"To announce that there must be no criticism of the president, or that we are to stand by the president, right or wrong, is not only unpatriotic and servile, but is morally treasonable to the American public." -- Theodore Roosevelt


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Wednesday, November 18, 2009

"Death Panels" of the Future: Mammogram Edition

Check out this post by Ed Morrissey at Hot Air (Carol @ Carol's Closet).

From Morrissey:

"What a difference six months — and a health-care overhaul proposal — can make! Just six months ago, the U.S Preventive Services Task Force, which works within the Department of Health and Human Services as a “best practice” panel on prevention, sounded a warning signal over a slight decline in annual mammograms among women in their 40s. In fact, they warned women of this age bracket that they could be risking their lives if they didn’t get the annual preventive exam (via HA reader Devil’s Advocate):

"'The downward trend, however slight, has breast cancer experts worried. Mammograms can enable physicians to diagnose the disease at early stages, often before a lump can be felt. "When breast cancer is detected early, it often can be treated before it has a chance to spread in the body and increase the risk of dying from the disease," says Katherine Alley, medical director of the breast health program at Suburban Hospital in Bethesda.

'The U.S Preventive Services Task Force, an independent panel of experts working under the Department of Health and Human Services, recommends that women older than 40 get a mammogram every one to two years. The task force finds the test most helpful for women between ages 50 and 69, for whom it says the evidence is strongest that screening lowers death rates from breast cancer. Other groups, including the American Medical Association, suggest a more rigorous schedule, saying the test should be done every year; insurers often pay for annual tests.

'But experts say they are seeing gaps beyond two years in many cases. Carol Lee, chair of the American College of Radiology’s Breast Imaging Commission and a radiologist at the Memorial Sloan-Kettering Cancer Center in New York, says many women understand that they need to have a mammogram but don’t go back for repeat tests after the first one. In Bethesda, Alley said she has even heard anecdotal reports of breast cancer survivors forgoing recommended mammograms.'

"But today, that same panel says … never mind:

"'"We’re not saying women shouldn’t get screened. Screening does saves lives," said Diana B. Petitti, vice chairman of the U.S. Preventive Services Task Force, which released the recommendations Monday in a paper being published in Tuesday’s Annals of Internal Medicine. "But we are recommending against routine screening. There are important and serious negatives or harms that need to be considered carefully."

'Several patient advocacy groups and many breast cancer experts welcomed the new guidelines, saying they represent a growing recognition that more testing, exams and treatment are not always beneficial and, in fact, can harm patients. Mammograms produce false-positive results in about 10 percent of cases, causing anxiety and often prompting women to undergo unnecessary follow-up tests, sometimes-disfiguring biopsies and unneeded treatment, including surgery, radiation and chemotherapy.

'But the American Cancer Society, the American College of Radiology and other experts condemned the change, saying the benefits of routine mammography have been clearly demonstrated and play a key role in reducing the number of mastectomies and the death toll from one of the most common cancers.

'"Tens of thousands of lives are being saved by mammography screening, and these idiots want to do away with it," said Daniel B. Kopans, a radiology professor at Harvard Medical School. "It’s crazy — unethical, really.""

Crazy but not without economic incentive. As The Washington Post article cited by Morrissey points out, breast cancer screening is expensive.

"The new recommendations took on added significance because under health-care reform legislation pending in Congress, the conclusions of the 16-member task force would set standards for what preventive services insurance plans would be required to cover at little or no cost. [actually according to HR 3962 the Health Benefits Advisory Council (HBAC) --all political appointees by the way-- would determine yearly what would be covered under qualified health plans].

"About 39 million women undergo mammograms each year in the United States, costing the health-care system more than $5 billion [emphasis mine]."

Diana Petitti then gives this amusing little lie.

"Petitti said the panel was not influenced by the reform debate or cost issues."

Later in the article, citing a host of studies, gives us this little bit of info. "While annual mammography for all women beginning at age 40 reduced the death rate from breast cancer by at least 15 percent, the modeling studies indicated that the added benefit of starting before age 50 was modest, the researchers concluded.

"For every 1,000 women screened beginning at age 40, the modeling suggested that just about 0.7 deaths from breast cancer would be prevented, while about 470 additional women would receive a false-positive result and about 33 more would undergo unnecessary biopsies [emphasis mine]."

Okay, let's go ahead and go with this best-case scenario-- and just forget that pesky drop of 15% in the death rate as this panel would like you to. For every 1000 women, .7 deaths are prevented by screening. So early screening does save lives, just not enough to be cost beneficial, I guess. So how many lives does this panel suggest we sacrifice for the sake of saving money? Sacrificed lives? Panel? Hmm.

"For women age 50 and older, cutting back to screening every two years would maintain 81 percent of the benefits of testing annually while reducing by half the number of false-positives, the computer modeling study estimated [emphasis mine]."

81% of the benefits. Sounds like a bargain unless you're part of that 19% whose health would suffer under decreased testing. Oh, well... Thems the breaks.

Now it's important to understand that under the current laws, this panel's recommendations don't carry the sort of weight. It's something that insurance companies weigh the benefits of against any other number of other factors, other recommendations, and other studies in their actuarial processes. It's this fact that is conveniently overlooked when current health care "reform" advocates claim "death panels" exist now in the form of private insurance determinations.

Under the HR3962 and undoubtedly under the pending Senate Bill, these same type people's findings (Pettiti, et al) would have singular and direct importance. The HBAC's "recommendations" would directly affect your health insurance, determine what would and would not be covered. In other words, if the HBAC decides that a sacrifice of 19% of the benefit of mammograms is acceptable, then you will no longer get yearly mammograms. And if you end up being one of those 1.9 in 10 whose health is affected by this cutback-- too bad. You'll be taking one for the team, for our "shared responsibility," and for social justice.

Do you remember when the House dropped the "death panels" out of the bill-- even though they didn't exist? Well, that was the end of life stuff. The real "death panels" are the HBAC (or an alphabet soup equivalent) and the way they will arbitrarily (with lobbying and all its rational fairness, of course) and surreptitiously ration care.

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