Elkhorn Creek Lodge

Mammograms And Rationing

Posted in medical by Eugene Podrazik on November 19, 2009

The U.S. Preventive Services Task Force (USPSTF) steps up to the plate, swings and whiffs.  In the face of other recommendations, it recommends that screening mammograms be started for women above the age of 50; instead of the current practice and recommendation of starting at age 40.


“While the bills are still being drafted and debated in Congress, health insurance reform legislation generally calls for the task force’s recommendations to help determine the types of preventive services that must be provided for little or no cost. The recommendations alone cannot be used to deny treatment,” he wrote.  (white house deputy communications director Daniel Pfeiffer; see above link)

And, from HHS Secretary Sebilius,

“The U.S. Preventive Service Task Force is an outside independent panel of doctors and scientists who make recommendations. They do not set federal policy and they don’t determine what services are covered by the federal government.” (see above link)

Of course.  And, of course.  The 900 pound gorilla that are the proposals of Obamacare will just docilely let doctors and their female patients make that mammogram decision on their own.

It’s probably true that there’s probably valid science behind the recommendation.  Some of my gynecological colleagues seem to think so.  It’s probably true that no, absolutely no, considerations of money were brought into the final decision.  But, it would be nice to know who sat on that panel and who paid them.  Full disclosure of funding is now standard by any presenter at any medical meeting for purposes of continuing medical education.

This is no different that my dealings with managed care back in its height in the mid-90’s.  I remember one incident where I was counseling a go slow approach for a series of medical tests only to have the patient challenge me on the basis I was shilling for the insurance plan by making that recommendation for a slower approach to treatment.  I was, in fact, trying to counsel not to pushing a surgical decision until we had exhausted all reasonable non-surgical options.  But, like our current congress, any remote affiliation with an insurance company destroyed all credibility.  That’s why I like to work for myself, in my own practice.  There is not even the appearance of working for anyone but my patient–I know, very quaint.

You also have to shake your head at this arrogant tin-eared administration in launching its first rationing recommendation on an incredibly emotionally freighted subject like breast cancer.  Not to say that this is all pure emotion, since breast cancer is the number two killer of women in this country.  Should have stepped off with, say, vaccinations of delta smelt.

So, you have the debut of health care rationing.  First, it demonstrates how political and how politicized every medical decision will become.  Instead of a physician and his patient quietly discussing the pro’s and con’s of a mammogram screening at 40, we will now have those heretofore decisions now shouted out in every congressional office in Washington, D.C.  Personal medical decisions will now be poll-driven by senators and congressmen fearful of losing the next election.

Whatever the merits, this decision will be shortly rescinded.  Probably, as a clause inserted in one of the health care reform bills now swirling around the halls of congress.  But, given the rank dishonesty underlying the push for ‘health care reform,’ whatever merits there may have been for this new mammogram recommendation will now be lost in a federal government that has no credibility.  That’s what happens when you try the bait-and-switch tactic of “never letting a crisis go to waste.”

Then, the tort bar will weigh in.  Which decision will sway a jury?  The USPSTF recommendation of mammograms over 50 or the American Cancer Society’s recommendation of mammograms at age 40, reiterated in the maw of this controversy.  Chances are that half of the jury will be women; and, women suffering from breast cancer make sympathetic plaintiffs.  Will congress be willing to protect physicians by making the USPSTF binding in any tort action?  Again, of course.

Welcome to the new world of identity politics.  Every disease will now have to have a lobby.  And, disease management will now hinge of who can deliver the campaign cash and stuff the ballot boxes on election day.  ACORN and mammograms anyone?


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  1. Mammograms And Rationing | health said, on November 19, 2009 at 1:37 pm

    […] The rest is here:  Mammograms And Rationing […]

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