> By all means, if you have studies showing that broad screening programs are beneficial in terms of overall (not cancer-case only) QALY then please share them. I'm guessing you don't.
I gave you one.
> Stop trying to put the burden of proving a negative on me.
You're making the claim there's more than a negligible negative effect not me.
> Do you have any data to support the claim that screening has more than a negligible positive effect on overall survival? (No).
Did I say there is a sizable positive effect on overall survival? I said it's irrelevant.
No you didn't, you gave me a simulation study that discussed what kind of sample size might be necessary to find statistically significant effects in all-cause mortality. There's not a single mention of QALY in there. Please stop misrepresenting things.
> You're making the claim there's more than a negligible negative effect not me.
The cost itself is a nonnegligible negative effect.
> Did I say there is a sizable positive effect on overall survival? I said it's irrelevant.
You're wrong.
It's borderline fraud, in my humble opinion, to go around suggesting that massive interventions should be evaluated based on their effects only on the people who benefit most, ignoring the negative effects on the other 98% of the population. Which is exactly what you did in your first reply to me:
> What you want to do is look at stage at presentation, treatment costs by stage, and screening costs. These were done for nearly every recommended screening program.
> The available evidence behind currently recommended screening programs unequivocally shows improved cancer-specific survival and earlier stage at diagnosis.
This approach to evaluating an intervention is intellectually dishonest and emotionally manipulative. Any evaluation that does not take into account the other 98% of the population--through overall survival or QALY or some other metric--is giving an extremely biased picture of what the intervention is actually doing to the population as a whole.
What are the downsides? You're speaking nebulously about negative effects on 98% of the population without mentioning them.
Several screening programs like breast have been rigorously evaluated from costs, benefits and harms. I know very well what the negative effects are, do you? You haven't mentioned anything specific or provided estimates of harms yet you're the one making the assertion.
> You're wrong.
So if we're all wrong, what's the argument and where's the evidence without resorting to no OS benefit ignoring that this is again not the point of screening.
> It's borderline fraud, in my humble opinion
Your humble opinion disagrees with the entire medical community, including the study you initially cited. So we're all fraudulently screening for what purpose? You know that physicians don't collect billings or work fee for service in academic medicine correct?
> Which is exactly what you did in your first reply to me:
Did I say that was the only reason to screen and ignore the harms? I used that as an example of why overall survival is not useful as an isolated statistic.
You're the one who wanted to limit the discussion to one measure, I was pointing out the flaws.
I gave you one.
> Stop trying to put the burden of proving a negative on me.
You're making the claim there's more than a negligible negative effect not me.
> Do you have any data to support the claim that screening has more than a negligible positive effect on overall survival? (No).
Did I say there is a sizable positive effect on overall survival? I said it's irrelevant.