Do New Mammogram Recommendations Patronize Women?

If they get your front end that happy they're probably afraid the back end would start laughing...

What is wrong with results based medicine? Isn't that how we determine what is best for a person's health? We've come a long way in the past few decades using the methods you seem to overanalyze. Mammography has detected breast cancer in its earliest stages on countless women. The benefits (since you asked) are lives saved. I will take preventative screening over crunching numbers and analyzing every detail of a procedure any day.

I also agree with Bi-Polar Bear that prostate screening and PSA testing should be done on a regular basis, as well as other screening tests that can prevent serious illness.

Unfortunately, if the government takes over our health care, they will be thinking as you do, engineer. It's not a conspiracy theory. It's what happens when health care becomes socialized.

It's not my definition of better, it is the absolute definition of better as defined as a more healthy outcome for the population as a whole. People can distort data to try and get statistics to come up with bogus numbers, but statistics used correctly can yield amazingly powerful results.

It's also not a matter of saying that "there is a price to life." It's saying that you can reduce someone's quality of life and their life expectancy by doing too much to them. More can be WORSE. For a lot of people, this is completely counterintuitive, but to doctors studying this, it makes perfect sense. I don't know if you listened to the link I posted (and it's fairly long, so I expect most people won't), but the upshot is that there is a real, tangible, measurable cost (and not just in dollars) to excessive medical testing and this cost can overwhelm the benefit. One place today where that is really obvious is prostate testing for men. There are very large and serious side effects to removing tumors from the prostate, but most tumors are so slow growing that they would never cause an issue during the life of the patient. Aggressive testing has produced a huge number of false positives leading to a significant reduction in life quality for a lot of men. Does that mean that it hasn't saved lives as well? Of course not. It would be fairly easy to identify men whose lives have been saved. But counting them and ignoring all those men whose lives were ruined is bad accounting. Every mammogram increases the risk of contracting cancer due to radiation. Maybe the risk is only one in a thousand, mabye one in ten thousand. But when 50 million women are getting tested, that adds up to a real impact AND THEY WILL NEVER KNOW THAT THE REASON THEY GOT CANCER WAS EXCESSIVE TESTING! They will always assume they were unlucky, genetically predisposed, etc. They may even thank their doctors for using mammography to "save" them. Only by studying large populations can doctors identify the cost of the test. You can measure the benefit of the test directly. Just ask your friend who had a cancer discovered in her forties. The result is that when doctors look at the data, they are vilified as people who put a value on human life instead of people who are trying to improve the overall health of the entire community.

Apparently you are not for results based medicine. If the data says you get better results with less testing, will you say "great, less testing" or "you are lying sacks of **** who want to kill people to save money?" It seems like you are leaning towards the latter.

A personal real life example for you. During my wife's first pregnacy, the doctors ordered an AFP test (alpha fetal protein?), something that was completely not necessary for a woman my wife's age. It can detect Down's Syndrone. It came back positive. The tension shot up. The next test was an amnio. Before the amnio, the nurse was going over the risks. A 1 in 700 chance of SPONTANEOUS ABORTION. She also explained that the AFP has an insanely high false positive rate and at my wife's age, the risk with a positive AFP result was around 1 in 700. Her comment was something like "the risks are similar" which is an absurd statement since they it's not either/or, it's both. But at that point, we had to go ahead with it. We were beside ourselves with worry. So this doctor stuck a huge needle in my wife, steering with ultrasound, penetrated the womb and drew out a sample of amniotic fluid. My wife spent the next day with stomach pain and muscle spasms wondering if our child would die. (Everything was fine.) For the next child, we told the doctor not to perform the test and that we'd just assume not know. Every year, 1 in 700 children tested die because their parents are advised to get an unnecessary test. But I'm sure you believe that I told the doctors to stuff it to save money. After all, an amnio costs several hundred dollars.

It already IS rationed - it's just that it's rationed in such a way that people who have the money to pay for health insurance or people who are lucky enough to work in jobs that provide it are getting the lion's share of the prime services available while there are others who get NOTHING.

Think of it as rationing this way - some of us get a T-bone steak dinner and others get NOTHING - not even bread and water.

So if everyone gets a mammogram after fifty - I have to agree that's a more agreeable sort of rationing than some people getting mammograms from thirty-five on and others getting NOTHING.

What's the difference between "results-based medicine" and the reduction/elimination of "defensive testing" that the Republicans offer as their version of health care reform?

And actually - I'll even go a step further. There is NO history of breast or reproductive organ or any other cancer in my family. I have a mother and three sisters still living with all their reproductive organs intact and two grandmothers who have died - neither from cancer. None of us has ever had any cancer of any kind. I used to get tested/screened every year just as a matter of course in the U.S. because my insurance provided it.
Since moving to England five years ago - I've had one pap smear and no mammograms. I don't miss them at all - and I don't think having them will make any difference at all in my life expectancy or quality of life, since I am very, very low risk for breast cancer or cancer at all due to genetics and lifestyle (I've never smoked, don't drink to excess, eat a very healthy diet, have borne a child and breast fed and am white with no family history).
I agree with Engineer that the radiation from the mammogram would probably be my biggest risk factor for breast cancer - so I have no issue with never having another mammogram again, in all honesty.

I'd be delighted to give my mammograms to another woman who has more chance of developing breast cancer.
Sometimes logic should take precedence over economics based on class system.

