Patterico's Pontifications

11/19/2009

ObamaCare: The Mammogram message

Filed under: General — Karl @ 11:08 am



[Posted by Karl]

I did not blog the US Preventive Services Task Force’s new guideline — that women in their 40s should stop routine annual mammograms and older women should cut back to biannual exams — because I did not have anything new to add. But now I do, so here is the refresher quote:

Some questioned whether the new guidelines were designed more to control spending than to improve health. In addition to prompting fewer doctors to recommend mammograms to their patients, they worried that the move would prompt insurers to deny coverage for many mammograms.

The new recommendations took on added significance because under health-care reform legislation pending in Congress, the conclusions of the 16-member task force would set standards for what preventive services insurance plans would be required to cover at little or no cost.

Obviously unsurprising, given that Pres. Obama has portrayed doctors as people who not only conduct wasteful tests, but unnecessarily remove tonsils and feet to pad their coffers.

In assessing the political impact of the announcement, I would note that prior polling has tended to show that women supported ObamaCare, while men opposed it. Democrats cannot afford to lose the support of women on this issue, but the announcement plays into a narrative already advanced by the pro-choice movement that ObamaCare will ration healthcare for women.

The Obama administration is clearly worried about this. HHS Secretary Kathleen Sebelius has been busy misleading the public, noting that the task force’s recommendation is non-binding, while omitting that it would become binding under the PelosiCare bill Obama endorsed.

I will leave the debate over the science behind the guideline to the experts. But in a nation where most adults know someone affected by breast cancer, I suspect most people will see government influence in a negative light. You cannot play the “one death is a tragedy, a million is a statistic game” when so many know one. The administration’s weaseling will only reinforce public suspicions about rationing under ObamaCare.

Update: Ed Morrissey notes that the brand new Quinnipiac poll has ObamaCare losing among women.

–Karl

70 Responses to “ObamaCare: The Mammogram message”

  1. As a legal type, what gives the right to the government whether you can have a mamagram, a colonoscopy or any other health related service you may want.

    This whole healthcare debate wreaks with un-Constitutional. How about taking that up in future posts. Forcing people to buy something from the government. whether it is healthcare, suciucide clown cars from government motors, or card board government houses … the possibilities of forced marketing are endless.

    bill-tb (365bd9)

  2. This is one more example of the cluelessness of these people. The Cancer Society has spent 40 years trying to get women to get mammograms and pap smears. Now they have even recommended they stop self examination. It’s crazy ! The self examination recommendation is based on a study of women in China and Russia who have no access to mammography. There is also some BS about deforming breasts with unnecessary biopsies. The vast majority of biopsies of mammogram lesions is done with needles, not surgical biopsy. These people don’t know any more about breast cancer than they do about terrorism.

    Mike K (2cf494)

  3. This is lose-lose for the HCR crowd. If they promote the limited testing, they feed the idea that reform will lead to rationing. If they refute it, they feed the idea that reform is guided by politics rather than science. If they ignore it, their opponents get to pick how to cast the issue.

    roy (a1e331)

  4. The fact that most of the public is ignoring this reinforces the Feds belief in what they are doing. At some point it will be too late – but the American public continues to blindly follow or care not.

    If this issue doesn’t strike a chord – loud and clear, then nothing short of having your property or life taken from you will.

    Corwin (ea9428)

  5. Barack Obama (SoA) doesn’t want women to get breast cancer. He would never admit doing anything to put them at risk, even if it would save enough money annually to balance ACORN’s shortfall, or keep him in arugula for 5000 years.

    ropelight (d4e3b8)

  6. Here’s the full text of “Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement.” Which I didn’t see linked in the WaPo.

    m (371e38)

  7. “what gives the right to the government whether you can have a mamagram, a colonoscopy or any other health related service you may want.”

    Everyone wants everything covered. You can of course get these done whenever you want and pay out of pocket, assuming they’re still available after years of lesser coverage under the plan.

    cassandra in MT (5a5d33)

  8. “what gives the right to the government…”.

    The only rights of the government were spelled out over 200 years ago. Since then, they’ve taken control of everything and anything they can get their hands on. And we let it happen.

    Corwin (ea9428)

  9. I think this whole program will push us to a free market health care system with cash payment but it will take away huge amounts of money with taxes, including a VAT, that would allow us to pay.

    Mike K (2cf494)

  10. My wife does CT, Mammo and Ultrasound. To your point, MikeK, most of the biopsies they perform are guided by the ultrasonographer and done with needles.

    She doesn’t like this bs at all.

    Pinandpuller (ac62c3)

  11. You can pay for this yourself–unless such things are illegal. From time to time, news from Canada or the UK illustrates various bureaucratic responses to such shows of initiative.

    Politically, though, not paying for something is easily demagogued into “doesn’t want women to have….” usually abortions. “Forbids….” That sort of thing.
    If the demagogues stay true to form, this will be seen as “forbidding”, even if it’s years before it really is illegal to pay for it yourself. Feminists will attempt to blame the patriarchy, although it’s pretty clear that if they’d voted for the republican side of the patriarchy,this wouldn’t be happening. Gonna be some craniums asploding over that.

    This is going to be a catastrophe. I hope it happens first to the folks who voted for these clowns so I can “remind” them as they flail about.

    Richard Aubrey (a9ba34)

  12. I’m high risk and I’ve have every kind of biopsy out there. So I get the false-positive factor but of course YMMV.

    cassandra in MT (5a5d33)

  13. This unforced error on the part of the administration, coupled with Holder’s pathetic performance against Graham’s questioning, pretty much convinces me that this administration is completely incompetent rather than so smart we can’t even figure out what they’re doing.

    It’s Occam’s Razor–the simplest answer is usually the right one. They are incredibly stupid.

    Patricia (b05e7f)

  14. I have two women in my circle of friends, both of whom were diagnosed with and had surgery for breast cancer before age 50. I am happy that they aren’t “statistics”.

    Bill Roper (15329b)

  15. My wife has mammograms every year, after I kept screaming at her to do so or else (this was before my diagnosis). I wanted her to get them before the usually recommended age, because breast cancer is prominent on both sides of her family (including her mother). She was diagnosed with stage 1 about three years ago, and had a mastectomy. Without that annual screening, who knows where we’d be right now.

    This kind of reasoning is why Canada is such a disaster regarding cancer diagnosis and prompt treatment. People are literally dying waiting for their first MRI or CT Scans – welcome to the future!

    BTW, where’s Myron to come on here and tell us all why this is such as awesome development?

    Dmac (a964d5)

  16. Richard, you can pay for this yourself, but what if you paid for some fucking insurance, and the insurance starts denying your claim, for coverage you bought for this kind of thing, because the government is interfering in medicine.

    That’s exactly the case.

    Dustin (bb61e3)

  17. My wife is apoplectic over the recommendation to NOT teach women self-exam. The justification for not doing so is that too many women create false positives from their self-exam, leading to unnecessary testing such as mammographies and MRIs.

    That is PURELY a cost-benefit analysis.

    Same for the elimination of screening for women over 75. The justification is that even if women over 75 develops breatst cancer that kills them, statistically it doesn’t reduce the life span of women over 75, therefore it’s not cost effective.

    This couldn’t have come at a better time — this is the perfect embodiment of what Obama/Pelosi Care will look like in practice. All judgments about medical efficacy are measured against financial cost — when the taxpayers foot the bill, the measurement will be against the budgetary limitations.

    Shipwreckedcrew (7f73f0)

  18. Nearly all the so-called quality initiatives that have come along, since PSRO in 1978, have been pure cost control measures. There are plenty of example of fraud; I see them every day reviewing workers comp claims, but the ability to measure is so limited that the government looks foolish when it tries. The only way to control utilization is to ask people to pay for routine care. That’s the way it was before health care became a crisis. It won’t be easy to go back but we have to or the whole system will go broke. We are very close now.

    Mike K (2cf494)

  19. Now if Palin had accused Obama of wanting to set up breast panels, the media would have called her crazy.

    The AP would have assigned 12 reporters to fact-check her Facebook page.

    MU789 (4e85ea)

  20. What an unforced error.

    Bubble Boy Barack hasn’t been paying much attention to the popular culture of the last 25 years when breast cancer was incessantly presented as almost as bad as rape to women. YOU need to get a mammogram. YOU. NOW. (or, if you’re under 40, SOON.) That’s my impression of the message being sent, in the same fashion but more intense than all the ads for men getting prostrate screens today.

