November 30, 2009
CDC Breast Cancer Recommendation not Supported
The recent CDC recommendation to delay breast cancer screening until age 50 is exceptionally revealing. The first is the lamentably poor state of benefit cost analysis of the CDC. The other is the role this type of policymaking will play in rationing health care under the current bills before Congress.
The CDC recommendations have already suffered a devastating blow by a peer reviewed journal and I expect them to be reversed in the coming months. But I have some research experience in this matter. While working as an economist in West Virginia our university research center tracked health care outcomes in several rural clinics. In one clinic the mammography machine broke and was not replaced for several months. We examined this natural experiment and found that preliminary cancer detections spiked right after the machine was replaced – presumably because women were forced to delay testing. Our study was plagued with the common limitations of medical research – small sample sizes, difficult and costly patient follow-up. Still, our findings suggest that delaying mammograms across this population cost lives. The benefits of replacing the machine outweighed the cost of screening by tenfold. Furthermore, all the other studies we read said the same thing: breast cancer screening is a very low cost way to extend life and reduce morbidity. The number and quality of studies were so convincing we didn’t bother to publish our study. Yet the CDC cited no benefit-cost studies to accompany their recommendations. Their medical colleagues are already pouncing on them, so I’ll say no more.
What concerns me though, isn’t bad research (better research is already fixing this problem) What scares me is that under the House and Senate health care proposals, virtually every medical procedure will have this type of government dictate deciding very personal medical decisions.
The ‘Death Panels’ label employed by some opponents of parts of the current health care reform were a bad choice of words. It sounded too much like a jury deciding for or against care for an ailing individual. This vision was easily discredited. The truth is nothing as personal as a Death Panel. Under the current proposal the same type of groups that made the CDC’s recommendations will outline guidelines about which treatment will be offered under a government program (or subsidized insurance plan). Since the government plan will quickly swallow private insurance, these treatment guidelines will set restrictions on treatment. For example, pancreatic cancer patients are likely to receive only pain relief and hospice.
Happily, no right minded insurance company or doctor is going to follow the CDC guidelines. That’s simply good business. But it’s not just about business and policy. Like many American families today mine prays for friends and loved ones afflicted by the disease. When it comes to screening for a cancer that strikes so many women in the prime of their lives we want to risk erring on the side of caution. That is the decision most families make. We all deserve a government that lets us.
About the Author
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