision-making thats leading many cancer patients to demand insurance coverage of experimental, high cost and low yield treatments. Not only does it make intuitive sense, but popular media extolls the intrepid hero who prevails and gets the girl, wins the talent show or defeats the aliens despite little chance of winning. Were a culture inculcated with high stakes gambles,especially if there is little to lose.
The DMCB recalls one of its middle aged patients with colon cancer that had spread to his liver. After multiple rounds of surgery (half his liver was removed), chemo and radiation, he was swollen, sickly, tired, gaunt and moribund. He agreed the treatments were pretty bad - until he considered the alternative.
Assuming IPAB survives, do we really think their pronouncements based on the usual approaches to comparative outcomes will really convince cancer patients to not seek hope? Will they really determine that hope is not medically necessary?
readmore
Months ago, the DMCB presciently argued that cancer patients appetite for high expense and low yield treatments was based on more than desperation. It said it was also based on doctors and patients quite rational realization that these treatments could rarely result in meaningful life prolongation. In other words, while an "average" life expectancy from a particular treatment might be reported to be "only" six months, knowing that some persons make it to 12 or more months while others died immediately (zero months) could prompt a reasonable cancer patient to choose a shot at getting the twelve months.
The prestigious medical journal Health Affairs has finally caught up the the DMCB. In the latest issue, Darius Lakdawalla and colleagues surveyed 150 persons with either breast cancer (N=47, 20 of whom had advanced disease), melanoma (N=20) or other types of cancer (N=83).
There were two surveys dealing with breast cancer and melanoma that presented two nominally equal chemotherapy treatment scenarios. One used a "hypothetical" survival outcome based on the usual kind of "average survival" statistics. The other presented a "hopeful" survival outcome that reported a "spread" of survival statistics that included the small number of persons with shortened as well as prolonged lifespans. The surveys were conducted face-to-face using interviews on representative patients drawn from multiple cancer treatment centers nationwide.
According to the authors, the survey was designed to test the appetite for risk among cancer patients. Behavioral economists have long known that persons generally per the "sure bets" ($100 now) over equivalently valued "hopeful gambles" (a coin flip to win $200 or lose it all).
Its also known that persons who are not well-off have a greater appetite for the hopeful gamble. Betting a relatively small amount with a large upside explains the luster of low odds state lotteries for socioeconomically disadvantaged persons. It could also account for the willingness of very sick cancer patients - who have little to lose - to demand long shot treatments, even if theyre toxic and experimental.
The results showed that 77% of the survey participants perred the hopeful gamble scenario. 71% of the patients with the melanoma scenario were prepared to "bet" two years of life in return for a 20% chance of living 4½ years. Among the patients with the breast cancer scenario, 83% were willing to bet 1½ years for a 10% chance of living 4 years.
These perences were also accompanied by a willingness to spend a lot of money to access the bet. On average, the melanoma patients were willing to pay at least $45,000, while the breast cancer scenario patients were willing to pay at least $90,000. Persons with higher income levels were willing to pay even more.
While the authors correctly note that more research is needed, the DMCB suspects this could explain the decision-making thats leading many cancer patients to demand insurance coverage of experimental, high cost and low yield treatments. Not only does it make intuitive sense, but popular media extolls the intrepid hero who prevails and gets the girl, wins the talent show or defeats the aliens despite little chance of winning. Were a culture inculcated with high stakes gambles,especially if there is little to lose.
The DMCB recalls one of its middle aged patients with colon cancer that had spread to his liver. After multiple rounds of surgery (half his liver was removed), chemo and radiation, he was swollen, sickly, tired, gaunt and moribund. He agreed the treatments were pretty bad - until he considered the alternative.
Assuming IPAB survives, do we really think their pronouncements based on the usual approaches to comparative outcomes will really convince cancer patients to not seek hope? Will they really determine that hope is not medically necessary?
When Being Infertile Women Can stink Macho Men
Friday, January 17, 2014
When Being Infertile Women Can stink Macho Men - Much like the ads on TV, angel of Khayangan fall because men perfume smell. It turns without using any perfume women can notice the macho man. Why just the macho? Because women can smell men with high testosterone grades.
Unfortunately it does not have the ability at any time, but when he was at the top of fertility.preceding study has found that when she was fertile, women are more attracted to identify and masculine environment of men. For example, a deep voice or manly attitude.
The investigators checked how women choose founded on the stink of testosterone and cortisolgrades of men. The male participants in the study were granted a top to wear for 2 nights in astrip. At this time, the men are prohibited from utilising detergent, drinking alcoholic beverage,fuming, and consuming garlic, red onion, green chili meal, dairy dairy cheese and other spicynourishment.
After that, participants were inquired to sniff her socks damaged male participants and assess the sexiness of male odor on a scale of 1 to 10. feminine participants were furthermore inquiredto fill out questionnaires on menstrual cycle and hormonal contraceptive use. To assess the levels of testosterone and cortisol men, the investigators used saliva trials.
The outcome discovered that women who are at the most fertile stage of her menstrual cycle is more like the smell of men with high testosterone levels. The womens shirt worn consider macho man most joy and the most sexy. But the woman could not stink a rat hormone cortisol ortension hormones male.
"This is the realm of the contentious research. Several studies have shown that a womans menstrual cycle affect mate assortment. Lot afresh discovered no effect of menstrual cycle on the preferences of the women," said psychologist Wendy Wood of the University of south California, as reported by LiveScience.
This mens body odor scent influenced by chemicals called androstenol. Men make more of this chemical than women. Male testosterone levels are also affiliated with the output of this molecule. Therefore, it seems that the women in the study answered to a unclear odor cues.
readmore
Unfortunately it does not have the ability at any time, but when he was at the top of fertility.preceding study has found that when she was fertile, women are more attracted to identify and masculine environment of men. For example, a deep voice or manly attitude.
The investigators checked how women choose founded on the stink of testosterone and cortisolgrades of men. The male participants in the study were granted a top to wear for 2 nights in astrip. At this time, the men are prohibited from utilising detergent, drinking alcoholic beverage,fuming, and consuming garlic, red onion, green chili meal, dairy dairy cheese and other spicynourishment.
After that, participants were inquired to sniff her socks damaged male participants and assess the sexiness of male odor on a scale of 1 to 10. feminine participants were furthermore inquiredto fill out questionnaires on menstrual cycle and hormonal contraceptive use. To assess the levels of testosterone and cortisol men, the investigators used saliva trials.
The outcome discovered that women who are at the most fertile stage of her menstrual cycle is more like the smell of men with high testosterone levels. The womens shirt worn consider macho man most joy and the most sexy. But the woman could not stink a rat hormone cortisol ortension hormones male.
"This is the realm of the contentious research. Several studies have shown that a womans menstrual cycle affect mate assortment. Lot afresh discovered no effect of menstrual cycle on the preferences of the women," said psychologist Wendy Wood of the University of south California, as reported by LiveScience.
This mens body odor scent influenced by chemicals called androstenol. Men make more of this chemical than women. Male testosterone levels are also affiliated with the output of this molecule. Therefore, it seems that the women in the study answered to a unclear odor cues.
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