    Plenty of famous women and private citizen women have had to fight breast cancer in their 40s. Breast cancer being a real concern in your 40s is conventional wisdom.

    So the Bubble Boy blithely continues on his way, drinking in the adoration of his cronies and what he imagines to be the masses, scaring more and more people every day. At first he started scaring people because they didn’t know what the hell was going on, but things definitely were not going the way they’d been promised they were going to go last year. Now they’re figuring it out. Poor Bubble Boy.

    chaos (9c54c6)

  21. This would kill many womens, this idea that the dirty socialists are pushing. The Sebelius one is a liar about how she’s enthusiastically pushing policies what will kill womens to the glory of the dirty socialist state. Someone should key her car.

    happyfeet (71f55e)

  22. “YOU need to get a mammogram. YOU. NOW. (or, if you’re under 40, SOON.) ”

    This is the truth, though. We all need to do this kind of thing, even if it’s not super convenient to our democrat overlords.

    comparing this to rape is another democrat trick… accuse anyone who disagrees with them, or even just wants to live life their own way, of being insane, horrible, ugly, stupid. No, I just want my sisters to be screened for cancer, and the democrats are starting to ration care before it’s too late to stop them.

    Dustin (bb61e3)

  23. Gee, a panel of democrat bureaucrats deciding on policies that will lead to death. If only someone had warned us about these death panels, that person would be well situated to lead the real health care reforms that fix this mess.

    Dustin (bb61e3)

  24. We should put Kylie Minogue and the dirty socialist Sebelius whore in a locked room and go out for a tasty dinner all of us together.

    happyfeet (71f55e)

  25. “HHS Secretary Kathleen Sebelius has been busy misleading the public, noting that the task force’s recommendation is non-binding…”

    There’s a way to make sure that it stays non-binding, and that’s to block socialized medicine.

    That way they won’t get tempted to make it binding.

    Dave Surls (ac98c1)

  26. I just want my sisters to be screened for cancer, and the democrats are starting to ration care before it’s too late to stop them.

    We’re lucky they’re so incompetent, if they’d been smart they’d have gone moderate and passed a moderate Obamacare and then went radical over its actual implementation after waiting a few years. Get Barack re-elected, then start rationing.

    But no these guys are just not good at the politics of governing and we’re very lucky for how bad they are.

    chaos (9c54c6)

  27. chaos, that’s a great point. It is fortunate that they have completely destroyed their chance for a moderate bill. They could have easily made it into a future disaster they would then clean up with a much more forceful bill later… kinda like how they handled the marketplace in general.

    Dwight, surely you’ve read the bill!

    Dustin (bb61e3)

  28. My 23-year-old preganant daughter took exception to the story. Her Facebook post is *ahem* direct on her feelings: “…will be damned if she’s waiting until 50 to get a mammogram, and I am by God teaching my daughter to perform self breast exams. Stupid fricking government and your ignorant jerkoff guidelines. Watch your grandmother die by inches from breast cancer and THEN tell me how long to wait for a screening, assholes.”

    Daddy’s girl.

    MAJ (ret) Kev (d9db9c)

  29. pregnant. Sorry. Not illiterate, just rushed.

    MAJ (ret) Kev (d9db9c)

  30. We need to provide free health insurance to 30 million people because, among a few things, free preventative care makes for a healthier population.

    ………….

    Less preventative care for women is good.

    ………….

    Everyone knows Preventative Care by its very nature is expensive b/c you are analysing a huge data set in order to find outliers for even more expensive treatment.

    By the notion presented by our Government, all Preventative Care Protocols in medicine should be dumbed down to save money, eliminate expensive testing and so on.

    HeavenSent (01a566)

  31. So what gives Obonehead?

    Are we about Preventative Health Care to live longer, healthier lives or are we about rationalizing resources and manipulating prices to save money?????????

    HeavenSent (01a566)

  32. When my wife married me, I was in the Army. They gave her a book called “Take Care of Yourself”. Army healthcare at Ft Sill was not very good back then (there were several deaths that seemed to be from incompetent medical attention), so my wife did not use their health care at all. But that book was pretty handy.

