Screening for Terrorists vs. Screening for Cancer
As the holiday travel season approaches, millions of American air passengers will become painfully reacquainted with Transportation Security Agency (TSA) screening measures. Passengers must submit to either medically unnecessary X-rays or intrusive gropings. Yet in the realm of health care the federal government has adopted a new policy of discouraging routine screening tests for many cancers. Although these two policies may seem superficially contradictory, they demonstrate an underlying common theme of the government seeking ever-greater control over our bodies and our freedom.
Screening travelers and screening patients share some common features. In both cases the goal is to sort through a large, mostly-normal population to identify the relatively few problem cases — either an undetected terrorist or a hidden cancer.
The TSA’s current approach of mass passenger screening has long angered many Americans. Frequent flyer Tabitha Hale described her own recent horror story at, “No, TSA, I will not lift my skirt for you.” Because the screenings are universal (lest the government be accused of “profiling”), the TSA routinely screens grandmothers and small children who pose no terrorist threat. Even worse, the TSA screeners are of dubious effectiveness. TSA screeners have failed to detect simulated bombs and real guns. The attempted hijacking of Northwest Airlines Flight 253 two years ago was thwarted not by the TSA but by alert passengers.
In contrast to mandatory screening for terrorists, the government is actively discouraging Americans from regular screening for common forms of cancer. The federal government’s U.S. Preventive Services Task Force (USPSTF) recently declared that men should not undergo routine screening for prostate cancer with the PSA blood test — currently considered part of prudent preventive health care for men over age 50 by many primary care physicians and the American Cancer Society. In 2009, the USPSTF similarly recommended restricting screening mammography to women over 50 (and only at 2 year intervals), despite the proven medical benefits of the current practice of screening women starting at age 40 at yearly intervals.
If you don’t have a family history of prostate cancer, then the PSA test is only a little better than tossing a coin. Don’t bother with it.
The PSA test is known to have around a 15% chance of false negatives (you pass the test yet you still have cancer), and a whopping 70% chance of a false positive (the test suggests you may have cancer but you really don’t).
Usually after a positive result, the patient next gets a prostate biopsy to confirm. That’s expensive–and very uncomfortable.
I’ve been there and done that. None of my ancestors had prostate cancer. My PSA score was 4.3, so I got the biopsy. It felt like they were firing a staple gun into my testicles. And the results of the biopsy were negative.
And yep, TSA is comparable to PSA. They also have a very high rate of false positives (they screen everybody) and false negatives (they have failed to detect contraband smuggled in by testers testing the system).
TSA doesn’t boast that they’ve managed to stop even one attempted terrorist attack. I can only conclude that they haven’t done so.
And your attitude if the biopsy had been positive for cancer?
See antibiotics and the fallout from the practice of just giving them to everyone for no reason just so people feel like something is being done. Sometimes recommendations for various screenings/procedures in medicine are given before all the information on their usefulness is given, but once they have spoken, if they legitimately feel the need to roll a recommendation back they find they can’t because the public only hears the authoritative voice declaring the truth forever that can never be changed or questioned. The history of medicine is full of all sorts of really embarassingly useless procedures no one talks about anymore. And good luck on the deciding with the help of your doctor what is right for you, because I have heard horror story after horror story about arm twisting of patients, not reasoned decision-making.
PSA screening and biopsy in those with elevated PSA do find a lot of cancers. The contraversy exists because if you use mortality data as the outcome, rather than the pathologic diagnosis of cancer, the benefits appear to be very small.
The same thing is happening with Breast Cancer and Thyroid cancer. It is very complicated to figure out the risk/benefits and optimal screening guidlines as these require long term studies with large number of people.
Dont believe all this government conspiracy crap, oh there are economics but it is a very legitimate scientific issue and there is some good reseach being done.
As a nation, we can’t afford to test over a thousand patients just to find ONE case of aggressive prostate cancer.
