
TIT FOR TATThis phrase was generated from the original uses of the two key words, "tit" and "tat," both meaning "a light hit." The reference was to retaliation, as in replying to a hit by hitting back.The Word Origin Calendar
In medical cost vs. benefit modeling (which strongly informs national medical public policy making and far too strongly informs the medical policies of HMOs), the most critical component is a value called "cost per life year gained."
If the cost per life year gained is under $50,000, that is generally considered a decent investment by US medical policy makers. If "cost per life year" gained is over $100,000, that is generally considered a wasteful medical policy because that money could surely be put to much better use elsewhere. Yes, this is cruel and heartless to some degree, but wide scale medical cost allocations do need to be made and, more relevantly, are continually made using these cost plus risk vs. benefit analyses. Think HMOs. Now consider why pap smears, blood tests and urine tests aren't recommended every month for everyone. Testing monthly could definitely save more than a few lives, and there is no measurable associated medical risk. But the cost would be astronomical versus the benefit over the entire US population when comparing these monthly tests to other therapies, procedures and medicines.
Now on to GARDASIL. By the time you pay doctors a small fee to inventory and deliver GARDASIL in three doses, you are talking about paying about $500 for this vaccine. And because even in the best case scenario GARDASIL can confer protection against only 70% of cervical cancer cases, GARDASIL cannot ever obsolete the HPV screening test that today is a major component of most US women's annually recommended pap smears. These tests screen for 36 nasty strains of HPV, while GARDASIL confers protection against just four strains of HPV.
Now let's consider GARDASIL's best case scenario at the moment -- about $500 per vaccine, 100% lifetime protection against all four HPV strains (we currently have no evidence for any protection over five years), and no risk of any medical complications for any subset of the population (Merck's GARADSIL studies were too small and short to make this determination for adults, these studies used potentially dangerous alum injections as their "placebo control" and GARDASIL was hardly even tested on little kids). Now, using these best case scenario assumptions for GARDASIL, let's compare the projected situation of a woman who gets a yearly HPV screening test starting at age 18 to a woman who gets a yearly HPV screening test starting at age 18 plus the three GARDASIL injections at age 11 to 12. Even if you include all of the potential medical cost savings from the projected reduction in genital wart and HPV dysplasia removal procedures and expensive cervical cancer procedures, medicines and therapies plus all of the indirect medical costs associated with all these ailments and net all of these savings against GARDASIL's costs, the best case numbers for these analyses come out to well over $200,000 per life year gained -- no matter how far the hopeful pro-GARDASIL assumptions that underpin these projections are tweaked in GARDASIL's favor.
Several studies have been done, and they have been published in several prestigious medical journals:
http://dx.doi.org/10.1001/jama.290.6.781
http://tinyurl.com/2ovy95
http://tinyurl.com/2tbuma
None of these studies even so much as consider a strategy of GARDASIL plus a regimen of annual HPV screenings starting at age 18 to be worth mentioning (except to note how ridiculously expensive this would be compared to other currently recommended life extending procedures, medicines and therapies) because the cost per life year gained is simply far too high. What these studies instead show is that a regimen of GARDASIL plus delayed (to age 21, 22, 23, 25 or 27) biennial or triennial HPV screening tests may -- depending on what hopeful assumptions about GARDASIL's long term efficacy and risks are used -- hopefully result in a modest cost per life year savings compared to annual HPV screening tests starting at age 18.
If you don't believe me about this, just ask any responsible OB-GYN or medical model expert. Now, why do I think all of this is problematic?
1) Nobody is coming clean (except to the small segment of the US population that understands medical modeling) that the push for widespread mandatory HPV vaccination is based on assuming that we can use the partial protection against cervical cancer that these vaccines hopefully confer for hopefully a long, long time period to back off from recommending annual HPV screening tests starting at age 18 -- in order to save money, not lives.
2) Even in the best case scenario, the net effect is to give billions in tax dollars to Merck so HMOs and PPOs can save billions on HPV screening tests in the future.
3) These studies don't consider any potential costs associated with any potential GARDASIL risks. Even the slightest direct or indirect medical costs associated with any potential GARDASIL risks increase the cost per life year gained TREMENDOUSLY and can even easily change the entire analysis to cost per life year lost. Remember that unlike most medicines and therapies, vaccines are administered to a huge number of otherwise healthy people -- and, at least in this case, 99.99% of whom would never contract cervical cancer even without its protection.
4) These studies don't take in account the fact that better and more regular HPV screening tests have reduced the US cervical cancer rate by about 25% a decade over the last three decades and that there is no reason to believe that this trend would not continue in the future, especially if we used a small portion of the money we are planning on spending on GARDASIL to promote free annual HPV screening tests for all low income uninsured US women.
5) The studies assume that any constant cervical cancer death rate (rather than the downward trending cervical cancer death rate we have today) that results in a reduced cost per life year gained equates to sound medical public policy.
As I said before, if any of you don't believe me about this, please simply ask your OB-GYN how the $500 cost of GARDASIL can be justified on a cost per life year gained basis if we don't delay the onset of HPV screening tests and back off from annual HPV screening tests to biennial or triennial HPV screening tests.
The recommendations are already in: http://tinyurl.com/33p9q6
The USPSTF strongly recommends ... beginning screening within 3 years of onset of sexual activity or age 21 (whichever comes first) and screening at least every 3 years ...
From The Curt Jester's continuation of Ironic Catholic's list comes these two comments from plantlady in the comments box that were just too funny not to pull out and share.
I volunteer at a facility for the elderly. The following are true happenings in its chapel:
1. If you ride your electrified scooter up the aisle to receive Holy Communion, remember to brake BEFORE you reach the priest. (A lady actually drove into Father, who lost his footing and quickly handed me the chalice so he wouldn't drop it!)
2. Remember to put on underwear. (As an elderly gentleman returned from receiving Communion, his pants fell down. Of course, he bent over to pull them up. After Mass, Father remarked that that was the first time he had ever been mooned on Easter!)
It occurred to me, reading over verses 7-8, God does not promise us that life will be easy if we trust in Him. The heat will come. The year of drought will come. What God promises is that we will flourish despite hardships. That He will be with us.5 Thus says the LORD: Cursed is the man who trusts in human beings, who seeks his strength in flesh, whose heart turns away from the LORD. 6 He is like a barren bush in the desert that enjoys no change of season, But stands in a lava waste, a salt and empty earth. 7 Blessed is the man who trusts in the LORD, whose hope is the LORD. 8 He is like a tree planted beside the waters that stretches out its roots to the stream: It fears not the heat when it comes, its leaves stay green; In the year of drought it shows no distress, but still bears fruit. Source
Oh my dear Wormwood, how can it be true?
The patient’s a Christian all because of you!
Now listen quite closely to the advice I give,
Devoutly religious is no way to live.
Make him look at his neighbor, not at the priest.
Make him wonder why her shirt is creased.
He knows for a fact that the woman’s a sinner.
Why she was the topic of yesterday’s dinner!
And if she really is as bad as they say,
Why, your task is so simple, it’s mere child’s play!
Never let him consider that he’s just the same,
For he knows deep down he’s never to blame.
So just do what I say and you’ll be in great shape.
Your affectionate uncle, Screwtape
SekkenThere is a Japanese word, "sekken", I would like to understand better. It is used to name the otherwise nameless social consensus, that is held to control Japanese public life...
A Japanese friend, who is irreverent towards her own culture, explained “sekken” to be the power that moves a large school of fish this way and that, as if they were a single organism. It is “the power that can move the entire school into the astute fisherman’s net”. She experienced it once herself, in a small way, when she wrote something controversial that happened to be true. She found herself in the position of the lone fish, who has somehow missed the tribal instruction to turn a sharp left.
4. If you come to Mass tired, don't slump disrespectfully. Depend on the skills that got you through high school. At least hold your head in your hands in such a way that you look reverential.Tom's favorite:
10. When all else fails, remember the secret Catholic motto: "I can sing quieter than you can sing."My contribution would be: If you are kneeling in prayer avoid breathing down the neck of the person in the pew in front of you (discreet throat clearing is allowed so the person knows you're there and might lean forward slightly.)
Her [Edith Stein's] contemplative practice led to her firm belief in the traditional Christian doctrine of deification. If we are not being transformed along the way, she was convinced, then all our preaching and service is in vain. She was careful to point out the difference between "leading the self-satisfied existence of the 'good Catholic' who 'does his duty,' ' reads the right newspaper,' and 'votes correctly' -- and then does just as he pleases" and becoming a new man in Christ. The beginning of real transformation precipitates a difficult but lifesaving crisis: "If, up to now, a person has been more or less contented with himself, the time for that is over. He will do what he can to change the unpleasant things he finds in himself, but he will discover quite a bit that can't be called beautiful and yet will be nearly impossible to change. As a result he will slowly become small and humble, increasingly patient and tolerant toward the specks in his brothers' eyes."This really hits the mark for me in terms of forcing our dependence of God and also being able to see ourselves for who we really are.By Way of Grace: Moving from Faithfulness to Holiness
by Paula Huston
Undeserved love also brings with it the possibility of being shamed. From the great chasm that lies between what we are and what those who love us think we are rises up a fruitful and challenging embarrassment, especially when it is they who glimpse our true calling long before we ourselves can see it. The German philosopher Nicolai Hartmann says that someone who is loved this way is "pushed beyond himself." In this sense, love becomes a clarion call to transformation -- the transformation of human nature made possible through the sacrifice of Christ.I never thought of that concept before ... that someone who is undeservedly loved is pushed beyond himself. But that is exactly what God does with us. Fascinating ... and humbling.
This aspect of love -- that it urges us to be better than we are, to grow into what God intended us to be -- explains how the person who loves us most can also be our best critic. It is because he or she wants our life to be truly good. Thus, the true lover forgives rather than excuses our human failings. The distinction is an important one. In excusing, he pretends that something bad did not happen after all. In forgiving, he affirms that it did indeed happen and that he hopes and prays we will come to recognize this fact and repent.By Way of Grace: Moving from Faithfulness to Holiness
by Paula Huston
*Alliance Teacher: And now, everyone can enjoy enlightenment and the comfort of true civilization....In my cowardly way I always was secretly relieved that my girls were too old for me to have to worry about what to do when I heard about certain vaccines for children that were made using aborted babies (ugh!).
Pupil: Why were the Independents even fighting us? Why weren't they looking to be more civilized?
Alliance Teacher: So with so much social and medical advances we can bring to the Independents, why would they fight so hard against us?
River: We meddle.
Alliance Teacher: River?
River: People don't like to be meddled with. We tell them what to do, what to think. Don't run. Don't walk. We're in their homes and in their heads and we haven't the right. We're meddlesome.
Alliance Teacher: River, we're not telling people what to think. We're just trying to show them how. (Stabs River in the forehead with pen)
AUSTIN – Gov. Rick Perry – usually a hero to social conservatives – surprised many of them Friday by making Texas the first state to mandate a vaccine for sixth-grade girls to prevent a sexually transmitted infection that leads to most kinds of cervical cancer.It so happens that not too long ago I had printed out Catholic Medical Weekly's evenhanded and informative article about this virus. I even read various portions aloud to Tom and Rose, with this being the money quote for us. (I have edited the layout to make it easier to read.)
Why isn’t it a swell idea?I encourage anyone with daughters to go read the full article as it gives very good information about the vaccine and the issues involved. No matter what your thoughts on the main issues it is important to be fully informed when you make decisions about this vaccine.
First. The vaccine does not remove the need for Pap smears nor will it do anything for a lady already infected.