    The government will tell us what to eat, to exercise, not to smoke, and how to handle basic problems. Of course, we already have the internet for that. What the government meant by preventative care was the stuff they don’t have to pay for. Government is power… it is not love. The government doesn’t care whether my wife or sister dies of cancer… they care if their tax money, power, and pork is able to buy the leaders a lot of favors and security.

    But this is America, and I have faith that we’ll handle this.

    Dustin (bb61e3)

  33. Dwight @ #27 – From the link that Karl provided above …

    (See Section 222 of the House-passed bill, “Essential Benefits Package Defined.”)

    JD (d606fc)

  34. At the point they said it wasn’t “cost effective” … d’oh, that was stepping in what they’d left on the stage.

    htom (60941d)

  35. Dwight, surely you’ve read the bill!
    Comment by Dustin — 11/19/2009 @ 2:30 pm

    Dwight was a sockpuppet of Andrew/Newt/multiple others, who was banned by Patterico. His comment was removed and deleted. As I’ve told Andrew (and anyone else who was trying to get around being banned), take it up with Patterico if you want to comment here.

    Stashiu3 (44da70)

  36. Remember when preventative care was going to save trillions and doctors would quit hacking off diabetic feet instead of using preventative care? Some preventative care is more important than others, apparently. Barcky and his socialist takeover of the healthcare system have showed women where they rank. Now, when you diagnose cancer, it will be stage 3+, instead of precancerous or Stage 1. Can’t you just feel the love?!

    JD (d606fc)

  37. Of course there is going to be some cost benefit analysis involved in the recommendation. There was with the rec for 40. Women can get breast cancer at a younger age, bit nobody is outraged that the current recommendation isn’t to start at 20 or 30. Women can also get other kinds of cancer- like brain cancer. But there is a cost benefit analysis recommendation not to get a brain scan every year.

    To me, the appalling part of this debate are the people who want govt health insurance, but Can Not Believe the govt is going to make cost decisions regarding their care. Or who don’t want decisions based on politics but are willing to fight the govt on recommendations that don’t suit them.

    MayBee (1f5ee5)

  38. Maybee, they not only don’t believe the government will make these decisions, but those who do believe in reality are called insane.

    Dustin (bb61e3)

  39. Maybee, that’s the crux of it. I don’t like the panel guidelines, which, in the view of many experts who have weighed in, are deeply flawed in both assumptions, methods, and analysis and predictions; but the overarching problem is that the panel is using pretext of “health” to save money for “the system.” In that case I’d like to opt out of that system and get one that is concerned with my individual well-being.

    SarahW (692fc6)

  40. Maybee, that’s the crux of it. I don’t like the panel guidelines, which, in the view of many experts who have weighed in, are deeply flawed in both assumptions, methods, and analysis and predictions; but the overarching problem is that the panel is using pretext of “health” to save money for “the system.” In that case I’d like to opt out of that system and get on that is concerned with my individual well-being.

    SarahW (692fc6)

  41. And I think people need to internalize this message: prevention care can not be counted on to lower health spending costs. Increasing prevention care for everyone will be very costly.

    These BC guidelines are meant to make us more in line with European practices, but American breast cancer diagnosis and treatment is superior in the states. I see this as a move to medical mediocrity, as herd husbandry becomes the mindset.

    Expert discussion on the panel findings can be found in the comments of this medpage article.

    SarahW (692fc6)

  42. Dustin.
    Exactly. But the point is that, even without private coverage for the government to effup, even with nothing but government insurance, you’ll probably have a problem with the Big Boys if you try to pay for it yourself.

    Richard Aubrey (e34121)

  43. Can’t wait for the new, improved guidelines on Prostate Cancer Screening.

    AD - RtR/OS! (e03258)

  44. Now, when you diagnose cancer, it will be stage 3+, instead of precancerous or Stage 1.

    Take it from one who has a little experience with that diagnosis – for the vast majority of cancers, when you get to Stage 3 (or Stage 4), you’re basically in deep sh-t. And guess what? Your treatment’s likely to be much lengthier, much more painful and thus a hell of a lot more expensive to treat in the end. So the taxpayers wind up paying through the nose for something that might have been much less expensive to treat, if it had been caught in the earlier stages.