That’s the ratio that British researchers have discovered. Out of 1,400 patients tested with PSA (many of whom then got expensive biopsies), only one case was detected that would have been fatal if it hadn’t been detected in time..
We could probably find even more cases of cancer if we gave every healthy person MRIs every year or so. But do you know how much THAT would cost?
If a PSA shows positive results, the next suggested procedure would involve the doctor putting on a rubber glove and performing a physical examination. The next step is NOT a biopsy.
As far as the old waiting-in-line-till-dying scare tactic, please read up on how much care is provided per dollar’s worth and how timely the care is in Norway and German and several countries the media rarely cites. I believe you will discover that the U.S. citizen should expect more for their tax dollars.
No. The Digital Rectal Exam has an even higher rate of false negatives. It has failed to detect prostate cancer in at least one-third of cases.
Unfortunately, this suffers from the usual fallacy of ‘I didn’t see it, so it didn’t happen’. If burglars haven’t broken into your house since you live in a good area that is well patrolled by cops and you, like most of your neighbors, have an alarm system and you live in an area with a high level of gun ownership, would you conclude that none of those factors made any difference? TSA makes the risk/reward ratio bad for the terrorists and the U.S. military keeps them very busy (and shrinking) elsewhere. When the military abandonment of the middle east allows the Islamists to regroup and regrow, and TSA is straightjacketed by arguments such as yours, do you really think that air travel will stay as safe as it is now?
The problem with this argument is that it proves too much. When dealing with low-probability events such as terrorist attacks, it makes *any* policy “effective” and thus justified in your eyes.
“I see you have some weird voodoo symbols over your front door.”
“Yes, it’s to repel polar bears.”
“There aren’t any polar bears in Los Angeles!”
“See, it’s working great!”
It’s not often I see an old joke of that type advanced as a serious argument.
Stripping everyone naked, forbidding luggage and sedating everyone for the flight would also be effective. It is a question of drawing the line. And an interesting datum on where one could draw the line is the example of Israel, which uses targeted rather than broad-brush screening, is under much greater threat, yet is also effective.
Getting on to an international flight last year (not in the USA, but the same principles are visible), my 7 year old daughter’s shoe buckles triggered the metal detector and she was quite traumatised by the subsequent taking aside and searching. Meanwhile a large Islamic woman in a wheelchair, being surrounded by metal, was simply wheeled in without a blink. Hmmm.
Well, I assume we now know how ObamaCare is going to “reduce health care costs for everyone”.
This schizoid attitude toward “public safety” only makes sense if you understand that to progressives in general and the Obama administration in particular, actual terrorists and real cancer are not defined as actual threats. (To themselves, that is; and they don’t care much about anybody else.)
In politically-correct dogma, Islamist terrorists, like the anarchist/leftist ones who preceded them, are seen as “freedom fighters”, struggling valiantly and gloriously against a repressive civilization (ours). As such, they must never be impeded; instead, the morally correct stance is to make law-abiding citizens pay for being law-abiding citizens of the “immoral” culture the terrorists are courageously striving against. Yes, ours. In an inversion of Augustin’s “an unjust law is no law”, our present crop of leaders believe that “Since our society is unjust, and you are a part of it, it’s all your fault, and we are going to punish you accordingly”.
As for cancer, the more cancers which go undetected and untreated until too late, the lower the cost of elder care to the government; because there are fewer elders still alive to require care. It’s really just that simple. All “socialized medicine” systems arrive at this end sooner or later, to avoid bankrupting the governments which run them. The Obama administration has simply learned from the experiences of the UK, Sweden, Canada, etc., and is getting a head start on the financial side of the ledger.
Once you understand that everything in this administration is run for the benefit of those in power: that those in power are ruled by dogmas which result in them loathing our society; and that they have nothing but contempt for those they rule, their behavior becomes much easier to comprehend.
clear ether
eon
I lived for a number of years in Moscow, Russia. My Russian friend had a very difficult time finding a hospital that would admit her 86 year old mother. She finally found a hospital for WWII veterans that would take her. In the course of their search, they met another woman who could not get admitted to any hospital. She was 65.
