Mammogram flap changing views on physician testing?
For months, we’ve been talking about how physicians engage in unnecessary or excessive testing so as to generate more profits or simply do the things they think necessary to defend themselves from the shenanigans of the trial lawyers.
The Page has often pointed out the problem with approaching the subject from such a broad, statistical based point of view. It’s very easy to conclude that physicians over-test for any reason that may satisfy you, until you are the one who the doc says needs to be on the receiving end of those tests. Whenever I’ve raised this issue, readers have been quick to complain that physicians already make too much money and are simply gouging their patients with technological pokes and prods so they can suck down a few more bucks. And if the complaints aren’t about doctors’ profits, it’s all about the trial lawyers.
So, how do you feel about medical testing this week?
The women of America are up in arms – or breasts- over a government task force telling them that they don’t need to get mammograms until they reach 50.
Who can blame them for being angry? There are a staggering number of women who are alive and well today due to the discovery of their breast cancer in time to do something about it – all thanks to a mammogram received before they turned 50 years of age.
But this overwhelming reaction of women is about something much more than the living, breathing stories of cancer survivors.
Both women and men ‘relate’ to the possibility that they could either become a victim of breast cancer or have a wife, mother or daughter become a victim. Thanks to effective – and highly useful – advertising over the years, Americans grasp that breast cancer isn’t something that just happens to someone else. They instinctively understand that it could actually become an ugly part of their own lives. As a result, nobody is much in the mood for anyone to get stingy with the mammography.
Yet, just last week, many of the same women and men upset by this week’s news were complaining about the high costs of testing – costs that end up being passed along to the rest of us in the guise of skyrocketing insurance premiums.
Today, the Secretary of HHS reminded everyone that the task force in question does not make policy for the United States and that she continues to recommend that women begin testing for breast cancer at age 40. This is a good sign as insurance companies will be loath to drop mammogram coverage for women under 50 while HHS continues to support the policy. No doubt, women everywhere are cheered by this news as well they should be.
But as the great mammogram disturbance of 2009 fades, let’s try and learn something from this week’s events.
The next time you want to rant about physicians over-testing, try to remember how you felt this week when you thought someone might take away a test that you deemed critical to the safety and security of your own life or the life of a woman near and dear.
Just like every woman in the country who reacted with distress over the notion of someone taking away life-saving breast cancer tests, everyone who has some reason to fear a serious illness feels the same need to take advantage of every test in the arsenal. So, when it comes to others, maybe we shouldn’t go all empirical evidence simply because we don’t believe their illness will ever become our illness. Try and remember how you felt when a government task force suggested changes that you believed left you exposed -– and then try not to do it to someone else. Others may not face breast cancer but they want to stay alive as much as you do.
Post Your Comment
You must be logged in to post a comment
T/S Members
Log in with your True/Slant account.
Hear, hear, Rick.
Rick,
I’m sympathetic with your reasoning, but you leave out why excessive testing actually can kill people. No test is perfect and mammograms are no exception. Imperfections show up as false positives (test says cancer, you don’t have it) or false negatives (test says cancer-free, you have it) Either of these errors can have fatal consequences. Therefore, your best health outcome may not be to test.
I say this even though my wife survived breast cancer because it was detected by a mammogram early enough to be treated successfully.
We all want to stay alive, but the best strategy for survival isn’t necessarily to submit to the conventional wisdom. We are constantly finding out that they didn’t have it quite right even though they seemed very certain.
True enough – however, it does beg the point. There are downsides to testing – but what we are talking about here is the opportunity for physicians and patients to make those calls on an individualized basis. While there may be some downside, your wife – happily- is an example of where the right call was made. I sure would not have wanted her to be a victim of a policy requiring that testing only be done at 50, assuming she was younger when she experienced the disease. If the government sets that policy, health insurance companies will follow suit -and that would be a very unfortunate result.
I also thing there is some experience with the market regulating itself in this regard. When the full body scans became popular, insurance refused to cover it taking the position that it was likely to produce false positives or discover disease well before ti needs to be discovered and dealt with.
They turned out to be right and the popularity of these tests have subsided significantly as people and doctors realized that the test was doing more harm than good.
In response to another comment. See in context »Rick,
In response to another comment. See in context »My wife was over 50 so would have taken the tests under the proposed policy. We most likely agree that having insurance companies decide what is the right policy is the wrong policy. Clearly, this is one more case where one size doesn’t fit all. A two-stage patient evalution plan makes much more sense than a flat age-based criterion. Screen patients based on genetics, family history, geographic history and lifestyle choices. Then test rigorously for indicated risks.
One way to reduce false results is to do more expensive tests. When the tests are applied willy-nilly, they are inevitably the cheap ones.