As soon as the word came out about the taskforce decision about breast cancer screening, I said to myself, "oh god, here it comes".  And is sure did come - a huge media frenzy regarding this topic.  It opened the discussion today as well on meet the press and the chief medical editor for MSNBC (Nancy something, sorry) made the point that I knew was coming:

SCIENCE WAS THROWN UNDER THE BUS OF PUBLIC OPINION.

Scientists have to job to take an intervention and study it - to help us determine is X interevention effective.  Now, in this study (which is not the only study by the way and not the end of the discussion) shows that 1/1900 40-49 year old women will have the screening and will survivie as a result.

Now, it would not matter if that number was 1/6000, we would be sitting here having the same discussion right now.

The question is, at what level would you the consumer not desire to have this test done?  1/4000?, 1/6000, 1/10,0000?  Or should it be done no matter what to save that one life?

There are in fact many tests that have undergone scientific review for say heart disease or for lupus, or whatever, any other disease not cancer.  The taskforce would have released their recommendation regarding this test, and no one would have noticed (not to say they shouldn't have). Were these decisions regarding say a test or a medication for heart disease less meaningful to people?

Anyway, the taskforce's job is about science.  National guidelines will now decide weather they agree - and FYI - there are many guidelines for major diseases, and they frequently do not agee....then it is up to the Doctor.

So do we pay for every test in the US that is very much marginally effective?

This brings up the other thing that was thrown under the bus too, the concept of an intelligent system of managed care in this country.  This is in fact, wheather everyone likes or agrees or not, why other civilized countries provide their care so much cheaper than we do.

That brings me to the quote that was mentioned in the new york times on meet the press today - Cannot find it at the moment, but to paraphrase, it was stating that American consumerism trumps good medical decisions as dictated by careful scientific analysis. (the words use by the NY times writer was much more eloquent than mine). We would rather pay out the nose for medications, procedures, or tests than be told NO.

I could go on, but for a related detail, see my previous post about the choice that we hold dear in this country (to no good end) and we pay for it out the nose:

http://www.ireport.com/docs/DOC-358044