Tuesday, November 24, 2009

Welcome to the United States of the Banana Republic

Last week, on the eve of the Senate health care bill vote, the United States Preventative Services Task Force (I will publish the task force member names separately) released new guidelines for mammograms. The recommendations of this task force, (which I am told and the list seems to verify, includes no practicing oncologists or OB-GYN's, rather it is comprised of professors and heads of university departments, you know INTELLECTUALS, the kind that propose theoretical policy they are never stuck implementing themselves) offer new guidelines that propose women in their 40's no longer receive routine mammogram screening, rather the tests should be given to women ages 50-74 and no longer ever year but every other. Additionally, the task force recommended that women no longer be encouraged to conduct Breast Self Examination (BSE) since there is no indication the examination produces results.

Creepy? Hold on, it is about to get creepier.

No where in the recommendation does the task force cite compelling evidence to support their recommendation. The paragraph below is pulled directly from the recommendation.

Estimates of the sensitivity of mammography vary with the methods used to calculate it. In a good quality systematic review, the first round of mammography detected 77 percent to 95 percent of cancers diagnosed over the following year, (emphasis mine) but only 56 percent to 86 percent of cancers diagnosed over the next 2 years. Sensitivity is lower among women who are younger than 50, have denser breasts, or are taking hormone replacement therapy. In screening trials, the false-positive rate of the initial round of mammography was 3 percent to 6 percent (i.e., specificity 94 percent to 97 percent)

The task force does not quantify the term "sensitivity is lower among women who are younger." How much lower? Yet, I have to admit I don't care. If the success in identifying women with breast cancer in their 40's is greater than 1% I am for it. Our society should be too. I have a feeling 100% of the children of women in their 40's would vote YES to preventative treatment for their mothers and since theses children will be paying the bills...

Creepiest? The big risk to continuing the annual test?

The consequences of false-positive mammograms (recall--3-5% of initial mammograms) are uncertain. Most, but not all, studies report increased anxiety (emphasis mine) from an abnormal mammogram. At the same time, some studies report that women in the United States may be willing to accept a relatively high number of false-positive results in the population in return for the benefits of mammography. Studies do not indicate that false-positive results diminish adherence to subsequent screening.

Now, we can't have that. Increased anxiety over false positives that does not diminish the woman's adherence to subsequent screenings, nor, according to the study cited, is an unacceptable risk to the women screened. It seems it is unacceptable to the PelosiReidObama care plan though.

After the outrage from the report, most health care organizations, Medicare and our Secretary for Health and Human Services, Kathleen Sebelius, (you remember Ms. Sebelius, the government official who gallantly showed us how to cough in our sleeves in the face of the H1N1 virus--just in case you can't get your hands on the vaccine...) all claimed they would ignore the recommendations.

But here is where Joe Wilson comes in. Ms. Sebelius can't make that claim. She misleads, over commits, obfuscates, she, well, lies.

According to the Heritage Morning Bell: "Both the House and Senate versions of Obamacare create detailed new federal regulations that micromanage all health insurance decisions. Specifically, Section 2713 of the Senate Health Bill would give the recommendations of the U.S. Preventive Services Task Force the force of law by requiring all health insurance plans to provide coverage (with no patient co-pays) for “items or services that have in effect a rating of “A” or “B” [recommended] in the current recommendations of the United States Preventive Services Task Force.”

Conversely, under Obamacare, last week’s Task Force decision to give annual mammograms a “C” rating (not recommended) will henceforth be viewed by insurers and employers as a justification for discontinuing coverage."

IN OTHER WORDS: While Kathleen Sebelius might ignore the recommendations of the task force, the bureaucrats that will doling out your health care, won't.

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