Another Mammogram Voice

by Admin on November 20, 2009 · 3 comments

in News, Patients, Payers, Providers

I feel compelled to add my voice to all the others talking about mammograms.

I spent years married to a radiologist who did nothing all day but diagnose DCIS and other cancers. He prided himself on his ability to diagnose ductile carcinoma in situ, and he thought he was saving lives. He didn’t know that many of those never progress, and in fact go away. He died before digital imaging became the norm, and he started to practice before doctors appreciated the dangers of overexposure to radiation. Like many radiologists, he died of cancer.

So my thoughts about mammograms are very complex. I’ll try to sum them up.

1) in America, we overdiagnose many diseases and treat things that don’t need to be treated.
2) medical knowledge is constantly changing
3) most medical knowledge is merely opinion
4) suggesting that we now overexpose women to needless radiation and biopsies isn’t rationing — it’s sound science for today
5) breast cancer and prostate cancer have something in common: they subject men and women to assaults on their dignity and sexuality, sometimes for nothing
6) men and women should be able to make their own choices about screening, so I’m glad insurance is still going to cover mammograms for women in their 40s
7) even my husband used to say that mammograms were not as good at detecting cancer as other forms of imaging for high risk women

See how complicated this is? It’s unfortunate that the panel of “experts,” which apparently didn’t have a breast cancer expert on it, released this while we are debating health care reform. It’s easy to see this new guideline as a way to ration care under “Obamacare.” Between this and the Stupak amendment, it is easy to draw the conclusion that we’re bending the cost curve over the backs of women.

But again, it’s complex. We’ve found out the same things about prostate cancer screening, so it’s not just about women. This is what is known as “evidence-based medicine” : let’s spend the money on things that do work, rather than pitch it away on things that don’t. That makes sense, doesn’t it? Why waste scarce health care dollars. Let’s only do things that are proven to work.

I’m a fan of outcomes-based medicine. I long ago learned that most back surgeries don’t work (for long), and that surgeons sell surgery as a panacea the way pharma sells drugs as a panacea. If we were spending our own money, and not the government’s or an insurance company’s, believe me we’d be finding out the most effective (and cost-effective treatments) before we authorize anything. It’s only because medicine is mostly paid for by third parties much removed from ourselves that we demand everything.

I don’t have the answers. I just want to raise the right questions, and keep us talking rationally instead of degenerating into ideological rants about science-based findings.

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