Second, it doesn’t do anything about other sexually transmitted diseases, although it’s easy to imagine a 12 year old (remember, that’s the target audience) who thinks it does. For that matter, I can easily imagine a 20 year old who might think it does, but that’s neither here nor there.
Thirdly, there are concerns that the FDA has "fast-tracked" licensure of Gardasil, without adequate study of its safety in little girls.[5]
Fourth, and most importantly, no one knows what effect universal vaccination of 9 year olds might have on adolescent tendency to have sex. However, the data of the past forty years of social experimentation suggest that it would tend to increase sexual activity. That’s been the outcome of all the other experiments on early immersion of young children into the fetid world of “sex ed” and teenage contraception, and there’s no reason this should have a different effect.
Regarding the morality of the vaccine itself, its manufacture does not involve aborted babies[6]. So the moral problems attached to, say varicella or rubella vaccines do not apply here.
HPV is a sexually transmitted disease. You don’t get it if the person next to you coughs, and you don’t get it from a water fountain or a toilet seat. Requiring HPV immunizations for young girls (and that is what ACIP “recommendations” amount to: requirements) is, in my view, no different from requiring that all school age girls be put on contraception....
In his executive order, Mr. Perry said girls must receive the human papillomavirus vaccine before school starts in September 2008. While noting that parents may opt out of the vaccine for conscience or religious reasons, he said it "provides us with an incredible opportunity to effectively target and prevent cervical cancer."Talking about the legislation yesterday, I told Rose that I do object. Without missing a beat she said, "I don't need you to object. I object on my own behalf. They can forget it." (A proud mom moment there.) I will be sending article links on to Hannah so she can see the facts behind the spin.
Only then did I discover the truth: religious faith is not comforting, as atheists so often accuse, but hard. Hence, its status as a virtue. In order to keep it, we must nourish it and protect it; otherwise it will be blown away by the changing winds of fashion. More, we must never forget that this virtue is a theological one, which means that it comes through grace. Sometimes keeping faith means nothing more than clinging with the desperate need of a trusting child.Amen to that! I never had characterized it to myself in that way until reading this passage. I was raised with the understanding that religious believers were clinging to false hope because they couldn't take real life, they needed the easy answers. On the other side of the equation, as it were, I know that living one's faith is a challenge that never ends ... luckily it is an interesting, exciting ride ... even when one is not having the best of times it is never boring.By Way of Grace: Moving from Faithfulness to Holiness
by Paula Huston
"In meditating," he [St. Francis de Sales] says, "we as it were count the divine perfections which we find in a mystery, but in contemplating, we sum up their total." The contemplative gaze is a holistic one, and one steeped in love. We are in the presence of God, and like human lovers who "are content, sometimes, with being near or within sight of the person they love without speaking to her, and without even distinctly thinking of her," we simply rest in God's nearness.I agree that this is quite a challenge in modern times where, as a people, we tend to analyze everything up to and including ourselves. However, it is a part of "letting go" in general to just push those inclinations aside when it comes to prayer.
This contemplative repose is easily disrupted if we become overly aware of ourselves, a special temptation in modern times. People who "voluntarily forsake [the state of contemplative repose] to note their own behaviour within, and to examine whether they are really in content, disquieting themselves to discern whether their tranquility is really tranquil, and their quietude quiet," soon become distracted.
Rather than maintaining their focus on God, they "employ their understanding in reasoning upon the feelings they have; as a bride who should keep her attention on her wedding ring without looking upon the bridegroom who gave it to her. There is a great difference ... between being occupied with God who gives us the contentment, and being busied with the contentment which God gives us." We must stop studying our emotional reactions as though we were involved in a scientific experiment if we are ever to meet God as he is. Though honest self-awareness is critically important to the spiritual life, contemplation only happens when we learn to set aside self-study in order to lose ourselves in God.By Way of Grace: Moving from Faithfulness to Holiness
by Paula Huston