Health Care: A government task force has decided that women
need fewer mammograms and later in life. Shouldn't that be between patient and
physician? We have seen the future of health care, and it doesn't work.
We
have warned repeatedly that the net results of health care bills before
Congress will be higher demand, fewer doctors, more cost control, all leading
to rationing. New recommendations issued by the U.S. Preventive Services Task
Force (USPSTF) regarding breast cancer and the necessity for early and
frequent mammograms do not convince us otherwise.
Just six months ago, the panel, which works under the Health and Human
Services Department as a "best practices" study group, was shouting its
concern about a Centers for Disease Control and Prevention study showing a 1%
drop in the number of women regularly undergoing such screening and
prevention.
The task force was saying that women older than 40 should get a mammogram
every one to two years. It found that frequent screening lowered death rates
from breast cancer mostly for women ages 50 to 69. But that was then, and this
is now.
"We're not saying women shouldn't get screened. Screening does save lives,"
Diana Petiti, task force vice chairman, said of the recommendations published
Tuesday in Annals of Internal Medicine. "But we are recommending against
routine screening."
Now the panel recommends that women in their 40s stop having routine annual
mammograms and that older women should cut back to every two years. The
concern allegedly is that too frequent testing can result in increased
anxiety, false positives, unneeded follow-up tests and possibly disfiguring
biopsies. Preventing breast cancer and saving lives almost get lost in the new
analysis.
"I have a particular concern in this case about who was involved in this
task force," says Rep. Charles Boustany, R-La., who was a heart surgeon in
private life. "There are no surgeons or oncologists who deal directly with
breast cancer or even radiologists. ... I've seen far too many young women
develop late-stage breast cancer because they didn't have adequate screening."
Little, if anything, has happened medically in the last six months to cause
such a shift. A lot, however, has happened politically as a health care
overhaul has limped forward on life support. The Congressional Budget Office
has been busy pricing these various bills, a process that includes screening
and prevention.
As we have warned, the growing emphasis seems to be on cost containment
rather than quality of care. About 39 million women undergo mammograms each
year in America, costing the health care system more than $5 billion.
"The American Cancer Society continues to recommend annual screening using
mammography and clinical breast examination for all women beginning at age
40," says Otis Brawley, its chief medical officer. "Our experts make this
recommendation having reviewed virtually all the same data reviewed by the
USPSTF, but also additional data that the USPSTF did not consider."
Daniel Kopans, a radiology professor at Harvard Medical School, says: "Tens
of thousands of lives are being saved by mammography screening, and those
idiots want to do away with it. It's crazy — unethical, really."
This, sadly, appears to be the future of medicine under government-run
health care. Aside from taxes on insurers, providers and device manufacturers,
we'll be up to our eyeballs in cost-effectiveness boards that will decide who
gets what tests and treatments, when and if. These are only recommendations
for now, but they are the shape of things to come.