Women all over America were thrown for a loop this week when the
U.S. Preventive Services Task Force dropped its endorsement of
regular mammograms for women aged 40 and above. But it went even
further and recommended against teaching women how to screen
themselves for lumps in their breasts.
Yikes! For decades we have all been told that screening was
essential in the war against breast cancer. “Early detection
saves lives” was the mantra. There have been public service ads
on TV. Forty-nine states have mandated coverage of screening in
insurance policies. The importance of early mammograms and
self-screening have been drummed into the heads of every woman
everywhere.
Now they are telling us it does more harm than good. Now they say
early detection results in false positives, needless biopsies,
excessive exposure to radiation, and the excision of lumps that
are benign.
This is only the latest in a string of reversals. Just recently
the National Committee for Quality Assurance abruptly dropped its
recommendations on lowering glucose in diabetics because it was
discovered that in some cases following its guidelines could harm
or even kill patients.
And two years ago it was found that, while hormone replacement
therapy (HRT) might be effective is treating the symptoms of
menopause and lowering the risk of colon cancer and dementia, it
also raised the risk of breast cancer, stroke, and ovarian
cancer. Suddenly all the guidelines that had been developed were
thrown out the window.
In each of these cases, the fall-back recommendation of these
guideline-producing committees was “consult your doctor.” Well,
Duh!
The fact is your doctor is able to prescribe the therapy most
appropriate for your condition, health history, risk factors, and
even genetic profile. Doctors can customize treatments to
the needs of an individual patient. All a committee can do is
tally up what is happening to a large number of people and
average it over the whole population.
But averages are meaningless in health care – and in everything
else. Iowa may suffer a drought in one year and floods the next
year. Average them together and you have a nice, mild amount of
rainfall. But that average tells us absolutely nothing about how
corn farmers fared in either year.
Health care by
committee is not a great idea in any event. But the real problem
comes when these committees declare with absolute, 100 percent
certainty that its guidelines are the way to go and every doctor
should do exactly what the guidelines say – until it changes its
mind. Then it will declare with absolute, 100 percent certainty
that the new guidelines are the only way to go.
Now today the Preventive Services Task Force is saying DO NOT get
an annual mammogram. But the American Cancer Society is still
saying you SHOULD get an annual mammogram. Each side accuses the
other of being influenced by business interests. On one side the
insurance companies don’t want to pay for mammograms, but on the
other side the companies that make the machines and supply the
x-ray film want to sell more stuff. Who should you believe?
And this is the biggest problem with most of the health reform
ideas coming out of Washington. The politicians are all
influenced by lobbyists on one side or the other. And none of
them care a whit about you, the patient.
Forget the committees and the politicians. Listen to the one
person who knows you bet — your personal doctor.
Pingback| 11.21.09 @ 6:45PM
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