    Unless the gov’t denies your treatment in the first place, then we’ll all save tons of bucks via your prompt expiration. Or is that the unspoken reality here?

    Dmac (a964d5)

  45. Well, we’ll make a deal in Afghanistan, corner the opium market, and provide free morphine to all of those terminal cancer patients; and, after 6-weeks or so, your friendly “Morphine-Man” will give you a double/triple dose, and they can close your file.

    AD - RtR/OS! (e03258)

  46. There is such misunderstanding about preventive care. There is early diagnosis, which mammography is. There is screening, like routine chest x-rays for lung cancer, a practice that ended in the 60s when they figured out it didn’t help. Early diagnosis for lung cancer doesn’t help. Early diagnosis for breast and prostate cancer does help.

    Preventive care is immunization and public health. Clean water is preventive care. Obesity and smoking are subjects for preventive care. Breast cancer is not. Preventive care can save money but there is no preventive care in the bills, except possibly immunization.

    One thing that mammography does do is prevent stage IV cancer by leading to cure at stage I. But it doesn’t prevent cancer except in one instance; that is DCIS or precancerous breast lesions. My sister had this in 1982. Against her surgeon’s advice, I told her to have bilateral subcutaneous mastectomies. She did and they found invasive cancer in one area. That was 27 years ago. It didn’t save any money, except maybe the cost of caring for her advanced cancer a few years later had she taken the advice of the people who didn’t want her to do anything.

    A few years ago, I heard a rant by a leftwinger about how some male doctors told women to have mastectomies even though they didn’t have cancer. Yup. That person probably voted for Obama. She’ll get her wish now.

    Mike K (2cf494)

  47. One of the best ways to prevent obesity is to keep smoking I think.

    I think with a high degree of certainty really.

    happyfeet (b919e7)

  48. Congressman Alan Grayson, Democrat – Florida 8th had a sign, I recall, on the floor of the House. It said that the Republican Health Plan was for people to “Die Quickly.” Could he have been talkin’ about women?

    I’d bet he might like an opportunity to revise and extend his remarks, especially if he was going to a Town Hall meeting.

    ropelight (14fb9b)

  49. Hi Mr. Karl. Do you think we have Newt Gingrich and his bitter bitter scozzawhore to thank for this? I rather think we do.

    happyfeet (b919e7)

  50. This subject could use some dispassionate discussion, with apologies to those who have been personally affected. Trying to come up with a guideline for these types of cases is difficult at best.

    Preventive medicine costs money too. Testing everyone for everything all the time is not practical. It is about tradeoffs unfortunately.

    What is the cost of the annual routine mammograms, along with the false positive resultant actions?

    What is the cost of treating the found cancers?

    What is the probability of finding the aggressive, critical cancers during these routine annual exams? For at risk woman? For low risk woman?

    Based on the anecdotal evidence, the reality would seem to be at risk woman should probably get intense exams twice a year starting at age 30, or earlier.

    But is that relevant for low risk woman?

    jeff (31e059)

  51. I have heard that the prostrate testing guidelines are undergoing similar scrutiny. While not as devastating as breast cancer, prostrate cancer is a concern for many men.

    Also, don’t forget, men also get breast cancer. Should they be tested?

    jeff (31e059)

  52. sorry, prostate

    jeff (31e059)

  53. There is a whole literature about cost-effectiveness analysis. For example, routine sigmoidoscopy finds colon cancers. So does colonoscopy. The cost for one cancer is about $300,000. That is actually what the numbers are. This is a complicated area. The politicians know nothing about this.

    It’s depressing.

    Mike K (2cf494)

  54. My only comment is that, in the health-care debate, this seems to be a foolish card played well too soon.

    Health organizations, from the American Cancer Society to Komen, have been pushing for the early detection of breast cancer for decades — for good reason. It is a mantra among those organizations. And now they’ve been gob-smacked and are trying to wrap their heads around this “finding.”

    They’ll come around to the task force’s opinion, though. They long ago gave up their political souls to the Democrats. But it will be costly, not only in respect and common sense, but in lives.

