The argument about the best method for colon screening at different ages will continue for a while. How does anyone argue FIT is NOT the preferred method for patients over 75, when the morbidity for colonoscopy is 0.68% vs 0% for FIT. The other age groups have proponents either way and the answers won't be clear for a year or two. FIT will have a prominent place.
But everyone seems to be missing the real use of Cologuard...anemia and occult bleeding workup, especially in the elderly where testing is risky. Don't you really want to know is if the patient's have colon cancer, while you work up the other forms of anemia or microscopic blood loss? How many people taking Eliquis, Pradaxa, and Xarelto as well as coumadin bleed small amounts? When they do bleed a little, is it because they have cancer or is it the medication? What if they have genetic problems taking one or more of the anticoagulant drugs? Carefully monitoring the blood loss might be reasonable until they get their left atrium ablated. It sure beats having a stroke, but colon cancer is worse. So why isn't Cologuard perfect in these patients? Why hasn't anyone talked about it? The market is huge for this use...this is way safer than investigations in people over 75. Is there a conflict of interest because doctors make money from invasive procedures like colonoscopy?
AGN is way undervalued. PFE trades at the dividend which will hold the stock at the $33 range. There is nothing the Treasury can do to block this inversion because of the 73,000 pages of the US Federal Tax code cuts both ways. And PFE has plenty of attorneys. Imagine Bernie Sanders complaining about the tax code when he has done nothing in 24 years to fix it.
The real dividend will be the split in 2017-18 of the Branded and Generic pharmaceuticals groups. This is the best and surest investment for the next 2 years on the stock exchange. In a few weeks the institutions will realize this.
They, like many medical panels, are older, not recently trained, physicians and academics that don't see a lot of real patients. They err on the side of not changing anything for years after the evidence is clear. Their medical opinion is considered a higher level of evidence than published research. That's is why flexible sigmoidoscopy is still included in the guidelines. Any doctor doing a flex sig in 2016 in the US for colon cancer screening will have a hard time defending it before 12 people at the Courthouse in a patient with a right-side colon cancer. None of these "experts" could even qualify to testify in the malpractice trial.
When you look at the make-up of the USPSTF there are no gastroenterologists and only 3 physicians that have any training in primary care. It's easy for them to believe a patient would prefer a colonoscopy and get one regularly. Apparently economics was not something they considered recommending a $3000 test that has risk of death rather than a $300 stool test with zero risk. Considering the current fee-for-service reimbursement environment perhaps they voted to protect doctor's income from colonoscopies since this test is going to decrease that revenue substantially.
It's time to be patient here...this test has substantial off-label uses that I will discuss in a different post. Less
Better yet, study his background. He has only an undergraduate college degree. The emperor has no clothes. He is fundamentally a gambler. He made one lucky short of Lehman Brothers in 2008 and has lost money since. He pled guilty to securities fraud in the UK. His veiled attempts at market manipulation in this country have failed recently. Only because he has had institutional lemmings in his hedge fund masquerading as an off-shore insurance company, he has remained in business.