25 November 2009

Killing Women Softly

The recent back to back recommendations to cut back mammograms and pap smears limiting them to older women should be viewed for what it is - health care rationing! These are murky waters to be sure, but the bottom line is -well - the bottom line. These recommendations are floated as evidence based science. Well, maybe. But, why did this evidence based science suddenly become so irresistably heavy? These evidence based 'facts' about mammography and pap smears have been known for years, even decades. Why the rush now? Why the big noise about it now?

Could it be because millions of previously uninsured women will suddenly be in a position to demand what others have had all along? And this time somebody else has to pay for it? And that somebody else - the government- is really all of us. So now, mammograms are wasteful and unnessessary until age 50. Besides, they only save 1 life out of 1900 women. The following excerpted article shows the fallacy in that argument.

The reason pap smears and mammograms were done willy-nilly in the past is because lots of money was being made by private care givers: pathology labs, radiology and OB-Gyn practices.
In the past many women only went once a year to their OB doctor for a pap smear. This gave the doctor a chance to take an overall look at other health issues as well serving in many cases as that woman's primary care doctor. Once a year doctor visits are not optimum care by any strech, but how about once every three years!
So women were herded in and their private insurers were fleeced for all they would tolerate which was a lot. Now the game is changed. Rationing is the new game being played. Rationing or care denial killed when practiced by HMO's and it will do the same as practiced by the government. HMO's were up-holding share-holder rights, and care denial was good for the bottom-line even if it wasn't too good for patients. Any CEO who didn't mind the bottom line was going to be sacked. But can government operate by the same demented free-market logic? I think not, because government is Constitutionally bound to protect the 'General Welfare'. The government is on doubtful legal and moral grounds to deny care because of cost. But, of course, the government, all of us really, is busted and subject to moral temptations. What has to be fixed first is the economic crisis if that is possible. If it is not possible you can forget health care anyway.

Cost-benefit analysis can kill. The failure to distinguish statistics from arithmetic can kill. In the current debate over mammograms, the number of women projected to be at risk of death due to cost-benefit analysis is about 47,000.
That is the approximate number the United States Preventive Services Task Force projected to die if its recommendations on scaling back mammograms had been accepted. It is their number, if you do the arithmetic, which they apparently did not.
Their statistics say that the life of "only" 1 woman in 1,900 will be saved if mammograms start at age 40 instead of age 50. In other words, a 40-year-old woman's "risk" of dying from breast cancer in the next ten years is only 1 in 1,900. That seems like no risk at all: 1 divided by 1,900 equals .000526. About half a woman per thousand. Minuscule, right?
Now, how many women in America would be affected?
The most recent (July 2008) census figures say there are about 304 million Americans, of which 50.7 percent are female. That's about 154 million females. Roughly 80 million of them are under forty and about another 20 million between 40 and 50. Of the 80 million under 40, each one, under the proposed guidelines, would not get a mammogram until age 50. If "only" 1 in 1,900 die as a result, that would be .000526 times 80 million, which equals about 42,000.
In short, moving the mammogram age from 40 to 50 would result in the deaths of 42,000 women now 40 or under, according to the statistics of the United States Preventive Services Task Force. Of the 20 million between 40 and 50, it could mean the deaths of as many as 10,500 women, though the figure may be somewhat lower because half are more than halfway through the critical period. There might be as few as half - say, 5,000 deaths. Adding 42,000 and 5,000, we get a ballpark figure of 47,000 currently alive American females who would die needlessly under the proposed task force restriction on mammograms. Of course, as more are born, the absolute numbers would go up.

No comments: