Screening for Terrorists vs. Screening for Cancer

After years of arguing that regular cancer screening saves lives, the government now warns that such routine screening creates unnecessary emotional distress, leads to further risky invasive tests, and raises overall health costs. Regardless of the scientific merits of these claims, blogger Glenn Reynolds notes that many skeptical Americans fear that the government’s real agenda is to save money at the expense of their health. Under ObamaCare legislation, the USPSTF will set the de facto standards for what preventive services will or will not be covered by government insurance (and most private health insurance), thus affecting millions of Americans.

Of course, medical screening tests (like all medical procedures) entail both costs and benefits. For example, most healthy nonsmokers do not need routine CT scans of the chest to detect early lung cancers. The risks of complications due to unnecessary biopsies of incidentally detected benign lung nodules outweigh the much smaller benefits of detecting rare early cancers in these patients. But if a patient has elevated lung cancer risk due to certain genetic conditions, environmental exposure, or significant smoking history, then the benefits of such screening can outweigh the risks.

Hence, Americans should reject a government-mandated “one size fits all” approach to medical cancer screening. Instead, patients should discuss with their physicians the relevant risks and benefits of various screening tests applicable to their individual circumstances. Patients can then decide what levels of risk they are willing to tolerate in the form of false alarms vs. failure to detect early breast, prostate, or lung cancer.

Similarly, Americans should reject the TSA’s “one size fits all” approach to air traveler screening. Most Americans support more selective “Israeli-style” screening, which focuses greater attention on passengers who fit certain age, cultural, and behavioral profiles associated with terrorists. The federal government could also allow airports and airlines to devise their own more passenger-friendly screening procedures, rather than forbidding them from “opting out“ of onerous TSA regulations.

Our government currently tells air travelers, “Submit to our screening despite the dubious effectiveness, bodily invasion, and needless emotional distress” while simultaneously telling patients, “Don’t undergo cancer screening because it might lead to further bodily invasion and emotional distress.” Despite this seeming contradiction, in both cases the government is really saying, “We’ll decide who can do what with your body.” The American founding fathers would never have imagined that the federal government would someday presume to restrict citizens’ medical or travel freedoms in such a fashion.

A current Internet joke goes, “Under ObamaCare, just show up at your nearest airport for free x-rays. Your wife gets a free breast exam. Mention al-Qaeda for a free colonoscopy.” Come 2012, Americans will have to decide whether this will remain a joke or not.