November 21, 2009

COST CONTAINMENT: “We’ll save even more money if we just get these women who are bitching about pain to hold their boyfriend’s hand or look at a picture of their kid. . . . And those silly Pap tests that had us thinking we needed a pelvic exam every year?The official word has come that you don’t need that testing so early or so often.”

Plus this: “Although women tend to love the notion of government control more than men do, it is women who will be told they’ll have to cut back. On treatments. And years. You know we’ve been taking more than our share.”

UPDATE: A reader emails:

My ex wife has spent her life in health care, and is now involved with clinical trials in cancer research. I asked her what she thought about the new guidelines on mammograms and Pap smears. She said, “Well, if they die sooner, I suppose that will save a lot of money in the long run.” She also commented on how many women they see in their 30s and 40s who have breast cancer.

They do seem to be turning on a dime regarding the early screening and detection stuff, don’t they?

UPDATE: Reader Jon Barlow, an orthopedic surgeon, writes:

Evidence that we are overscreening has been documented in the literature in various manners for the past 10 years or so. One excellent example is breast self exams for women. Evidence has shown in a fairly reproducible manner that breast self exams do not improve mortality, but do lead to unnecessary procedures (for cystic change, etc). In any system, we should do what is right for patients. I don’t know the literature on mammography, but we need to ensure that we are doing what is right for the majority of people. That’s the rationale behind evidence based medicine. To cite that one knows “many women in their 30s” with breast cancer doesn’t imply that we should all get mammograms at 30. I am as vehemently opposed to the current health care reform as you are….we just need to be certain that we continue to use facts as our basis rather than feelings.

Well, it’s true that there’s a genuine dispute over the value of early screening. But it’s also true that the turnabout on this seems to be happening quite suddenly. And that timing gives rise to a worry that the shift, perhaps just from one plausible approach to a different plausible approach, is taking place now because of politics. Perhaps that’s harmless — they’re both plausible approaches, right? — but it’s still troubling.

It’s also true, as Ann Althouse points out above, that any politically inspired limits on health care will affect women more, because women are considerably bigger consumers of health care services. That’s something we’d be hearing a lot about, if the usual suspects weren’t lined up firmly behind ObamaCare.

MORE: Reader Tim Johnson writes:

I’m a fourth year med student going into Ophthalmology (eyes). The medical community seems to have known for a while that breast self-exams weren’t effective. But as recently as Breast Cancer Month last month, we were telling women to self exam monthly. The real reason for the seeming quick turnaround is where the debate occurred. Like I said, while the medical community has debated this for a while, we continued to tell women to keep self-examining as if nothing had changed. I think this episode really offers lessons for future controversies and guidelines. As new data debunk prior assumptions, slow transitions in the lay community should reflect those in the medical community, so as to avoid the whiplash we’re seeing now.

When experts try to present a united front to the public despite doubts within the profession, it usually produces less, not more, credibility in the end.

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