Monday, May 28, 2012

PSA and "moderate certainty" Don't screen says the central authority

See here for the latest pronouncement of the USPSTF regarding PSA screening.In a word "don't"

I suppose "moderate certainty" is a notch or two below"absolute certainty" The USPSTF made their dictum on the basis of moderate certainty.

Dictum is the correct noun since it seems according to ACA the determinations of the USPSTF will become the rules for CMS and how long will the other third party payers take to follow their lead?

DrRich ( aka Dr. Richard Fogoros of the blog, The Covert Rationing Blog,)seems to actually have read much if not most of the lengthy ACA and said this about the new role of USPSTF quoting chapter and verse.

Obamacare, which is now the law of the land, makes the USPSTF the final arbiter of which preventive services are to be covered by private insurers (Section 2713), by Medicare (Section 4105), and by Medicaid (Section 4106). Only those that have achieved a grade of A or B by the USPSTF will be covered. And if you believe you will be able to purchase for yourself PSA screening (or any other medical service which Obamacare has decided not to cover) you have not been paying attention. Perhaps you can do so today (if you’re not on Medicare or Medicaid), but probably not for long.

The conclusions of the USPMTF in regard to PSA are presented as a scientific conclusion although one that apparently only reaches the level of moderate certainty. However, opponents of that conclusion have made cogent arguments. See here.

There is in fact evidence that PSA can save some lives but the disagreement is in how to determine ( or who shall determine) if the benefit exceeds the cost or is the ratio inverted. In the judgement of the panel the benefit does not exceed the risk. This is a value judgement not a scientific judgement. It is not an argument raised only by those who are ignorant of statistical concepts or driven by financial concerns as was claimed recently by the chair of the panel.( See here for my comments regarding that.)

Thomas Sowell has written that in the last fifty or more years there has been a major shift in the " locus of decision making" moving toward a more centrally located site.It has taken several forms; from the family to the state,from the local government to the central government and now from the individual patient with counseling from his physician to a panel whose pronouncements will be determinative.

No comments: