Washington Matters
Breast Screen Screaming
Goes Beyond the Pale
It's cruel to turn a tough medical issue into a political football.
By Mark Willen, Senior Political Editor, The Kiplinger Letter
November 20, 2009
Advertisement
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 recommendations 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.
Reader Comments (24)
Posted by: Susan at 11/20/2009 02:35:36 PM
Didnt' realize this was a biased political publication.
Posted by: JP Jones at 11/20/2009 03:42:49 PM
har har--methinks you write this to protect Obama
Posted by: Speedy at 11/20/2009 05:30:37 PM
Of course Obama is trying to ration health care. His message to Medicare people is "go home and die quietly."
Posted by: Will at 11/20/2009 07:07:16 PM
For some reason the prostrate screening change did not get the attention this did. The current guidelines have been in effect for years. There is a month devoted to breast health. Forgive me for being suspicious when there is a major change in course when the major news for the last 6-7 months is how to cut health care expenditures. And regardless of when they were appointed I assume they answer to the current president. guess I'm just silly.
Posted by: Tom at 11/20/2009 07:39:22 PM
I found a simple solution to the political football - I ignore all editorials in the WSJ...I'm left to wonder how credible the rest of publication is.
Posted by: Dietroly at 11/20/2009 08:32:10 PM
This is the welcome page for the dietguidance.us Association web site.
Posted by: M. Stockman at 11/21/2009 06:20:48 AM
Some of your points are well made, but as with most others in the media your latent liberal tendencies sneak their way out. So we should 'trust' the same people who approved Cerebrex? We should 'trust' the same people who allowed lead-laced toys in from China? he fact that nobody really knows what changes this 'health care overhaul' will bring about is a huge red flag. As far as 'trust' goes, that's why we have accountability (by EVERYONE) to the people.
Posted by: ME at 11/21/2009 10:07:53 AM
Sane conversation backed with data. Amen. I've been through the whole breast cancer scare. I think my lumpectomy was unneccessary. I will be taking tamoxifen because it is cheap and proven effective to reduce risk but I think my needle biopsy and lumpectomy put me at an unneccessary risk. I think my calcifications would have likely stayed the same or disappeared and it opened my eyes to how much the medical field drives our local economy. There's no money in prevention.
Posted by: Dr. Gayle at 11/21/2009 12:25:39 PM
I encourage the adoption of single-payer insurance. I do not favor mandates for insurance, nor tying these proposals to the IRS code for prosecution and fines. This being what it is I am encouraging more women to wake up and realize that mammogram is a known cause of breast cancer and they should demad better and safer choices such as thermography and ultrasound.
Posted by: Marty Smith at 11/21/2009 02:45:19 PM
Sorry, Mark, you will not find many who agree with your position. Politicizing health care started with the liberal administration and congress currently in power. People really are worried about government run health care, rationing and "death panels" and this latest government sponsored study findings that will lower health care costs plays right into those fears. I don't know if this latest reversal has anything to do with health care reform currently being considered by congress, but the timing makes one suspicious. Me thinks you protest too much and your liberal bias is showing like Marilyn Monroe's legs over the subway grate. The real problem is the average US citizen has lost faith in both government and the fourth estate. Neither is to be trusted as neither tells the whole truth, only the convenient parts that support the speaker/writer's agenda. I used to believe the press would protect us from big government. Now I think you are all of the same ilk, far more greedy and dangerous than wall street bankers or health insurance companies or greedy doctors...My wife and I have shrugged, retired early from good paying jobs and moved to a remote area of the southwest US. We will lay low and watch this ironic and sad play unfold as the US become a second rate power (at best), much like Rome, Japan and the UK. Your article shows how far out of touch with reality you and the fourth estae really are. Good luck out there on the right coast, you will need it over the coming years.
Posted by: Tony at 11/21/2009 04:18:02 PM
If what I have read is correct, the panel on mammography did not contain one oncologist let alone an oncologist that specializes in breast cancer. It appears that a panel of scientists and Dr. impresses you even if they do not know a thing about the subject, as long as it agrees with your political views.
Posted by: CarolF at 11/21/2009 08:12:27 PM
I'm going limit my comment to the personal medical choices. Years ago I decided not to radiate my breasts repeatedly. The many risk factors related to me put my chances of breast cancer as minuscule. If some day I get a lump, I'll deal with it. In the meantime I have plenty of other health issues to handle. The older I get, the more I realize I'll die of something some day.
Posted by: RachelSun at 11/21/2009 08:59:38 PM
You people are pathetic. You are so blinded by hatred that you refuse to acknowledge what the author is saying. The panel was appointmed BEFORE Mr. Obama became President. They are independent scientists and physicians using scientific data and not politics. How is speaking the truth biased? It is not.... Your only goal is to destroy.
Posted by: joe_thousandaire at 11/21/2009 10:05:03 PM
Of course these issues are going to become political as long as the government continues to expand their power over the American health care system. If you don't want medical debates to become political, then keep the politicians away from our medical system.
