The Spectacle Blog

Forget the Committees

By on 11.21.09 | 10:33AM

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.

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