Breast Cancer Test Balloon


November 17, 2009 | Comments

Stop the presses, ladies! And stop those self-examinations. Yesterday a government panel – the U.S. Preventive Services Task Force, part of the U.S. Department of Health & Human Services – which influences Medicare and the insurance industry, announced a change in recommended guidelines for breast cancer prevention practices.

For years now, the American Cancer Society has recommended that women begin annual mammograms at age 40, accompanied by monthly self-examinations at home.

The new guidelines: Begin mammograms at age 50 and repeat every two years. And those self-exams at home? Forget them. In fact, those techniques, said this panel, should not even be taught anymore. Previous recommendations, they claimed, have led to too many false alarms, which lead to too many unnecessary biopsies (and thus, though not officially announced but certainly implied, unnecessary payouts for said biopsies).

While I have yet to hear any official fallout from this, I have conducted my own little fallout myself. I personally know three women whose breast cancer was identified in the early stages – and before they had reached age 50 – because of mammograms and self examination. All three are still with us today, grateful, I’m sure, that they were subject to the previous guidelines, as under this new set, they would be gone. Indeed self-examination, in particular, deemed of “no value” by this panel, was the very key to the survival of a family member of mine. No value, you say? She would beg to differ, and so would we, her family.

But I have a feeling that the survival of the women in my life, and yours, who survived because of genuine preventive practices, is of no concern to this government panel, or any other government panel we are likely to see in the future. Let’s be honest and substitute the phrase “cost-cutting” for the word “preventive” in this task force’s name, and think about what this group is recommending.

What I gleaned from reading the new guidelines is that too few lives are saved by earlier diagnostic intervention. My question back at them, then, would be: So whose lives will we be sacrificing? Will it be mine? My daughter’s? Your daughter’s? Our moms’?

I suppose we should get used to this, though, folks. Perhaps this was simply a test balloon floated to see what kind of response an announcement about restricting proven life-saving diagnostic tests would garner. For months now we have been told that this is the direction we must take in the name of fairness and health-care reform. We have heard plenty about the magical cost-cutting powers of prevention, too, but we apparently have to accept that there will be casualties along the way. Hope and change come with a price, you know. Yes, they do. But sorry, I’m not buying.

You see, no matter how many lives, how many women, they deem an acceptable loss, it’s too late. I will not accept these guidelines because I know all too well that those previously in place save lives, pure and simple. They saved the lives of women in my life – and I am sure the lives of women in your life, too, women who are with you today because of early mammograms and self-examination.

This panel, and, I suspect, the agenda that drives it, would call our survival stories anecdotal evidence. I would, in turn, call that bean counting. And I would call it unacceptable.

Betsy Siino

So the lowering of the quality of healthcare has started already even before the government totally gets its hand on our healthcare.

The government can't win a war, or come in out of the rain. Cut medical costs by having tort reform. Ha! Lawyers donate to campaigns.
I do think that there is a problem with elder care. We are way overtreated. Phneaumonia used to be the old man's blessing. Now, they save him so they can make a fortune on all the obvious ills that will befall him. I get particularly pissed at the lack of pain relief given to old terminal patients. Big deal if they become addicts.
I agree with Jon. I had BC at 65. It was caught early because I had regular mammograms. I'd done them since they were first available.
Vote NO to government health care. It's really government death care.

Kathleen

Obviously, I am not more knowledgeable about breast cancer than a government led panel of experts. Yet I know enough to look askance at advice that only women 50 and older get mammograms every two years and those in their 40s skip the test altogether.

New cancer-screening guidelines, published in the Annals of Internal Medicine, fly in the face of conventional wisdom and longstanding consensus from cancer groups, radiologists and other experts that women get annual mammograms starting at age 40.

Science routinely second guesses itself and women have often been caught in the middle. The controversy about estrogen-replacement therapy is one example.

Moreover, the U.S. Preventive Services Task Force isn’t nixing mammograms. They acknowledge the test’s early detection benefits.

But here’s what galls me: Not enough lives are saved, the experts say, to justify mammography as a routine screener for breast cancer.

Here’s a question: Of the lives saved by mammograms, which ones weren’t worth the effort? Certainly my sister’s life — saved not only by a mammogram’s detection of something amiss, but subsequent biopsies, surgeries and rounds of chemotherapy — was worth the effort more.
But, says the panel of experts, mammograms’ potential for harm outweigh their benefits. In about 10 percent of cases, they produce falsepositive results.

The solution is not to take away a woman’s choice have mammogram, but rather to work to reduce the rate of false readings.

Would I prefer forgo a mammogram? Absolutely. But spurring me on is not just my family narrative, but this reality: Breast cancer kills more women than any other cancer except lung cancer.

Last year, more than 182,000 American women were diagnosed with invasive breast cancer and 40,000 died of it.

Adding to my annoyance is this intrusion of politics into medicine. Under healthcare-reform legislation in Congress, the new recommendations would help set standards for what preventive services insurance plans would be required to cover.

Have firms just been given a green light to refuse to cover mammograms for women under 50? If so, at nearly $200 a test, women of modest means have been dealt a life-threatening blow.

I know science must operate in large statistical terms but people are not numbers. If the life saved by a mammogram is my own, I am more than justified in wanting routine screenings.

written by Lynne Varner

The poor think this is great. It's not. My mother taught me that with money, most medical things can be taken care of. For example, if we outlaw abortions, or won't cover them under insurance, really no problem with money. Just go to another country. London was the town of choice in my mother's day.
When I had BC, I joined a BC group. I got quite an education in Managed Health Care. My insurance paid for whatever crossed my mind with no copays and no refferrals needed. Their insurance was a nightmare of being sick and having to go to the Doctor of the MHC choice (definitely not even close to the best) and fill out a lifetime of paperwork to get reimbursed. It was awful. Frankly, many of them died because of the wrong doctor or delayed care.
Any government plan will be even worse. When money gets tight, people will die. Just a fact.
If this is so great, then the federal and state employees should give up their staggeringly expensive plans and go on the new one. How much do you want to bet that they are exempted and will continue their great free coverage, at taxpayer expense.

Kathleen

You are 100% right K

I'm staggered that INTELLIGENT people are saying "no to government healthcare". You have the unhealthiest population on the planet. Your government spends the most per head of population on health care BECAUSE of the system you have where private hospitals rake in the dollars because they "care" for people. All national health care systems have faults - as do all governments - yes, there are problems - why not try to solve those problems rather that saying government healthcare shouldn't exist? Do you ever wonder why so many people think all "Americans" are stupid? Take your "freedoms" to their natural conclusion - abondon government health care, government policing, government street cleaning, government education and live in a big house with a wall around it and armed guards on the gate and send your children to a posh school in a big car driving through the trash covered streets. Or if you don't make it live with the crackheads in a shack. Are you really all that stupid? I don't think so. Most passport carrying US citizens that I have met are well educated, outward looking, Bush hating, people with brains that are working. No wonder they all live abroad. I don't agree with the "green" recycling system my local council uses because I think it's a negative return to sort my rubbish into paper, glass and other but this is not going to turn me against street cleaning and refuse collection done by people who are employed at the tac payers' expense. Are you guys really against government health care? Really?

Permit me to take issue with your post. I am not sure why you must use exaggeration to make your point. It discounts your legitimate points when you make a statement that is blatantly untrue.

You state the US has the "unhealthiest population on the planet" No true, so why say it?

That the US Spends the most "per head on health care." This is a statement that has so many convoluted factors. Adjusted for GPD? What is taken into account? Preventative? Tort? This is one of those things where statistics lie and liars use statistics.



"Hospitals rake in dollars" Actually Lawyers rake in Dollars and I will address that point later in the body of this reply.

"Take freedoms to their natural conclusion" Street cleaning and the like are handled on a local basis, whereas health care is not. Some geographical areas are cleaner than others because of the perceived importance to that geography.

You make the statement that you basically judge a persons intellect by whether or not they hate Bush. Now that is funny, because I generally rate someone's intelligence by the fact that if they hate people at all they are generally ignorant.

Now allow me to help you understand those who oppose a national health care system here in the US.


You see, there are alot of Americans who see that one of the biggest problems with health care in the US is actually Tort. Our government, (comprised mostly of lawyers) have created a society that wants to sue anyone and everyone for anything they can to attempt to win a payday. The lawyers in our government encourage this because they, Congressional Lawyers, like the fact that they have built into our system a way for them to make money off that tort as well. Many many things in the US would be much less expensive if there was a limit to the amount you could get from a judgment. The cost of defending yourself from legitimate lawsuits as well as frivolous suits adds greatly to the cost of doing business in general in the US.

We love our country, and we love our Constitution, but we see that it has been hijacked by those in power and we see them hijacking a huge portion of our GDP in this health care grab. We do not trust our government to be able to run this program in an effective manner.

What surprises me is that people from other countries would care at all who runs the US health care. You don't have any dogs in this fight,,,, you really don't know the average American, and the struggles he and she has. What we see as Americans, is other countries always coming to us to bail them out of messes from natural disasters to ruthless dictators and invasions. Then we are looked upon as invaders after we do. Most of us could not care less about your health care and wonder why you have any opinion on ours. But the last thing we want is for someone who has not lived our life, who knows nothing about what we deal with from day to day to act as if we are stupid for wanting to keep our freedoms instead of trading them to the government in exchange for getting free medication.


Lastly, just because there are those opposed to a national health care in the United States, does not mean that we are happy with the system that we have, we simply think that the government is not the solution to this problem. Do not make the mistake of making that assumption.

"What surprises me is that people from other countries would care at all who runs the US health care"- this is exactly the kind of attitude that annoys so many people around the world and paints US citizens as arrogant isolationists. You are painting me as different because I come from somewhere else and have to deal with a different government. Why would I care about the health of people in the UK but not in the US? I have an opinion and I state it and it is valid. If you can't trust your government to run a health care program how can you trust it to invade other countries in the name of bailing them out? Maybe they are good at war but bad on health? You take issue with my use of the word "hating" - I apologise if that was a bad choice of word, I don't mean that kind of hate. Bad word, sorry, I mean those who disgree with Bush's attitudes and politics. As for labelling the US as the unhealthiest population on the planet - I don't need statistics, look around you. Then travel anywhere else and look around you. It really is that clear. As for the cost of health care, I'm going on percentage of GDP and yes I'm basing it on statistics that I've seen and am of course aware of how statistics can be used to mean anything. Anyway the US government spends a hell of a lot of money on health care and hospitals rake in the dollars. Lawyers too - like they do everywhere. Yes, I do care about the health of Americans, and I care about the everyday problems of people all around the world. I also take issue with many of my own governments policies - a governent that, like yours, is as corrupt as they come and dresses it abuse of the system up as law and legal procedures (anglo-saxon "legalised" corruption that you got from us in the first place - and worse, in some ways, than the kind of corruption that pollutes the developing world) and all kinds of nonsense. I joined this debate because I have an opinion - that the US needs a national system of healthcare, run by the government or a government agency. Whether or not it's any of my business or affects me directly is beside the point. And I am not being "anti-American" - hopefully my message is clear and is interpreted properly as the polar opposite.

As far as Americans being isolationists, well that is just human nature. We first concern ourselves with our own preservation, then our immediate family, extended family, community, region, then country, and then lastly, someone on the other side of the world.

I do not like what my country has become, but what I want to get across to you that you are not understanding is this. Those same people who run all over the world imposing their will on other countries are the same people you would suggest we hand over a huge chuck of our GDP to. You think that Obama is some improvement on Bush, and the truth is, he is the same monster in different clothes, with a different plan that will come to the same end. Government grab of control of our lives a piece at a time.

You call us isolationists, yet complain that we have our hands in the business of others too much... you cannot have it both ways. I would think that you would want us to be isolationists, to stay out of other countries affairs. I mean those were the reasons you hated Bush. I want us to stay out of the business of others as well. But I also want my government to stay out of my business. To let me choose my own paths, to decide what is best for me instead of some bureaucrat deciding for me. Besides, I really do have my own best interest in mind, does he?

Our government runs medicare, its broken. Our government runs Medicaid its broken. Our government runs social security, its going broke. Our government runs VA hospitals and they are broken. So we are supposed to accept national health care run by these incompetent politicians? 60% of Americans have health care they are happy with. If the only goal of reform was to cover the 25 million or so people that do not have health care it could have been done and far cheaper with some of that stimulus money that was wasted. I do believe we need to reform our health care system. The cost, If the Obama administration was serious about cutting costs tort reform would be included. They say health care reform would be partly funded by stopping fraud and abuse. Excuse me but if there is that much fraud and waste stop it now. The Obama says time and time again "If you like your health care plan you can keep it" Lies Both bills the one from the house and the other from the senate, Give employers a "GRACE" period to get a qualified plan. HUH If we can keep our plans what the hell does my employer need a grace period? I believe in personal responsibility and states rights. The government should be getting smaller not bigger.

First of all. Social Security was establihed for those over 65, when 65 was equal to our current 90. Almost noone made it to 65. So, they had a surplus, and decided to put all kinds of disabled people into collecting from Social Security. That, plus the aging population broke Social Security. Why didn't they set up a second fund? Well, that would have allowed the public to know what was happening.
What is your definition of people who can't afford health insurance? My definition is that they live in inexpensive houseing and honestly only earn enough for housing,food, and basic clothing. SURPRISE, these people are already covered by government plans. Who is not covered by the government and say they can't afford health insurance? I'll tell you. I drove a 10 year old car, until it died. That upset people. I would watch the clerical, warehouse, and production employees rolling out of the company parking lot in brand new cars and SUVs. They were driving home to their 2 and 3 bathroom apartments or homes. I have 1 bathroom. Yet, they explain that they can't afford health insurance. BULL! It's their value structure that needs an overhaul. Oh, and they aren't dieing either, they don't have any life insurance either.
I was raised that one is responsible for oneself. In turn, the government minded it's own business.
As to street cleaning, the government doesn't clean my street. We have this silly concept that we each clean our own area, and the areas of our older neighbors. Until they put in minimum wage, every store had a highschool kid that swept up the business areas, and hosed down the streets. Now, of course, individual companyies can't afford $10.00 an hour for this function, so now the government does a lousey job of keeping our cities clean.
The VA! Don't even go there. Government run health care is excellent for Presidents and Senators. But, if you are a wounded soldier, you'll be treated inadequately and so far from home, that your family can't even visit you to give some moral support.
I can't tell you how many papers I sign refusing tests. My insurance covers them, but they are unnecessar and my doctor and I both know it. I sign to cover her ass. Because of a lack of tort reform, she has to live in morbid fear of being sued, because she didn't give every possible test. That's where your healthcare money is going.
The bill is a pork barrell disgrace. AARP, Unions, Lawyers, they will all get a piece of the pie.
Regional high schools don't work. Government health care won't work.
Our poor health, as a nation, has to do with our eating habits, not our health care system.

Kathleen

Doc, I do understand what you are saying and you make your point very well. And I am not ignorant (but most non- Americans are!) of the fact that many people are covered by government health care in the US - the elderly, the poorest etc. I just fear the end result - yes I exaggerated my points before but this was intended to emphasize them maybe I went overboard. It's not much different here. More and more gated communities are spring up, more and more people have security on the front doors of their apartment blocks, more and more people are sending their kids to private schools and struggling to pay for it, more are taking up private health insurance because the National Health Service is a postcode lottery depending on how well the local hospitals and doctors surgeries are managed. On the cost of health care in the US, I've worked abroad in five different countries, and all of my employers provided me with worldwide medical insurance. The difference is that four of them did not extend this to the USA and Canada because the potential costs are colossal in the USA and also in Canada for foreigners. The exception was when I worked for an oil company and it gave me the whole deal plus a bundle of other benefits that made life incredibly easy. They offset this all against tax in your country and mine and others and even offset tax in one country against tax in another and so on. Well that's a pretty good indication of the cost of healthcare in the USA. My insurance would pay for any treatment I needed in super expensive economies such as Japan, Iceland and Norway but not the USA. When healthcare isn't run by the state it is super expensive.The USA has more expensive health care than any nation with a higher GDP per head. That's a bad thing. Government should be getting smaller not bigger - I agree 100%. But it should focus on the essentials and access to affordable (affordable for all of it's citizens and residents) healthcare should be one of it's priorities. As for Obama, I'd take him over Bush anyday but yes he's a politician and they are all the same breed of course. I got no beef with you and I respect everything you say but I am going to have to disagree strongly in this - I will happily hand over a portion of my income to the government if it provides a system of national health care for everyone. I'm not 100% up on the exact details of Obama's healthcare package and I know it's controversial but the basic principle is there. And if the USA as a nation (the most powerful on the planet in many ways at the moment) meddles in the business of other nations but expects them to have no opinion on its own problems, the "anti-American" sentiment that is based on ignorance and sloppy thinking will persist. Many people out there really do hate you because of your nationality. I usually spring to the defence of the Americans when the anti-imperialist talk rears it's ugly head and make the point that it's the government not the people. Most people can't see the difference between a nation's government and it's people. For some reason Brits abroad get off lightly and the mud doesn't stick to us even though our government and yours speak with one voice at the UN and on most global issues. Maybe Blair sounded more artculate and was a better bullshitter than Bush.

The United States has the best health care in world but because of its inefficiencies, also the most expensive. The fundamental problem with 2,074-page Senate health-care bill (as with its 2,014-page House counterpart) is that it wildly compounds the complexity by adding hundreds of new provisions, regulations, mandates, committees and other arbitrary bureaucratic inventions.

Worse, they are packed into a monstrous package without any regard to each other. The only thing linking these changes — such as the 118 new boards, commissions and programs — is political expediency. Each must be able to garner just enough votes pass. There is not even a pretense of a unifying vision or conceptual harmony.

The result is an overregulated, over-bureaucratized system of surpassing arbitrariness and inefficiency. Throw a dart at the Senate tome:

You’ll find mandates with financial penalties — the amounts picked out of a hat.

You’ll find insurance companies (who live and die by their actuarial skills) told exactly what weight to give risk factors, such as age. Current insurance premiums for 20-somethings are about one-sixth the premiums for 60-somethings. The House bill dictates the young shall now pay at minimum one-half; the Senate bill, one-third.

You’ll find sliding scales for health-insurance subsidies that will radically raise marginal income tax rates for middle-class recipients, among other crazy unintended consequences.

The bill is irredeemable. It should not only be defeated, it immolated, its ashes scattered over the Senate swimming pool.

Then do health care right way — one reform at a time, each simple and simplifying, aimed at reducing complexity, arbitrariness and inefficiency.

First, tort reform. This is money — the low-end estimate is about half a trillion per decade wasted in two ways.
Part is simply hemorrhaged into the legal system to benefit a few jackpot lawsuit winners and an army of extravagantly rich malpractice lawyers such as John Edwards.

The rest is wasted within the medical system in the millions of unnecessary tests, procedures and referrals undertaken solely to fend off lawsuits.

Second, even more simple and simplifying, abolish the prohibition against buying health insurance across state lines.

Neither bill lifts the prohibition on interstate competition for health insurance.

Because this would obviate the need — the excuse — for public option, which

left wing of Democratic Party sees (correctly) as the royal road to fully socialized medicine.

Third, tax employer-provided health insurance. It creates a $250 billion annual loss of federal revenues — the largest tax break for individuals in the entire federal budget.

This reform is the most difficult to enact, for two reasons. The unions oppose it. And the Obama campaign savaged idea when John McCain proposed it during last year’s election.

Insuring the uninsured is a moral imperative. The problem is that Democrats have chosen the worst possible method — a$1 trillion new entitlement of stupefying arbitrariness and inefficiency.

The better choice is targeted measures that attack the inefficiencies of the current system one by one — tort reform, interstate purchasing and taxing employee benefits. It would take 20 pages to write such a bill — not 2,000 — and provide the funds cover the uninsured without wrecking both U.S. health care and the Treasury.

umustmuck13-You right on the money. Tort reform would end endless costs by insurance companies. These costs come fom too many tests, and outrageous settlments. When I was young, health insuraance premiums were a deductible item. Go back to that. We have mandatory car insurance, mandatory life insurance for mortgages, why can't we have mandatory health insurance? For unemployment recipients and welfare recipients, they must do mandatory volunteer work at least 20 hours per week, unless disabled. The recipient of the volunteer workers must cover them for health insurance. That leaves the disabled and they are already covered under medicaid.
The volunteers can work for non profits, so the unions don't whine.
Any government plan must make all government workers operate under the same plan as the rest of the nation.

None of this will happen. Both the right and the left are up to this stinko to their eyeballs. Only differnce is right talks against it until they get enough pork to insure their reelection.

Kathleen

To President Obama and all 535 voting members of the Legislature, It is now official you are ALL corrupt morons:





The U.S. Post Service was established in 1775. You have had 234 years to get it right and it is broke.


Social Security was established in 1935. You have had 74 years to get it right and it is broke.


Fannie Mae was established in 1938. You have had 71 years to get it right and it is broke.



War on Poverty started in 1964. You have had 45 years to get it right; $1 trillion of our money is confiscated each year and transferred to "the poor" and they are still poor.



Medicare and Medicaid were established in 1965. You have had 44 years to get it right and they are broke.


Freddie Mac was established in 1970. You have had 39 years to get it right and it is broke.



The Department of Energy was created in 1977 to lessen our dependence on foreign oil. It has ballooned to 16,000 employees with a budget of $24 billion a year and we import more oil than ever before. You had 32 years to get it right and it is an abysmal failure.



You have FAILED in every "Government Service" you have shoved down our throats



while overspending our tax dollars:





AND YOU WANT AMERICANS TO BELIEVE YOU CAN BE TRUSTED



WITH A GOVERNMENT-RUN HEALTH CARE SYSTEM??

The flap over breast cancer screening has provided a fascinating insight into the political future of ObamaCare. Specifically, the political left supports such medical rationing even as it disavows that any such thing is happening.

No sooner had the Health and Human Services Department's U.S. Preventative Services Task Force recommended against mammography for women under 50 than Secretary Kathleen Sebelius rushed to say don't worry. The decision had "caused a great deal of confusion and worry among women," she said, promising that no policies would change. New Jersey's Frank Pallone vowed to hold hearings, and Senator Dick Durbin leveled the gravest charge Democrats can make: The task force was "appointed by President Bush."

The political duck-and-cover was also on display in that vanguard of ObamaCare known as the New York Times, which ran at least four much-ado-about-nothing items even as it endorsed the reduced screening. On the same day as an editorial and op-ed, a front-page "news analysis" lectured that what the public really needs is "a transformational shift in thinking" about the "evidence-based" medical future that the mammogram decision portends. Yes, and no doubt the Times will tell us what "evidence" to follow.

Even more revealing was Princeton's Uwe Reinhardt, a leading liberal health-care economist, writing on the New York Times Economix blog. Mr. Reinhardt sees the task force's handiwork as an exemplar of "rational decision-making" that had nothing to do with cost analysis, even as he claimed that rationing based on cost is inevitable.

You have to admire Mr. Reinhardt's partisan dexterity. He knows that no government task force is ever going to justify a treatment denial with an overt claim to costs. Instead, the task force found a sneaky way to use clinical data to take costs into account without admitting it. It cites all sorts of harm associated with the problem of "overdiagnosis"—i.e., too many costly procedures. This is a reference to mammograms that lead to further tests and treatments that in hindsight are unnecessary.

The HHS task force concludes that this harm outweighs the benefits of saving lives through early detection, yet this makes little sense unless financial costs are a priority. For instance, the panel cites patient anxiety from false positives, yet the literature also shows overwhelmingly that women would rather risk a scare than allow a cancer to progress—especially considering that about 75% of all breast cancers develop in women who do not have special risk factors.

In any event, the distinction between cost effectiveness and clinical effectiveness will be moot if ObamaCare passes. The House bill gives the HHS task force the mandate to review "the benefits, effectiveness, appropriateness, and costs of clinical preventive services" in making its de facto insurance coverage rulings. As Mr. Reinhardt notes, "at some point soon the rising cost of American health care actually will force Americans to bring monetary costs into the analysis as well."

What's really going on here is that the left knows its designs will require political rationing of care, but it doesn't want the public to figure this out until ObamaCare passes. Then it will begin the campaign to instruct the rest of us that we must follow the guidance of Princeton professors about what medical care we can receive. Americans will simply have to accept that the price of government-run health care in the name of redistributive justice is that patients and their doctors must bow to the superior wisdom of HHS task forces.

Just don't admit it until after the White House signing ceremony.