Posted by: Ted at 11/22/2009 12:07:30 AM
Nobody said anything about Bush trying to ration care because he wasn't trying to take over 1/6th of our economy. When you first read the headline, wasn't your first thought, "here's a little taste of what the Obama care will be like".
Posted by: Jack at 11/22/2009 09:08:57 AM
The comments posted here are ridiculous (how significant no one challenges the substance). The panel is all Bush appointees and as Willen points out, they said the same thing about prostate cancer. Why is everything an Obama plot? Why can't Republicans disucss anything on the merits of the issue?
Posted by: Mark Chatham at 11/22/2009 09:31:57 AM
We're never going to get anywhere in this country if we insist on seeing a conspiracy lurking behind every tree. I don't know whether the new recommendation makes sense but it does seem like it's the same for prostate screening. And I find it hilarious that the same people who scream about spending too much money are the first to object when someone suggests maybe we're wasting needed dollars. Republicans complain the health bill won't cut costs but reject every attempt to do that, playing on fears of Americans. What passes for debate is depressing in the extreme. Thanks for at least trying.
Posted by: Zael Lutz at 11/22/2009 09:43:45 AM
Finally, a rational response to this issue. Science is being trumped by a wash of noise and political nonsense from people who know nothing abou the issue.
Posted by: Nomen at 11/22/2009 11:06:28 AM
Reality check!!!!! Our health care is already being rationed in the form of high deductibles and co-pays. Many people WITH insurance are not seeking proper treatment because they can't afford it. This has been cleverly made to look like it is the patient's own fault for demanding too much. Where to begin? The problem is not profit, it is maximum profit. What is the difference? Maximum profit is like a cancer that can only grow by throwing out pesky impediments like ethics, morals, fairness, loyalty,and patriotism. The current business model for insurance companies, drug companies, hospitals, and medical providers IS maximum profit. With that maximum profit comes the ability to throw billions of dollars at our politicians, ad campaigns, and spin experts to continue to deceive the public and protect their gold mines. Unfortunately, it isn't just healthcare but our whole economy that has been infected with this malignant maximum profit disease. Feel free to get a second or third opinion from whatever expert you choose but the final prognosis will be the same. TERMINAL
Posted by: Concerned Woman at 11/22/2009 04:05:06 PM
There is nothing biased in saying President Bush appointed the panel and that in 2008 the panel recommended fewer tests for prostate cancer. Both facts are verifiable on the panel's website. The critics seem to be saying that we can trust scientists, doctors, and nutritionists when the administration is Republican but not when it's Democratic.
Posted by: Nomen at 11/22/2009 07:06:25 PM
Having degrees in Chemistry & Physics and working with x-rays for years has given me a healthy respect for the effects of cumulative radiation damage. Although x-rays are a wonderful and useful diagnostic tool when needed, they are highly overused especially on younger patients. Whether it be unnecessary yearly dental x-rays on children or mammograms on young women, the risk far exceeds the benefit unless there are other definite indications that they are necessary. Unfortunately, most x-rays being given are a source of revenue rather than a necessity. It's even more unfortunate that there seem to be experts giving contradictory advice. Use your own common sense. Regular self examinations won't hurt you but being repeatedly exposed to radiation especially at a young age could cause the very cancers you fear. Remember, almost all the experts are on somebody's payroll and their opinions will reflect it. Consider the source and don't be misled by hype and advertising. AS far as the healthcare debate goes, don't be fooled. Both sides don't want to admit that it is really about the money(big money) and who gets it. Everything else is just a smokescreen. Healthcare is already being rationed by huge deductibles and co-pays along with escalating premiums while our insurance companies make record profits. While you are at it, do a little reading on where most of the lobbyists money goes and who the lobbyists represent. It gives a whole lot better perspective on our current problems.
Posted by: Pete at 11/22/2009 09:13:48 PM
Of course the prostate exam findings weren't an issue during the Bush years. A government takeover of health care and its attendant potential for rationing wasn't looming then. Also, prostate testing is far less reliable than mammography, prostate cancer is much slower growing and generally affects older men, while breast cancer is often more aggressive in the very population (younger women) now being advised to postpone any sort of breast exam.
Posted by: MIke at 11/22/2009 10:50:25 PM
NOt surprising that a federal agency would call for a reduction in testing. Just a prelude to rationing and accounting based medical care. Three years ago the Veterans Adminsistration, all seeing, omnipotent and wise, determined thru their own "science" that diabetic veterans only need test their blood sugar once a week.The science used was math not medicine. WIth several hundred thousand diabetic veterans, they reduced their cost of diabetic testing supplys substantially. I am waiting oto hear the recommendation from a government health care official that women passed child bearing years should have their brests removed to prevent cancer.
Posted by: dawn at 11/23/2009 11:10:26 AM
Mark, sSince you are a man, you do not have any idea what you are talking about. What is the purpose of this commentary from you except to give us your opinion? Give us the facts. who cares about who is in office. This story is biased and not worth of publishing. Try giving us something with the facts that you have experience in.