Preventing Preventive Medicine

 

mammograms_health_care_reform_091120_wmainThe American Cancer Society has just released new breast cancer screening guidelines that substantially scale back its previous recommendations. They move much closer to the controversial recommendations made by the United States Preventive Services Task Force (USPSTF) in 2009. According to the ACS, screening should now be delayed until age 45, with annual screening until age 55, then biannual screening until age 75, when screening should stop. These new recommendations meet the USPSTF roughly halfway. (Until this week, the ACS recommended annual screening after age 40.)

I am no cancer specialist, but merely a simple country cardiac electrophysiologist. In general, I still have a residual amount of trust in the ACS (as opposed to, for instance, the American Heart Association). So I am open to the idea that the new ACS recommendations may in some way be reasonable.

However, admittedly without any direct evidence, I suspect that the ACS has instead chosen to interpret available clinical evidence in a way that moves them closer to the USPSTF, as a matter of institutional survival. For it will not pay, in the long run, for any professional organization to get on the wrong side of the USPSTF.

This is because the Obamacare legislation converted the formerly unobtrusive and mild-mannered USPSTF (which for many years had made polite recommendations that it hoped doctors might take into account on occasion, and which sometimes they did) to the final arbiter of which preventive services would be offered, which could not be offered, when, and to whom. Whatsoever the USPSTF may bind on earth will be bound in heaven, and whatever the USPSTF loose on earth will be loosed in heaven.

To illustrate: The 2009 mammography “recommendations” by the USPSTF were so inflammatory that they threatened to upend the pending Obamacare legislation itself at a critical juncture. To put out the fire, Secretary Sibelius immediately announced that, of course, these were mere recommendations, and, of course, women and doctors could decide for themselves when and how often to do mammography. But then, to render her patently false statement true, Congress was obligated to quickly amend the legislation to specifically exempt mammography from the restrictions imposed by the USPSTF on all other preventive services. (See Section 2713.)

There is a very good reason why Obamacare took complete control over preventive services, which is: Preventive services must be curtailed as much as possible.

I realize how upside-down this sounds. Speaker Pelosi herself famously declared that Obamacare is all about “prevention, prevention and prevention!” But here’s the sad fact. Preventive healthcare services cost the healthcare system far more money than they can ever save; for this reason, any healthcare system in which costs are paid collectively is going to have to find a way to stifle these preventive services.

While this statement may initially seem counter-intuitive, a few moments of thought will show you the truth of it:

  1. The preventive measure itself costs money.
  2. The preventive measure may not be very effective.
  3. Many “preventive healthcare services” consist of some kind of screening test for “early detection,” and these screening tests almost always produce more false positive results than true positive results — leading to the need for more definitive, more expensive, and often invasive confirmatory tests.
  4. “Early detection” of any medical condition often detects “occult” disease that might never become manifest.
  5. Treating the diagnosed — and often occult — medical condition often costs a great deal and produces expensive complications. And it is often ineffective.
  6. Often, early treatment of many medical conditions won’t lead to a cure, but will instead convert what would likely have been a relatively short and fatal (i.e., relatively inexpensive) disease to a much more chronic, much more expensive disease.
  7. Spending money to prevent a particular medical condition gives the beneficiary the time to develop some other medical condition – possibly a much more expensive one – in the future.
  8. If the patient whose life is saved by the screening test and subsequent therapy is an Old Fart (like myself), that patient will persist, for several more years, to soak younger, worthier Americans for Social Security and Medicare payments.

Q.E.D. The healthcare system will spend far more money by offering these preventive services than by not offering them.

This result should not be very surprising. It is the natural result when healthcare services are paid for collectively.

Consider what would happen if smoke detectors were regarded as a preventive medical service. Smoke detectors clearly save lives here and there. But we cannot show any real data proving that the overall survival of Americans who have smoke detectors is significantly higher than of Americans who don’t. So if it were society’s job to buy smoke detectors for every individual, then society would – rightly – determine that the cost is not worth the insubstantial benefit.

The only reason most people have smoke detectors is that it is not society’s job to pay for them. The individual does. And the individual does not care that smoke detectors cost $1.2 million per life saved. They only care that the life saved, potentially, is theirs, and that owning the smoke detector that might just save their life does not cost them $1.2 million; it only costs them $19.99.

I am not arguing that preventive services are useless or undesirable. I am simply pointing out that, even when a preventive medical service works exactly as designed, as long as you must pool resources to provide that preventive service to everyone, you will necessarily lose money.

This ought to prove embarrassing to our leaders, who have spent the last few years assuring us otherwise. Indeed, one cannot overemphasize the extent to which they have doggedly insisted that preventive healthcare services are not only cost-effective, but that precisely because of such preventive services (delivered in our new healthcare system’s remarkably efficient manner), we will enjoy tremendous cost savings over the next decades.

That preventive services are simply too expensive is not news to our leaders. They understood it all along. And accordingly, in the Obamacare legislation they took pains to provide themselves with the tools they will need to keep down costs. There is no fighting it.

We can expect to hear repeatedly over the next years that many of the preventive services we’ve all been sold on are, in fact, wasteful and dangerous after all. In some cases, these assertions will be correct. But correct or not, that’s what we will be hearing.

One hopes that the new ACS recommendations on mammography are based purely on an objective assessment of the data. But any professional organization that is as seriously misaligned with the USPSTF as the ACS has been regarding breast cancer screening is asking for it. Whatever the merits of its new recommendations, the ACS has done what it needed to do.

Doctors who value their professional viability will quickly get on board. Women will just have to hope that they fit under the favorable half of the bell-shaped curve.

Published in Domestic Policy, General, Healthcare, Science & Technology
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  1. iWe Coolidge
    iWe
    @iWe

    This is truly excellent analysis, and made me rethink the “obvious” about preventative care.

    Thank you!

    • #1
  2. The King Prawn Inactive
    The King Prawn
    @TheKingPrawn

    Isn’t preventative medicine best practiced by first evaluating risk factors other than just age and gender? It seems to me that some narrowing of focus would make preventative medicine a more worthwhile endeavor.

    • #2
  3. iWe Coolidge
    iWe
    @iWe

    The King Prawn:Isn’t preventative medicine best practiced by first evaluating risk factors other than just age and gender? It seems to me that some narrowing of focus would make preventative medicine a more worthwhile endeavor.

    For things that are easily fixed in young people (with solutions like vaccines), preventative medicine is a no-brainer.

    But as people get older, the “balance of payments” in terms of government expenditure tilts over, and the person, whatever their other qualities, becomes a net liability. It is why the NHS in the UK prefers to issue painkillers to people with serious illness, and then sends them home to die quietly.

    It is precisely how a godless society conducts business. And a strong central government run by enlightened philosopher kings. But I repeat myself.

    • #3
  4. The King Prawn Inactive
    The King Prawn
    @TheKingPrawn

    iWe: It is why the NHS in the UK prefers to issue painkillers to people with serious illness, and then sends them home to die quietly.

    It is precisely how a godless society conducts business. And a strong central government run by enlightened philosopher kings. But I repeat myself.

    I’m actually very curious about the moral/philosophical calculations on this sort of thing. Without collective payment (via insurance or government) sending people home to die would be the only option except for the wealthy. Even mundane things like the $2700 CPAP machine I picked up yesterday would be out of reach of many people without some kind of pooling of risk and resources. We’re obviously the sort of people who want to do better than send people home to die, but we also have to count the cost.

    • #4
  5. Jim Beck Inactive
    Jim Beck
    @JimBeck

    Morning KP and iWe,

    I was filming a grand rounds at IU and the speaker said that with the exception of vaccines all preventative medicine screenings cost more that they save in early detection.  He pointed to Italy which pretested all young men before playing sports for cardiomyopathy. This is a disease where the structure of the heart can, when stressed, cause heart failure and sudden death. Soon the cost per lives saved became too high, and Italy stopped the testing.  The doc also went on to compare the lives saved from early detection as a function of patient’s age from annual mammograms.  He noted that the number of lives saved quickly becomes in his mind unsupportably expensive.  His point was that preventative medicine was not a money saver.  This grand rounds entirely supports DrRich’s post.

    Perhaps our hope for savings will depend on DNA analysis of each individual which would point to each individuals health risks and which therapies would work for the specific individual.  Until then maybe the only open thing we could do is compare which screenings at what age can economically be supported. Also we could openly say that many aspects of preventative medicine do not save money, and may even take money from more promising uses.  This is difficult position to be in.

    • #5
  6. DrRich Inactive
    DrRich
    @DrRich

    The King Prawn:Isn’t preventative medicine best practiced by first evaluating risk factors other than just age and gender? It seems to me that some narrowing of focus would make preventative medicine a more worthwhile endeavor.

    King Prawn,

    You have a good point. However, especially since the policy of the USPSTF is to consider only data from prospective randomized trials, getting the long-term outcomes data necessary to do what you suggest (evaluating very focused subgroups) would be prohibitively expensive in both time and money.

    From a more cynical viewpoint, the less focused the population of your subjects, in general the less likely you are to see a benefit in long-term outcomes with preventive measures. (And thus, you won’t have to buy those preventive services for the population.)  So almost all studies that look at preventive measures enroll large, undifferentiated populations.

    For instance, a study looking at the benefits of seat belts under our current paradigm would evaluate overall mortality rates – say, over 10 years – in people who wear seat belts as compared to people who don’t.  It would be very difficult (probably impossible) to measure any significant difference. However, if the study were done looking at overall survival (seatbelt vs no seat belts) only in people involved in car accidents, it is far more likely we’d see a big difference. Our public health experts habitually do study A, but not study B. And so, we’d learn, seat belts are pretty useless after all.

    • #6
  7. iWe Coolidge
    iWe
    @iWe

    The King Prawn: I’m actually very curious about the moral/philosophical calculations on this sort of thing.

    You are overthinking this. The bureaucrats who decide whether or not to spend the money is always trying to minimize their own risk, so as to maximize self-perpetuation.

    There is no grand calculation that includes quality of life, or future contributions to society – there is, instead, the “silo” thought process of the individual bureaucrat.

    • #7
  8. MLH Inactive
    MLH
    @MLH

    The smoke detector analogy is good but I like: imagine how expensive your car insurance would be if it covered oil changes and brake checks.

    • #8
  9. DrRich Inactive
    DrRich
    @DrRich

    The King Prawn:

    Without collective payment (via insurance or government) sending people home to die would be the only option except for the wealthy

    King Prawn,

    I think most of us believe that a form of collective payment is a necessary component in healthcare; as you point out, that’s what health insurance is supposed to be. And most of us would also agree that, regarding that collective component, some well-defined limits on spending are absolutely necessary in order to keep the system viable.

    Where I (and I think most of us at Ricochet) differ from most Progressives is that we believe that we, as individuals, ought to have the right to purchase non-covered healthcare services for ourselves, with our own resources, if we choose to do so. (We might even support the idea of tax-advantaged Health Savings Accounts to fund such purchases.) Progressives are deeply opposed to such an idea, and have arranged Obamacare to stifle individual prerogatives to the fullest extent possible.  If the USPSTF says you can have it, then you MUST have it.  If the USPSTF says no, then you CAN”T have it, even with your own money (unless you can find a doc and a facility willing to buck the system.)

    This is what makes USPSTF guidelines (and all “guidelines” under Obamacare) such serious business.

    • #9
  10. DrRich Inactive
    DrRich
    @DrRich

    Jim Beck:Perhaps our hope for savings will depend on DNA analysis of each individual which would point to each individuals health risks and which therapies would work for the specific individual.

    Jim,

    This is absolutely true, but in my opinion this truth presents a major threat to Obamacare and the whole Progressive philosophy on healthcare (and life), to wit: the road to societal perfection requires individuals to subsume themselves to the collective good, as defined by the directives promulgated by designated experts.

    The biggest ultimate threat to Obamacare (and Progressives) is the specter of individualized healthcare made possible by DNA typing and new technologies that allow for targeted, individual therapy based on such DNA typing, and things like nanosensors.  Individualized medicine inherently undermines the Central Authority and its entire operating principle.

    Progressives are likely to deal with the threat by controlling it.  I fear that, if they revert to behaviors that may be in their own DNA (and which they loudly proclaimed early in the last century), they will attempt to use such information not to provide individualized medicine, but rather to identify individuals who ought to be, in some way, culled.

    • #10
  11. Vectorman Inactive
    Vectorman
    @Vectorman

    DrRich:The only reason most people have smoke detectors is that it is NOT society’s job to pay for them. The individual does. And the individual does not care that smoke detectors cost $1.2 million per life saved. They only care that the life saved, potentially, is theirs, and that owning the smoke detector that might just save their life does not cost them $1.2 million, it only costs them $19.99.

    Your analogy about Smoke Detectors (SD) is good, but it also has problems. I’ve added the (previously) recommended AC/Battery Backup interconnected SD to each floor in my 1978 house to replace the original battery SD in the bedroom hall, including both SD types  (ionization and photo-detector) and CO monitoring.  To sell a relative’s 1967 house, that city demanded each bedroom now have an SD (battery ionization type only), which is inferior to my system. But I might have to add the extra SD’s to sell my house.

    So even if we pay directly for our preventative care, what’s to stop the government bureaucrats from cooking up more regulations that cost us more money for inferior results?

    • #11
  12. iWe Coolidge
    iWe
    @iWe

    DrRich: they will attempt to use such information not to provide individualized medicine, but rather to identify individuals who ought to be, in some way, culled.

    They already do.

    Premature babies who are going to be expensive? Abort.

    Death Panels are not just about processes. They always consider the “input” in terms of patient age and some assigned “value.”

    • #12
  13. DrRich Inactive
    DrRich
    @DrRich

    Vectorman:So even if we pay directly for our preventative care, what’s to stop the government bureaucrats from cooking up more regulations that cost us more money for inferior results?

    Stop them? Why, it’s guaranteed!

    • #13
  14. DrRich Inactive
    DrRich
    @DrRich

    iWe:

    DrRich: they will attempt to use such information not to provide individualized medicine, but rather to identify individuals who ought to be, in some way, culled.

    They already do.

    Premature babies who are going to be expensive? Abort.

    Death Panels are not just about processes. They always consider the “input” in terms of patient age and some assigned “value.”

    iWe,

    Sadly you are correct. Note that many (all?) of the recommendations on preventive medicine put forth by the USPSTF are arbitrarily stopped at age 75.  Women over 75 still have a substantial risk of breast cancer – but no more screening for them.  Similarly, despite the fact that colon cancer is common in old people, the USPSTF says no more colonoscopies after 75.

    Ezekiel Emanuel’s article earlier this year in Atlantic (Why I Hope To Die at 75) was not a coincidence, but was part of an overarching strategy to get us all used to the idea that healthcare services shouldn’t be expected any more when we reach that age.  I will not be surprised, on my 75th birthday a handful of years from now, to get into my (government mandated) self-driving car and punch in the coordinates for the gym, and to be driven instead to the local Soylent Green factory.  If this doesn’t happen it won’t be because of a lack of effort.

    Watch that magic number (75) and you will see it popping up all over the place.

    • #14
  15. Vance Richards Member
    Vance Richards
    @VanceRichards

    We have 300 lbs lineman wearing pink cleats and now we are being told,”eh . . why don’t you put off that mammogram for a few more years”?

    My wife had her first mammogram at 40 and it found about eight different cancerous tumors. If she waited until 45 . . . well she probably wouldn’t have made it to 45.

    That doesn’t mean everyone would benefit from that, but having a system where bureaucrats get to make most of your medical decisions is scary. I want what is best for me, not what is best for most people.

    • #15
  16. iWe Coolidge
    iWe
    @iWe

    My wife adds that Doctors are horrified when people ignore them about vaccines – but as medicine becomes increasingly politicized, people have very good reasons to distrust what they are being told.

    So we lose the fight to provide vaccines because doctors under the Obamacare umbrella are clearly not working in our interest in so many other areas of health.

    • #16
  17. Pilli Inactive
    Pilli
    @Pilli

    The thing that really sticks in my craw is that none of this applies to members of Congress or to the bureaucrats that administer O’care.

    They all conveniently exempted themselves from it.  This is a crime against the citizens and is a major step toward isolating the government from the people.

    O’care would get fixed quickly if they were mandated to participate. Can you imaging a 75 year old Congress woman being told she can’t have a mammogram?  Or a 75 year old Senator with colon cancer being handed some pain meds and told to go away?

    • #17
  18. Mendel Inactive
    Mendel
    @Mendel

    So to paraphrase this post “most early preventative care is a waste of money, but it’s a bad thing (and possibly evil) that the government won’t pay for it”.

    The sentiment is defensible (and one I agree with), but we shouldn’t ignore the inherent contradiction in our rush to denounce socialized medicine.

    The underlying problem is that the amount of preventative care we subjectively want is likely much greater than what is actually economically worthwhile based on all objective criteria available. That dilemma is the real root of the problem, and does not become much easier in the absence of government-run healthcare.

    What would the situation be if everyone was paying out of pocket? People with enough money would probably pay for unnecessary tests providing them peace of mind, while those of less means would be just as healthy (with regard to these conditions) yet many would likely live in a constant state of unease.

    • #18
  19. Mendel Inactive
    Mendel
    @Mendel

    The King Prawn:

    iWe: It is why the NHS in the UK prefers to issue painkillers to people with serious illness, and then sends them home to die quietly.

    I’m actually very curious about the moral/philosophical calculations on this sort of thing. Without collective payment (via insurance or government) sending people home to die would be the only option except for the wealthy. Even mundane things like the $2700 CPAP machine I picked up yesterday would be out of reach of many people without some kind of pooling of risk and resources. We’re obviously the sort of people who want to do better than send people home to die, but we also have to count the cost.

    This bears repeating.

    We all despise the notion of government deciding when we should die, but how would it work if everyone paid for their own healthcare? Many, probably a majority, would die younger than they now do with Medicare.

    There is a real moral dilemma here. We don’t want to let people die because they can’t afford something. We don’t want government to overpay for healthcare people don’t need. Yet we also don’t want government to decide when people die.

    There’s no way to square that circle. None.

    • #19
  20. Grey Hare Inactive
    Grey Hare
    @greyhare

    I have been told more than once, by two different insurance providers, that I must get my ‘preventive care’ if I want to keep my coverage. This should end well.

    • #20
  21. Front Seat Cat Member
    Front Seat Cat
    @FrontSeatCat

    I don’t agree. I had my first mammogram at 35, which was the suggestion then. They found micro-calcifications, which were removed and I believe saved me from a worse fate. I cannot imagine if I had waited. I’ve been fine ever since – but I have seen many young women who have been found to have breast cancer (I did a walkathon). While sitting in a doctor’s office with cold nervous hands awaiting my yearly exam in a room filled with women feeling the same way (it’s not fun), one young woman stood up and said testing prevents, so its all good – don’t be afraid. She had no hair so I think she knew, and everyone agreed and breathed easier.

    I believe this is about money and insurance companies – since the change with Obamacare. My mother-in-law has had several tests as part of her routine exams for years, eliminated. They are covering less. They keep changing the rules for other screenings – or saying the tests are not as productive or accurate as they thought. Don’t buy it.

    Also, if there is a concern about-false positives, have the test redone or get a second opinion. An accurate diagnosis should outweigh cost. If it is a false-positive, then money is saved on needless surgery or treatment.

    • #21
  22. Bryan G. Stephens Thatcher
    Bryan G. Stephens
    @BryanGStephens

    The King Prawn:

    iWe: It is why the NHS in the UK prefers to issue painkillers to people with serious illness, and then sends them home to die quietly.

    It is precisely how a godless society conducts business. And a strong central government run by enlightened philosopher kings. But I repeat myself.

    I’m actually very curious about the moral/philosophical calculations on this sort of thing. Without collective payment (via insurance or government) sending people home to die would be the only option except for the wealthy. Even mundane things like the $2700 CPAP machine I picked up yesterday would be out of reach of many people without some kind of pooling of risk and resources. We’re obviously the sort of people who want to do better than send people home to die, but we also have to count the cost.

    If we are going to have government $ in healthcare, I vote for a pure voucher program. Phase out Medicaid and Medicare, and phase in vouchers. Let the market recover, and people can pay for their health  insurance that way. The government already spends over 50 cents on every dollar, why not just let the consumer decide?

    Couple that with a Federal law to allow insurance across state lines, and making all providers post what they are reimbursed by all sources for procedures (so a $20,000 self pay is not $2000 by BCBS etc.)

    • #22
  23. Ralphie Inactive
    Ralphie
    @Ralphie

    Pilli:The thing that really sticks in my craw is that none of this applies to members of Congress or to the bureaucrats that administer O’care.

    They all conveniently exempted themselves from it. This is a crime against the citizens and is a major step toward isolating the government from the people.

    O’care would get fixed quickly if they were mandated to participate. Can you imaging a 75 year old Congress woman being told she can’t have a mammogram? Or a 75 year old Senator with colon cancer being handed some pain meds and told to go away?

    I’d hit like a million times if I could.

    • #23
  24. Ralphie Inactive
    Ralphie
    @Ralphie

    I don’t think CPAP machines would be 2700 if third party pay had never happened.

    • #24
  25. DrRich Inactive
    DrRich
    @DrRich

    Mendel:So to paraphrase this post “most early preventative care is a waste of money, but it’s a bad thing (and possibly evil) that the government won’t pay for it”.

    Mendel,

    This is not an accurate way to paraphrase my post. In the name of Ricochetian civility, I will not insist that you read my post wrongly; indeed, I will most humbly stipulate that I may not be the clearest writer in the world.