In the UK, care is delayed so long, a number of patients die waiting for it. It is hard not to conclude that this is by design. In every country that has socialized medicine, a parallel system for those who can afford care on demand comes into existence. At least in Russia, I knew that anyone who could afford care would steer way clear of the “free” care, which could often kill you, it was so bad.
There were constant horror stories about the free care, especially concerning childbirth. Many babies and mothers are lost and this is explained matter-of-factly by the principle of survival of the fittest. Human life is cheap in the socialist/communist mindset.
Is it any wonder Russia is facing a demographic catastrophe? So far, no one is forced to have more babies by the government, but people in general vote “NO” to the future in Russia by having only one child.
Can you believe a sitting president would hold up China as an example for Americans to emulate? Let’s remember the name of that country, it is Communist China. We are living through perilous times.
In states like the USSR, only two “demographics” mater to the ruling oligarchies other than themselves. Namely, that there are enough workers to keep things running and pay taxes, and enough young, fit men with rifles to protect the government from its enemies, real or imagined, domestic or foreign. (Especially all those workers.)
Anyone who doesn’t fit into a “useful” category can’t expect the government to care about them, “socialist brotherhood” and “workers’ solidarity” be damned.
As for our present POTUS being enamored of Red China, keep in mind that in the academic circles he comes from, such views are not only not controversial, they constitute the mainstream of “enlightened thought”. I guarantee that he could say such things in a faculty lounge at Harvard and get applause for his “clear thinking”. Such academics see the PRC as an example of what the rest of the world could be with The Right People (i.e., themselves) running it without having to listen to anybody else’s backtalk.
The modern-day academic worldview, which President Obama espouses, is less connected to reality than the average LSD trip, circa 1968.
cheers
eon
“In politically-correct dogma, Islamist terrorists, like the anarchist/leftist ones who preceded them, are seen as “freedom fighters”, struggling valiantly and gloriously against a repressive civilization (ours). ”
I’m sure some people have said this, but let me assure you– as a writer and a college English teacher, I’m very familiar with the progressive left/liberals/whatever term you’d like to use, and this thing you said above, that is not a real thing. I have truly never heard a single real life person say such a thing, not even in the halls of liberal, godless academia or in the corners of dank poets’ bars.
I’m sure there are lunatics out there saying such things– there are lunatics out there saying everything, pretty much. But this is a textbook strawman above.
I’m not sure what you’re saying here. One the one hand, you say that you’re sure that some people believe such a thing (and indeed they do), and yet you call it a “strawman.”
*You* might not have personally heard anyone say it, but the universe is not confined to your immediate experience.
What I’m saying is this: even though there are surely fringe lunatics who truly believe that terrorists are freedom fighters locked in a valiant struggle, they are not representative of any mainstream viewpoint or any particularly large group of people.
That is, if I wanted to smear ANY group based on their ideology, I could cherry pick the most insane thing that the most insane people tangential to their cause have said, but it doesn’t mean anything. Even if eon read some crazy person online claiming this (although, for the sake of accuracy, eon actually offered no evidence at all that this belief exists), it’s fallacious to then take that comment and use it to deride all leftists or progressives or whomever.
Or, maybe even more importantly– it’s just an unnecessary discussion. It’s not a real thing that actual people making decisions and affecting policy believe, and there is no evidence that it’s a real thing that these people believe. So it’s irrelevant.
It’s the same kind of thing as, say, Huffington Post finding some fringe group of libertarians praising the conditions in Somalia and then pretending they’re representative of the larger group. Every group has its crazies. They’re best left ignored, and it’s misleading, at best, to villify that group through blanket generalizations based on the craziest things that you read on the internet.
Well, how else do you explain Obama’s pattern of being an apologist for the country he “leads,” showing thinly-veiled support for our enemies, outright disdain for our allies, not to mention his far-leftist domestic agendas?