Same story here... the AFP results with my first pregnancy took too long to come back. I work in the diagnostic testing industry and I knew that meant it was being repeated due to being either too high (possibly indicative of Downs) or too low (possibly indicative of spinal bifida ). I was a nervous wreck waiting for the results. It came back abnormally low and an amnio was ordered.

In the meantime, I called the group who produce the test (I happened to work for the company that manufactures the assay) to get the science behind AFP testing as a pre-natal screen. What I learned was that low AFP results can come from one of three things - 1) dates are wrong and one isn't as far along in the pregnancy as they thought (not the case here), 2) anecdotal evidence that it could mean spinal bifida (fear and anxiety were unbelievable), or 3) a small fetus that isn't producing AFP at the levels that a larger fetus produced.

The results of the amnio came back fine but the two-three week wait for the results was HELL! I gave birth to a small (6 lb), full-term baby girl.

I refused the AFP testing on my second pregnancy.

I think "defensive testing" is done when there is no indication of injury, but a test is done so that on the very off chance that something is missed, the doctor can claim in court to have done everything possible. Results based medicine is more using large population statistics to identify practices and procedures that produce the best outcome for the entire population. Any doctors out there who can better inform us?

I haven't done any in-depth studies on "results based medicine." When I think of that term, I think of several people I've known who have had a disease caught in its earliest stages because they had regular screenings for that particular disorder. I've also known people who have not kept up with regular tests and have contracted diseases. However, I don't know how many people of my acquaintance who have been tested and the results were negative, nor do I know how many weren't tested and still did not contract a disease. What I truly believe is that people should be informed and then be allowed to make their own decisions as to whether or not they want to have periodic testing done (I'm talking about the average person who cannot afford to pay out-of-pocket for these expensive procedures).

The new recommendation about putting off mammograms until women are 50 sent up a red flag for me. Like I said before, I think this is just the beginning of health care rationing that will affect all of us if the government gets into the health care business.

To use your words - yes, I think the government is a bunch of "lying sacks of **** who want to kill people to save money." Of course, THEY don't have to worry about it because they have their own health insurance that isn't available to we the people.

But aren't they subject to the same recommendations? Won't government insurance follow the same recommendations that every one else does? Not that your response is atypical. The problem is that any recommendation that appears to save money will be met with the same response from a lot of people, even if the original idea is not based on cost, but on providing the best service. And the idea of providing better health care by reducing testing is very counter-intuitive, but sometimes intuition is wrong.

My understanding from what I've read is that their insurance is different than what the rest of us will get under government-controlled health care. I could be wrong, and I'm going to do some research because I really would like to know for sure.

I do agree that providing better health care is the most important issue here. I also believe that there is excessive testing in the health care field. But I still think people should have the right to get the best information they can on whatever health care subject they are concerned with and then, with the help of their doctor, decide whether or not to have tests, regardless of cost or what the government dictates to them.

Then we are agreed and I'll leave you to read up on healthcare. I really do recommend the radio show link I posted above if you are interested in healthcare. As long as people understand the benefits and risks of testing, the choice should be up to them and their doctors to make free of government influence and fear of lawsuits. The mammography recommendations that started this thread are only recommendations as it is.

You do? Agree that everyone has the right to have whatever test are deemed "appropriate" regardless of cost?

Not me.

To discuss prostates and breasts in the same context might be adding apples to oranges, since many a slow growing prostate cancer can let a man die of other causes, while a cancer in a breast does not afford a women that luxury.

Plus, the problems remaining after prostectomies is far different than the problems remaining after mastectomies.

Perhaps, the conservatives that are anti-public option have the simple point that many people were happy with what they had. Like the saying goes, if it is not broken, do not fix it. The government wants to "fix" health care for everyone. It is not broken for everyone; only some people, and fixing it for them will just be raining on the parade, so to speak, on those that do not want it fixed, in my opinion.

You said more is not always more; well, more fixing is not always more (better) health care for more. Your analysis paradigm can be applied to the respective populations too of those that want health care fixed, and those that have no need to have it fixed for them.

Fixing health care for everyone is just the ruse, I believe, to make health care affordable to those that do not now have health care.

When you start reading minds, I end the discussion, since I doubt you read minds. Even if this is just a colloquial way of talking, I prefer not to be dealing with someone that infers they know other people's thinking, since other readers can misconstrue what might have been said previously. Too misleading a style of discussion for me.

interesting.

My point here is not to compare prostates to breasts, but to point out a more obvious case where "more" in terms of more testing does not result in a better outcome for the entire population. Some men's lives are saved and other men's lives are destroyed, so how do you balance it? You use a lot of math to determine when the benefits outweigh the risks. The same is true of breast cancer, but it is a lot harder to see the negatives. Yet they are still there, there are risks to excessive testing. Mammography does cause cancer from radiation exposure. These doctors who are being vilified are trying to help you understand that risk, not trying to kill women or save money.

Not mind reading, but making a logical deduction from the data presented. I posted an opinion that excessive testing can lead to negative effects and that statistical studies can reveal this. The replies back are that my worldview is that you can put a dollar value on human life and that not everyone agrees with that cynical position. From there it is logical to assume that if I refuse to have a test done that I believe is not of value, that I will be accused of just trying to save money. I don't have to read minds to assume that people will be consistent.