    Ag80 (3d1543)

  55. Mike, you’re right, there’s a cost analysis that is pretty complicated. And far from one size fits all, of course.

    It makes more sense for each of us to decide what we want. Do we want to aggressively seek out cancers? Do we have reasons to believe we might have certain ones? Is it worth the cost, to us, of performing this or that test?

    This is freedom. Freedom isn’t ever a black and white roadmap. Obama wants to control what we can and cannot do… what levels of prevention are ‘right’. I just want to chose for myself, for the rest of my life, which expenses I am willing to incur. They only have to win once. As soon as Obama has signed something, Game Over.

    Dustin (bb61e3)

  56. To AD #43 and jeff #51,

    No need to redo prostate guidelines, ALL prostate screening is currently USPSTF grade D and will not be covered (only A & B are to be covered).

    I read the coverages of the original House bill and understood the restriction…one of the few specific clauses. The current bill expands the verbage but changes not the meaning.

    Teflon Dad (287a17)

  57. Does anyone here, from the Medical field, know anything about the situation in the UK as regards pap smears. As I recall what I have read in the US all women are recomended to have such tests performed annually as soon as they are sexually active and starting at age 21 at the latest. Insurance companies are required (by the government) to pay for such tests.

    In the UK the recomendation is for women over 30 to get the test, and women under a certain age (25 IIRC) are forbiden to have the test under NHS. Some women (who have a history of relevent health problems in their families) have gone ahead and gotten the test and found issues only to have the NHS refuse to cover the discovered medical condition because it was found as the result of an illegal test.

    The specific case I recall reading about was of a 23 year old who was refused treatment for Uterine or Cervical Cancer.

    Have Blue (854a6e)

  58. Have Blue, that’s a tremendous tragedy.

    It’s worse when your state, basically an extension of your people’s power over you, does a thing like that. Refusing treatment because someone didn’t go by the government recommendations? I would not be surprised at all if that came to America.

    If only they would let the states decide if they wanted these systems, then Americans could move to places that followed their preferences.

    Dustin (bb61e3)

  59. Wonder why this congress is more interested in Obamacare than in economic/job recovery?

    krusher (87eaf3)

  60. Sorry if i am repeating, I havent read all 59 posts yet…. but…
    There’s one other factor overlooked here.
    The bureaucrats in charge of these programs make these recommendations based on “years of productive life” remaining.
    These are government employees, basing their decisions on how many more years a person can be productive to the the government
    Congratulations citizen, now when a bureaucrat decides you cost the state more than you pay in taxes, they cut off your care.
    This is the very reason why you dont want the government running so much of the economy, it begins to believe that is is the economy, and the taxpayers exist to serve the machine.
    I seem to remember a quote from the president recently saying “this budget is the economy” or something along those lines.

    thatguy (eb09ed)

  61. “Obama wants to control what we can and cannot do… what levels of prevention are ‘right’. I just want to chose for myself, for the rest of my life, which expenses I am willing to incur. They only have to win once. As soon as Obama has signed something, Game Over.”

    Obama and other reformers are very concerned with management of a herd, where they are shepherds and you are flock.

    Maybe they really believe Physicians are accused of having abandoned their professional outlook in favor of money-making and marketing – scaring unwarranted screens/tests/procedures/treatments on patients.
    Maybe they really believe Patients arignorant cows who have no clue, no voice, no unique individual circumstances to consider, no ability to weigh evidence, history, etc, even with advice of their own doctor, and/or are hapless victims of incomplete advice skewed towards profitability.

    The solution to everyone’s agitation is to put routine care costs in hands that restore the proper notion of who is in control…the individual patient in consultation with the physician.

    Untaxed Medical savings accounts and transparency of cost for routine care give patients every incentive to understand the relative risks and benefits and to choose what level of risk, how much anxiety or what possibility of overtreatment exists, and keeps other people from deciding for you based what is most cost effective to maintain a herd.