    Instead I will offer an alternative paraphrase, and assert that this is what I meant to say:

    Our leaders are lying to us. They say, “Preventive medicine is the backbone of Obamacare, and is the method by which we will realize great cost-savings.”  All along they knew this to be false, a fiction. Preventive services are destined to be cut back, and with another lie: “These services are not medically useful.” The truth would be: “These services may be helpful to individuals, but not to the collective; therefore you may not have them.”

    By the way, you seem to imply that I must be in favor of a system where individuals must pay their own way all the time.  Not so. I am in favor of a pooling of resources for a large swath of healthcare services. However, allowing individuals to retain their own prerogatives is critical, and, I fear, this stipulation requires individuals to pony up for at least some of their own health expenses.

    • #25
  26. Mendel Inactive
    Mendel
    @Mendel

    DrRich:Congress was obligated to quickly amend the legislation to specifically exempt mammography from the restrictions imposed by the USPSTF on all other preventive services. (See Section 2713.)

    This is revealing. We always wring our hands about the government refusing to pay for treatment and leaving people to die. But history suggests just the opposite: we’re still a democracy, and in general people vote themselves more benefits paid by others’ money, not less.

    The mammogram exception to “guideline-driven medicine” is exhibit A of this phenomenon, and the permanent “doc fix” is another example.

    The problem in every facet of American government is that voters constantly vote themselves new goodies. Why do we think government-run healthcare will be any different?

    • #26
  27. DrRich Inactive
    DrRich
    @DrRich

    Bryan G. Stephens:If we are going to have government $ in healthcare, I vote for a pure voucher program. Phase out Medicaid and Medicare, and phase in vouchers.

    Bryan,

    Vouchers in healthcare, vouchers in public education, and for that matter, capitalism itself, all fly in the face of the fundamental Progressive truth, to wit: establishing the perfect society will require the enlightened few to direct the actions, beliefs and behaviors of the masses, and therefore will utterly require the stifling of individual prerogatives.

    No go on vouchers. Sorry.

    • #27
  28. DrRich Inactive
    DrRich
    @DrRich

    iWe:My wife adds that Doctors are horrified when people ignore them about vaccines – but as medicine becomes increasingly politicized, people have very good reasons to distrust what they are being told.

    iWe,

    Your wife is a wise lady. Doctors today have their professional viability threatened if they do not carefully follow centrally-generated “guidelines,” whatever they may think about their accuracy, or their suitability to an individual patient. If someone believes she can trust her doctor, that’s great. I’m sure the doc is a wonderful, empathetic person.

    So if circumstances are right you can perhaps trust . . .but still, verify.

    • #28
  29. Mendel Inactive
    Mendel
    @Mendel

    DrRich, apologies if you thought I was trying to incorrectly impugn you with certain motives or opinion.

    However, I stand by one point: on a purely economical level, it makes no difference whether preventative care is paid for collectively or individually: if it’s a losing deal it’s a losing deal. This is true for any type of insurance or risk-based purchase. However, it is precisely for that reason that we should leave the decision to individuals.

    I agree that Democrats and Obamacare architects are constantly talking out of both sides of their mouths. But the first reaction for those of us who hate Obamacare is often to assume that the opposite of whatever Obamacare calls for must de facto be true.

    Healthcare delivery isn’t (only) screwed up because the government gets involved. It’s screwed up because it’s much more complex and difficult than most any other type of transaction we make. We need to keep that in mind when defending any alternative systems.

    • #29
  30. DrRich Inactive
    DrRich
    @DrRich

    Vance Richards:My wife had her first mammogram at 40 and it found about eight different cancerous tumors. If she waited until 45 . . . well she probably wouldn’t have made it to 45.

    Vance,

    I am very glad your wife’s mammogram was performed before doctors began adhering to the new ACS guidelines, or worse, to the 2009 USPFTF guidelines – which would have had her wait until she was 50.

    Still, the experts who make these guidelines are well aware of cases like your wife’s, and they insist that such women are outliers, and urge (under threat of penalty) that doctors regard them as such.  To prevent the great harm from unnecessary mammograms (such as the voiced harm of unnecessary biopsies, and the unvoiced harm of expense), they say, there will be collateral damage no matter where you draw the line.  Doctors will just have to learn to accept such collateral damage as an unavoidable cost of fighting the good fight against cancer.

    As for the women themselves, they can console themselves that their missed opportunity to catch breast cancer at an early stage was ameliorated by the fact that something like 7 or 8 women avoided an unnecessary biopsy. So it’s all good, and their sacrifice to the service of the collective is appreciated.

    • #30
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