Medical analysis in question as experts clash on mammograms
WASHINGTON (MCT) — It is a core tenet of the push to improve American medical care and control its cost: Experts should study the effectiveness of treatments and procedures to determine which work best.
That is essentially what the U.S. Preventive Services Task Force did before recommending this week that women in their 40s should no longer get annual mammograms to screen for breast cancer.
And if the health care overhaul now moving through Congress wins final approval, such advisories could become a central element in the nation’s health care system.
But the uproar sparked by the mammogram report, complete with charges of impending rationing, is a harbinger: A potentially revolutionary improvement in the medical system would likely bring controversy, confusion and uncertainty along with it. Proposed changes to standard medical procedures, even when supported by scientific evidence, almost always challenge the status quo — from other experts’ opinions and doctors’ habits to the feelings of patients and the bottom lines of businesses.
Further complicating the problem, opinions may vary among qualified experts And even the most careful evaluations cannot always provide definitive answers questions about what works best for all patients.
“Unfortunately, there is no magic way to make these decisions,” said Dr. Sean Tunis, a former chief medical officer for Medicare and Medicaid in the Bush administration who works on ways of evaluating medical technology.
The problem, Tunis and others experts say, is that leaving these decisions to the marketplace — as the U.S. health care system has done for decades — has not produced very good results, even for patients.
Doctors in one hospital favored one surgical procedure or drug regimen, while those in another favored something else. Individual insurance companies decided to cover some procedures and not others, often varying their policies from patient to patient.
Even state lawmakers have gotten in on the act, passing hundreds of laws requiring that consumers in their states get particular health benefits such as prostate cancer screening or, in one case, varicose vein treatment. According to the Council for Affordable Health Insurance, an industry group, there are now more than 2,000 insurance mandates nationwide.
The variations and the resulting differences in the way that patients are cared for is one of the main reasons that the American health care system is so inefficient, many experts believe.
The United States spends a greater share of its gross domestic product on health care than any other industrialized country, yet ranks near the bottom in many outcome measures such as unnecessary deaths and infant mortality.
A 2003 study by the RAND Corporation found that adults receive the recommended care for many illnesses only a little more than half of the time. The results were even worse for children.
Obama and his congressional allies have pledged to correct these shortcomings in their health overhaul, in large part by expanding the health care system’s reliance on independent, unbiased institutions to recommend standards of treatment and develop basic levels of medical coverage.
Those institutions will likely look a lot like the U.S. Preventive Services Task Force that evaluated the efficacy of breast cancer screening.
In fact, the Senate Finance Committee’s health care bill — the likely foundation of the legislation the Senate is expected to begin debating soon — relies on the task force ‘s recommendations to outline what preventive benefits Americans should have access to in new insurance exchanges. (The House bill would create a new task force to do the same task).
The existing task force, created 25 years ago, is composed of 16 public health specialists, including academic deans, professors and department heads at major medical centers. They are charged with reviewing studies and other data on preventive services, such as medical imaging and cancer screening, and evaluating their benefits and potential dangers. They then grade the service, based on the strength of the evidence.
“This is the kind of analysis we should be doing,” said Dr. David Shih, senior director of medical affairs at the American College of Preventive Medicine. “These are exactly the kind of things we should be looking at.”
But the task force’s analyses are not without controversy.