    SarahW (692fc6)

  62. While not as devastating as breast cancer, prostate cancer is a concern for many men

    Point of fact, if its not caught early, prostate cancer is just as devastating if not more so than breast cancer. Non-metastatic carcinoma of the prostate has a fantastically high cure rate, metastatic prostate cancer is uniformly fatal. In a previous job, I was working on treatments for CaP and believe me, once it has spread, that’s it.

    thatguy (eb09ed)

  63. Have blue, what you described might very well be the most horrifying thing I have ever read. Do you have a link? My understanding of cervical cancer is that the high risk age group starts at 25?
    I know I have had women that I know very well need treatment of at least precancerous lesions in their 20’s. if one of them were refused treatment or denied a screening procedure that resulted in a horrible disease, in my mind that is perfect justification for violent action.

    thatguy (eb09ed)

  64. Cost-cutting is what these panel recommendations are about.

    That said, there is a long controversy about whether early screening has a mortality benefit in younger women.

    When my mother was about my age, back in the seventies, she deferred her mammogram; she did not want the radiation exposure (which was higher in those days), there no clear benefit to her, she had no special risks of breast cancer and some characteristics associated with a lower risk of cancer.
    She had read and understood the current controversies.

    And it’s a long running controversy.

    For her trouble, the doc wrote a Seinfeldian snark in the margins “Patient reads too much”. She was able to stand her ground, though, and her thoughtful gamble served her. (I should add that when older and the benefits of mammography were clearer, she took advantage of screening tests.)

    What bothers me most about the panel recommendations is that, unlike earlier controversy centered on data not supporting ANY mortality benefit for routine screening of women between 40-49, the research and the panel itself acknowledge there is a clear mortality benefit to annual screening for women in that age range.

    The controversy has changed in character, its not that lives are not extended with early detection of breast cancer in that age range, it’s not that there will be no increased mortality if the new guidelines are adopted. The goalposts have shifted.

    SarahW (692fc6)

  65. Back when the Clinton proposal was in play I read an article by the person that was head of the Hastings Institute, a bioethics think tank.

    His point was also that preventive care/screening and cost savings don’t generally mix. He said that one way to save costs, if that is the goal, was to stop giving childhood immunizations. In that scenario more people would die young and relatively quickly, and less to die of chronic illness in old age. Obviously, he was not advocating for that, but just pointing out the logical inconsistency that is introduced when the goal of health care becomes something other than health care.

    MD in Philly (227f9c)

  66. Someone above compared it to managing the health of a herd, say of cattle or pigs. Quite a lot is known about this, it’s a big industry.

    For cattle or pigs, or chickens, there is very probably detailed information about diagnosing when the animal has reached the point of diminishing returns.

    The same issues of profit and so forth are involved. There is the minor difference that we Americans vote, but if gov. controls our health care, it has gone a long way toward controlling our votes.

    jodetoad (059c35)

  67. One thing that has not been talked about is that the guidelines also ban payment for “clinical breast exam” for women over 40. ALL women over 40. That means the doctor can’t teach self exam and can’t do a breast exam. I said before, this is pushing us to the point that routine care will be paid for personally or you won’t get it. I’m OK with that but why is all the money being collected ? They aren’t going to provide care for that money. It will go to bureaucracies that determine what we should do with our lives.

    Mammography has about a 30% false negative rate when cancer is present, especially in young women.

    Mike K (2cf494)

  68. Now in addition to foregoing mammograms they want to do pap smears for cervical cancer every other year.

    This amounts to attempted murder of all American Woman as well as Political Suicide.

    MaaddMaaxx (b91eb0)

  69. “the guidelines also ban payment for “clinical breast exam” for women over 40” Mike K.

    Thanks for that bit of info. Pretty unfathomable.

    Similar to the issue about legislating for reimbursement about end of life discussions. In defense of the decision, some stated that it was an important thing that was currently not covered by Medicare. I assumed that was true, and that argument did more harm than good, in my opinion. If a doctor spends 20 minutes discussing end of life issues with a patient and the family, is that not worthwhile? Is it expected to be a donation of time? Is the doctor “not allowed” to provide an “unnecessary service”? What third party has business dictating what is important in a discussion between a patient and the doc?

    [The point is not to maximize profit for the non-docs, but more often than not, the time taken for such discussions ends up coming out of the time belonging to spouse and children.)

    MD in Philly (227f9c)

  70. Can Democrats prove they aren’t callously putting women at serious risk just to save a few bucks?

    I know Dems want to pass healthcare, but I had no idea they were willing to go this far.

    ropelight (962db0)


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