Breast Screen Screaming
Goes Beyond the Pale
New guidelines on pap smears from the American College of Obstetricians and Gynecologists couldn’t have appeared at a more confusing time, coming as they do just a few days after a federal advisory commission reversed course and called for fewer preventive breast cancer screenings. The decisions are generating a lot of controversy, and that’s perfectly appropriate. But neither should be used as a political football.
It’s more than a little disconcerting to wake up and find a major reversal of such importance splattered across the front pages, and there have been far too many of these medical reversals in the past few years. The public is left with huge, legitimate medical questions: Have millions of women been subjected for years to needless risk, not to mention bother and expense? Or is the panel using inconclusive evidence to jump prematurely to a conclusion that will put many more women at risk of cancer?
It’s both infuriating and frustrating when doctors disagree on a course of action, and we as a nation need to ask the best minds in the field to get to the bottom of it. Those who say it’s better to be safe than sorry and want to continue the old policy are ignoring what could be important evidence that unnecessary screening is dangerous – both because of the radiation involved and because of the false positive results that often lead to unnecessary procedures that are far more dangerous than people think.
But as much as this is an important medical issue, it is not a political issue, and any elected official or media pundit who tries to make it one is playing cruelly on the fears of ordinary Americans. Many Republicans in Congress, backed by a silly editorial in the Wall Street Journal, say the recommendation's main aim was to save money and is part of President Obama’s attempt to ration health care. That may be a convenient argument in the health care debate, but it is downright wrong.
Consider this: In August 2008, the very same panel made a similar change in recommending far fewer screenings for prostate cancer. Did anyone attack it as a Bush administration attempt to ration care? Are the critics able to explain away the fact that the members of the advisory panel are doctors and scientists (not politicians) who were appointed before Obama took office? And why does no one pay attention when they insist they were under no pressure and are actually barred from considering costs in considering guidelines or when experts note that the recommendations are more in line with those of the World Health Organization, Britain and many other developed countries.
Too many Americans are truly schizophrenic on the issue of government involvement in health. We want federal officials – indeed, demand that federal officials – do more to make our food safe. How can they if they don’t determine what is healthy and what isn’t? We let the Agriculture Department recommend a diet. We let regulators determine the level of lead that is safe on the toys we import. We let the FDA decide which drugs and medical devices are safe and effective. When they reject something, does anyone accuse them of rationing so Medicare can save money? Of course not. So why do we trust these government medical experts and not the advisory panel, which is arguably freer of political pressure?.
The answer to our dilemma isn’t to take the government out of all health care decisions. That’s just crazy. And you’d have to be extremely naïve to believe that the critics of the mammography recommendations truly aren’t intentionally playing on public concern to make the case against a health care bill. If anyone is guilty of playing politics with the nation’s health, it is them..
This is a serious issue that deserves a serious debate. Have we created a political climate where that is simply no longer possible? It certainly seems that way.