This week the The U.S. Preventive Services Task Force (USPSTF) released recommendations concerning breast cancer screening that seem stunning.
Among the recommendations is that against routine screening of those age 40-49. Your moderators are generally supportive of the concept of evidence based medicine, when the evidence considered is sufficiently broad. The task force recommendation is limited in that:
- it is based on mortality and longevity data alone, ignoring other positive medical outcomes
- it seems biased by the comparatively larger number of screens necessary to save a life, without considering the comparatively larger economic value of saving that younger life
- it is absolute in its recommendation. The panel could have, instead, recommended less frequent screens in the 40-49 year olds had they created a decision tree that considers the results of an initial screen (this would preserve the existence of a baseline exam, which itself may impact the survival data of those age 50 and up). This action could reduce the number of exams required, under age 50, yet still save the same number of lives as the current protocol does
- It ignores a wealth of unpublished clinical experience
- it fails to consider the recommendations of several specialty societies (themselves experts in the field)
- etc
The HHS Secretary Sebelius then made a statement reflecting her view that this report would not impact upon third party payment decisions. In doing so, she injected this action of the USPSTF into the health care reform discourse.
Thanks for keeping us abreast of the situation.
ReplyDeleteSanjay Gupta:
ReplyDeleteSANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: About 75 to 90 percent of breast cancers are found in women who have absolutely no family history and no identifiable risk factors. If you are a woman hearing that at age 40, right now watching, 75 to 90 percent of breast cancers found with people who have no risk factors, no family history, what should they do?
LUCY MARION, PREVENTIVE SERVICES TASK FORCE: I would not recommend it. I would not make a recommendation. We’re saying that the benefits are small.
GUPTA: What do you mean by that? When you say the benefits are small? Let’s not beat around the bush here. What exactly are you trying to say?
MARION: We look at it in various ways. For example, we look at life years gained by the actual screening every year or every other year. And the life years gained for that group is not very large. There are some life years gained. But it’s not very large.
GUPTA: You’re a nurse and…
MARION: And I know…
GUPTA: I don’t want to, you know…
MARION: I am.
GUPTA: … dig ourselves into a whole [sic] here. You’re a nurse, you’re in a profession of healing and compassion.
Are you comfortable with what you’re saying right now? Because what you’re saying, what I’m hearing you say is that you’re saying some lives just aren’t worth it. We — that’s why we’re changing these screening recommendations. And that is an incredibly frightening thing to hear from someone like yourself.
Is that what you’re saying?
C'mon Dr. Gupta ... may as well say it: "Death Panels"
MORE BOOBS:
ReplyDeletethe ny times, in an editorial on hcr, stated,
"Senator Barbara Mikulski, Democrat of Maryland, championed an amendment that directed a unit of the Department of Health and Human Services to issue guidelines on what preventive services private insurance plans should provide free to women. Then... she declared that her amendment guaranteed women preventive health screenings and care at no cost, including mammograms.
... Senator David Vitter, a Louisiana Republican, offered an amendment to her amendment that directed the government to ignore the task force’s most recent mammography recommendations. With the Vitter language inserted, Senator Mikulski’s amendment was approved by a vote of 61 to 39. ....
This sorry episode does not bode well for reform efforts to rein in spending on other procedures based on sound scientific evidence of their potential benefits and risks for patients."
SORRY EPISODE?? Shame on the ny times!
This amendment resulted from bipartisan concern not over efforts to rein in spending, rather an over-riding concern over the unsoundness (and incompleteness) of the 'science' that this task force is attempting to advance.
It's On!
ReplyDelete