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Excellent Op-Ed re New Breast Cancer Guidelines
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Anonymous
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Not sure this is right for political forum, per se, but since it is an op-ed, thought it appropriate. I saw this piece in today's Wall Street Journal regarding the new breast cancer screening guidelines in the news recently.
http://online.wsj.com/article/SB10001424052748704204304574543721253688720.html In my opinion, this piece does an excellent job of explaining the underlying assumptions, methodology and valuations of these proposed guidelines. From what I can tell, it all boils down to economics. Tell that to the 44-year old whose life was saved by a screening mammogram at age 40.... |
Anonymous
I know everyone hates this term - but welcome to rationing of health care by the government. The White House is already starting to back peddle on the mammogram issue, though. |
Anonymous
| Why does the rationing seem to be concentrated on women's health though?? That's being pushed by conservatives. |
Anonymous
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The irony of spinning this as an Obama plot to ration healthcare is that conservatives are the first to cut public programs for free mammograms for the poor and the first to support private insurance companies cutting back on screening to increase profits.
The main fear being raised from this study is that private insurance will use it as reason not to cover mammograms for women 40-50 without risk factors. This is exactly the type of healthcare that conservatives support, letting the private market manage healthcare as free market. This is so wrong as insurance is anything but free market! As most people have health insurance through their employers, they have little choice to vote with their dollar anyway. They have limited choices and virtually no transparency into what is or isn't covered as it stands now. |
Anonymous
Any citations for this? Otherwise, it is just spin. |
Anonymous
The White House had nothing to do with this to begin with. Do you seriously think they are so incredibly stupid as to propose a change in breast cancer screenings BEFORE the healthcare bill is passed? Knowing that breast cancer is one of the big hot button diseases in the voting population? This was a scientific and medical decision that dates back to Bush. In 2002 they revised the old guidelines to include women 40+ but said that it was a subjective age choice. They kicked off a lot of research which culminated in the report. I don't agree with it, but I don't see anything political in it. The WSJ points out that economics influence the decision, but they downplay the other aspects, namely the large numbers of false positives and the impact on the women, as well as the relative likelihood that these cancers will be detected on their own. Lastly, since the committee members serve four year appointments made in staggered fashion, it is highly likely that three quarters or more of the panel members were selected during the Bush Administration. I find it odd that the press is not investigating this particular subject. It would be way easier to resolve the issue of political influence if we knew exactly which members were selected by each administration, and see how they voted in the panel recommendation. Surely this is simple research. I'd bet dollars to donuts that this is not covered because it would spoil the Obama bashing fun. |
Anonymous
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Yes, in the time since the last post I can say that only three members have been selected out of the 16 panel members in all of 2009. The nominating process started in June of 2008 and the selections were finalized in March of 2009. http://www.reuters.com/article/pressRelease/idUS185934+11-Mar-2009+PRN20090311
I can see that the next nominating process started around may but those appointees will not begin terms until 2010. See the Federal Register for that one. So basically 13 of the 16 committee members are appointed during the Bush years. Maybe you should go down to Crawford Texas and ask why Bush is secretly plotting to ration our health care. |
Anonymous
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OP here. Of course, all the liberals on this board rush to make this into some "bash the conservatives" moment, rather than addressing the merits of the issue at hand. My primary intent was to draw attention to the statistics and economic choices underlying the study so that some women might be better educated about it and not foolishly follow these guidelines (IMHO). Frankly, I think the marginal cost of the extra screening is clearly outweighed by the lives saved--the lives of mothers, wives, partners, friends--can't put dollar values on those.
I agree with the poster who said that the WH had nothing to do with it--of course not--it would be ridiculous timing for them. But the type of economic rationing of healthcare proposed by the study--which will hurt the low and middle income families/individuals who depend on insurance subsidized healthcare--is EXACTLY what will happen under a government health care plan. Insurance already effectively rations healthcare but what it chooses to cover and not cover--those that can't pay out of pocket get screwed--not a perfect system by any means. A government run plan will be no different, except everyone gets screwed. At any rate, ladies over 40 and those over 35 with family history of BC, get your mammograms and do your self-exams. |
Anonymous
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Do you really think the study was economically influenced? This type of risk/benefit comparison goes on all the time in medicine. In fact, I think there was something similar about follow up procedures to prostate screenings a few months ago but it didn't get much attention.
