normal mammogram
AMA: “The American Medical Association adopted a policy at its annual meeting Tuesday that says all women ‘should be eligible’ for screening mammography at age 40, taking a stand in a continuing debate over the benefits and drawbacks of certain preventive services.” In 2009, “the US Preventive Services Task Force (USPSTF) caused an uproar when it recommended against routinely providing mammograms to healthy women before age 50 because there is some evidence that the net benefit is relatively small.” CQ points out that “Health and Human Services Secretary Kathleen Sebelius said afterward that the task force does not set government policy and that women across the country were worried and confused by the recommendation.”
MedPage Today (6/20, Walker) reports, “A number of medical groups, including the American Cancer Society, the American College of Radiology , and the American Congress of Obstetricians and Gynecologists disagreed with the USPSTF recommendations and said women younger than 50 benefit from having routine mammograms.”
BLOGFINGER MEDICAL COMMENTARY By Paul Goldfinger, MD, FACC
One of the characteristics of the new healthcare plan will be an attempt to force doctors to follow practice guidelines. In principal, I support the use of guidelines if they are written by physician experts, if doctors retain control over patient care, and if they contain flexibility for the individual situation. For a doctor who practices evidence based medicine and who places the best interest of the patient first, there is nothing to fear in such guidelines. In fact, such guidelines may reduce law suits, because if the doctor follows guidelines, his actions may be more defensible in court. But, as you can see, sometimes these guidelines are wrong, and doctors need to be vigilant as occurred in this mammography situation.
These mammography guidelines were established in 2009 by a “Task Force” which has been in existence since 1984, under the auspices of the Department of Health and Human Services. The new guidelines were controversial when they came out and they still are. The panel originally consisted of 16 doctors—experts in the field of preventive medicine. But with the passage of the new healthcare law, another bureaucracy has been layered on top and placed in charge. They are AHRQ –the Agency for Healthcare Research and Quality.
I am very suspicious of bureaucrats meddling into medicine and I am worried that medicine will be run by government bureaucracies. Note above where Kathleen Sibelius, in discussing the guidelines, refers to “government policy.” I have spoken to a number of practicing doctors, and they all express similar concerns about guidelines, electronic medical records, new mandates to give GP’s the keys to the kingdom, and huge healthcare organizations created by mergers. A number of respected physicians have said to me, “You got out just in time.” There is confusion and low moral regarding the future of healthcare. I’m happy to see the AMA and other specialty organizations speak out for the benefit of patients.
The public needs to pay attention to what happens with healthcare. Don’t be fooled into thinking that higher quality and lower cost will occur together.
The Government should not be both a payer and a determiner of coverage for whom it pays– that is a huge conflict of interest. It is exactly this conflict that drives so much opposition to any expansion of the Government’s role in health care in this nation.
A key objective of the Government — and other entities that “manage” care –is to minimize cost. Their very sneaky way to do this is to apply a population-average approach to indiviual situations (via guidelines that physicians have to follow in order to get reimbursed for their services). Since few people are “average”, few will get the type of care that will be optimal for them as individuals (including considerations of patient preferences such as getting a pill rather than an injection).
A population average approach to evaluating new therapies is similarly bad for patients. Consider a cancer therapy that improves the population of users’ survival by only 5 months on average. However 10% of patients live 5 more years. In this case, the Government would say that the drug is not worth the cost — and they would not reimburse it. This happens in many other countries including the UK.
If you want the best possible care, you will not want the Government telling your doctor what’s best for you. The slope here is very slippery….