Obviously, I’m new here, and I swear I”m not stopping by to troll; I followed a link my brother posted elsewhere, and I actually pretty much agree with the post itself. But all I can do, bobbcat, is assume that you’re intelligent enough to come to a more rational conclusion re: Obama’s crappy foreign policy. Is it that he’s an inexperienced leader who is too concerned about trying to please everyone all the time (and therefore never really making anyone happy since he’s just paying them all lip service)? Or is it that he secretly sides with the terrorists and sympathizes with their valiant cause?
I mean, let’s just be rational adults for about 20 seconds and think about this one. There are literally thousands of more reasonable ways to explain why Obama’s foreign policy is shaky, and thousands of explanations that actually can be supported with real empirical evidence.
when the government does something it is never “for the people” it is for a select group only. (as well as generally unconstitutional and morally dishonest)
Many medical studies coming out these days seem focused on proving that this or that intervention, or this new (and expensive) drug, are not cost effective, or do not give universally good results in everybody.
It is as if they have now adopted a population-economics perspective, rather than focusing on those who are improved by the intervention.
The groundwork is being laid for a massive contraction of covered medical services by medicare and medicaid. Private insurers almost invariably follow medicare practices in this regard.
Obamacare must be repealed.
It’s not just cost-effectiveness.
There have been studies on the enormous emotional stress to a patient and his family by false-positive test results.
You tell a patient that the test “suggests” he may have cancer. You’ll scare the hell out of him and his family for weeks until a more definitive test can be conducted.
And experience has shown that if you administer enough different tests to any patient, at least one of those tests will show something anomalous: Possible heart problem or cancer problem or blood disorder problem or whatever. But most of the time, those anomalous readings are just flukes or outliers–false positives.
Not what I was talking about, but thanks.
I finally got to the bottom line with why I no longer fly with the TSA barrier standing between me and my flight. MY DIGNITY IS NOT UP FOR GRABS, pun intended. Oh, American Airlines has just declared bankruptcy. I wonder why?
Perhaps we should combine the two programs: allow TSA X-rays to be used for medical screening. Two fantastic government programs for “one low price”
Mr. Hsieh, like Hitler and other racists, sees People of Color as a disease. Rather than inspecting everybody to search for Muslimness, he proposes a search-and-destroy mission targeting the world’s Muslims. He has placed Bush’s final solution for Muslims back on the agenda. I wonder how many death camps like Gitmo and Abu Gharib that would take?
Poe’s Law!
Poe was a right-wing apologist for slavery. What have I to do with him?
However, to give credit his due, his fictional stories are a great way understand the true nature of the corporate economy and its protective propaganda matrix that spawns websites like this one.
*WHOOOOSHHHH*
That’s the sound of an easily Google-able reference going over your head.
You did look at the bio picture, yes? Dr. Hsieh is “a person of color”. I know how much that matters for your sort, I’m surprised you missed it.
The difference is that a cancer screening detects at most one case of cancer which can kill one person.
An airline passenger screening can detect a terrorist who could kill several hundred people.
So far, in the last 10 years since 9-11, airline passenger screening hasn’t detected any terrorists.
Richard Reid got on board. He wasn’t stopped by screening. He was stopped by the other passengers, who really fixed his wagon good.
Anyone that travels outside America can compare the manner people are treated. Airports in Asia and Europe treat people with a higher level of respect and dignity than what used to be the Good Ole USA. Its almost like getting cheap thrills by the TSA.
Its a bit sad to watch the USA falling apart these last few decades, over reacting to small matters, completely ignoring serious economic issues…. Watching the current GOP debates is almost self abuse, what happened to politicians that actually had tangible attributes.
The Israeli airport security system is great. They have ONE major airport.
And, it is labor intensive, and requires that individuals doing the checks THINK.
Can the $10/hr drones who work for the TSA carry this out?
They can’t even carry out what they’re supposed to be doing now.
The Israeli system is not applicable to the USA as a wholesale adoption.
EXCELLENT article!!! I couldn’t agree more with Dr. Hsieh.