I have not dug into it to understand how the committee quantified things like anxiety over false positives which is probably the area with the most weakness. The validity of a screening test is based both on false negatives and false positives. For many medical screening tests the false negative rules over the false positive. The harm from false positives is anxiety and unnecessary diagnostic tests but that could be managed with more effective communication from doctors. (As someone who had an AFP reading that was off and doctor who told me we tested positive for Downs I understand the anxiety. When I learned the false positive rate for AFP and the way the statistics are measured I felt much better.) |
Anonymous
What do you mean WILL happen? We make cost benefit tradeoffs all the time in medicine. You could get a full body scan every ten years, but you don't. Why? For the exact same reasoning used in the mamogram case. It doesn't save a lot of lives proportionally, it costs money, people will freak out at a whole lot of benign spots identified, and to a lesser extent we will all take a radiation hit. We also make cost/benefit tradeoffs when we legislate the speed limit, when we choose to fund or not fund bridge repair, or when we establish building codes. I think people do not realize how many decisions we make as a society, which prevent or enable a certain number of deaths every year. I personally do not like the opinion of this committee. But it's wrong to say this is a new way of looking at things. Joe citizen may not have given it much thought before, but it happens every day. |
Anonymous
| OP here. I agree that these cost-benefit analyses are already at work in all types of insurance (medical, life, etc.). I think what is most onerous is the idea of a government-run health care system, where the recs of these committees have influence on coverage for everyone--so the overall standard of care, not just access to care, goes down. In other words, you can no longer even buy decent healthcare because it is no longer economically rational for the medical profession to provide it. |
Anonymous
OK, but they won't have the power to prevent any insurer from covering a procedure. They only get to establish minimums, according to the WSJ article above. So how could they make the insurance companies stop paying for mammograms or anything else? |
Anonymous
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Insurance plans are still covering mammograms for women who want them at age 40. If you look at mammogram rates, they are low. The issue is not that women are clamoring for mammograms, the issue that many women who SHOULD get one don't.
The NY Times columnist Gail Collins, a breast cancer survivor, had a much better take on this than this article. The problem is that consumers don't understand the terminology of this Task Force (because it is really aimed at primary care physicians, not consumers. The C recommendation, which is what the Task Force rated mammograms for women age 40-49, are only not recommended as ROUTINE. All that means is, when you turn 40, you won't get a reminder - "get your mammogram." Read the full report and the language. Doctors and patients can still decide on an individual basis to get the screening. And the recommendation does not say "women, ignore changes in your breasts." It just says there is no evidence that physicians TEACHING self exams saves lives. If you see a lump, whether you are 23 or 57, you health plan will pay for your mammogram. All of the major insurers have come out and said they will still cover mammograms for women in their 40s who want them. |
Anonymous
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We always hear about the women that are "saved" by early screening, but how many of you have friends who had an abnormal mammogrm and then a follow-up study, followed by a biopsy and maybe even surgery all to find out there was nothing wrong to begin with as that initial mammogram was a false positive. This happens a lot and is not without its harms.
One of best freinds, called me a few months ago, because her doctor called her and told her the mammo was abnormal. She was hysterical since her 64 year old boss was diagnosed with breast cancer earlier this year. It took a couple weeks before my friend could get a disgnostic mammo and then they decided to do a biopsy just to be sure. Thankfully all was normal, but the physical pain, stress and anxiety it caused really took its tool. What was worse though was as my friend was going through all this she read up more on breast cancer and learned that it is much more common in older woman then in younger women. When we talked about this new recommendation, my friend said wishes she would have waited to have her first mammo So, remember more testing is not always better, that's why the recommendation says a woman should discuss with her doctor and it should not necessarily be routine. |
Anonymous
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Yes, my grandmother went through the same thing with a false-positive scare. Thankfully she did not have any problems due to the biopsy. But no one likes to anesthetize and operate on an elderly woman with breathing trouble.
BTW I saw that ACOG just moved the recommended age for PAP smears up to 21. The logic appears similar in nature to the mammography decision in this post. |