To Hell With “Government Experts”, Keep Feeling Your Boobies

As an engineer, I’m quite familiar with the concept of the feedback loop, root cause analysis, etc. when it comes to preventive maintenance. For example, lets say you’re supposed to change your oil every 3,000 miles. But over time, it’s discovered that your car’s engine runs just as well and doesn’t wear any worse when the oil is changed every 5,000 miles. The obvious cost-savings is further bolstered by costs saved due to a reduction in the chances that the local lube shop will break something while performing this routine maintenance. (Generally, studies show that up to 20% of machine failures are introduced through scheduled maintenance).
It looks like the new recommendations that include pushing breast cancer screenings to 50 years old from 40 years old and advising against women performing self-breast examinations is based on a similar process.

The U.S. Preventive Services Task Force, a government panel of doctors and scientists, concluded that such early and frequent screenings often lead to false alarms and unneeded biopsies without substantially improving women’s odds of survival.
“The benefits are less and the harms are greater when screening starts in the 40s,” said Dr. Diana Petitti, vice chairwoman of the panel.
Dr. Eric Braverman, a clinical assistant professor of integrative medicine at Cornell Weill Medical College in New York, also backs the new guidelines, arguing that mammograms are not nearly as effective in detection as some other tests, like MRI’s and ultrasounds.
“I’m not impressed by mammograms in general,” said Braverman, who called manual examinations a “total failure.”
“I support the new guidelines because I think it will lead to better testing. [The ultrasound] is a better screening procedure that’s safer and easier and picks up things fast,” he said, adding that he thinks women should receive ultrasounds as part of their routine medical exams, beginning at an early age.

The problem here is that people aren’t machines. When your talking about human life, the anecdotal examples that fall outside of the guidelines prove to be the rule. For every 5 false-positive 43 year olds, there is another 43 year old (or younger) who caught her breast cancer thanks to the current guidelines. There is no commensurate dollar figure.
Meanwhile Health and Human Services Secretary Kathleen Sebelius has said that “our policies remain unchanged” and that she “would be very surprised if any private insurance company changed its mammography coverage decisions as a result of this action.” Wanna bet? Dr. Cynara Commer, a professor of surgery at Mt. Sinai’s Surgical Oncology Department in New York…

…is very concerned that the new guidelines are the top of a slippery slope toward rationing, and questioned the timing as the Senate is about to vote on health care reforms that could end up containing a so-called public option.
“The government-run insurance companies are definitely going to be using these federal guidelines as opposed to using the American Cancer Society guidelines, and the American Cancer Society is not going along with these guidelines, and we can only hope that the private insurance companies don’t follow suit,” she said.
“I think it’s coming down to saving costs. I don’t think we should be doing that at the expense of women,” she added.

And men, don’t take this sitting down. Your ass (colonoscopy guidelines) could be next.

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14 years ago

Allelujah! Every word.

14 years ago

Very impressed with this article Marc and it sums up nicely the intent on changing the landscape of medical treatments here in America.

14 years ago

In a parallel universe where there is no government control over testing, this might eventually emerge as a better protocol. Or not. Decided by scientific and medical debate.
In this universe, it is seen as an unwarranted intrusion by government into medical decision-making. Rightly so, too. With the government paying, changes that save that government some money will always be suspect. Even if the change is beneficial.
Government shouldn’t be a player. A limited referee, yes.

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