In a favorite episode of the sitcom “Taxi”, two characters, who are not married to each other, are stranded in a taxi during a bitterly cold snowstorm, and realize the only survival strategy is to generate enough heat through sex to last them until they are rescued. But they agonize over the choice: Sex? Death? Sex? Death?
The humor comes because almost any rational person forgives the exculpating circumstance and thinks these choices are so wildly disproportionate that to agonize as though they are morally equivalent is bizarre.
Yet the US Preventive Services Task Force, (a creature of the Agency for Healthcare Research & Quality within the Dept. of Health and Human Services), and perhaps appropriately first convened in 1984, has just radically revised the proscribed policy on mammography with a rationale that is the inverse of what almost any woman would accept.
In their view, so what if you save significantly more lives by screening earlier – hey, you can minimize anxiety, false-positive results, and what turn out to be unnecessary biopsies if you cut it out. Death? Risk of false positive? Death? A little anxiety? Your government’s agency, in this report meant to be used “as a basis for reimbursement and coverage policies”, just picked death over anxiety.
(Of course, if your goals are to minimize all the anxiety, false positives, and costs, we can do that by not giving any tests at all! Any takers for the medical system of sub-Saharan Africa?)
A significant part of the recommendations weren’t arrived at by looking at actual data, never mind actual patients – they just compare various mathematical models of what the probabilities of different screening protocols might be. And that’s not surprising – the “perspective” of the report is “societal” – can we say Orwellian collective good – and this by the same folks who are promoting cost-effective analyses (CEAs) which necessarily reduce your life to what they determine its monetized quality to be.
Now it certainly is true that there are declining benefits to screening at younger ages and increased frequencies. But it is patients and their doctors, not statisticians (none of whom seem to be oncologists) who ought to make those final calls. If anyone wanted proof that you do NOT want your health care choices determined by a government bureaucrat who is allocating costs and caring more about “society” than people, but instead want medical reforms that preserve the opportunity to make your own choices about what’s appropriate to you, this is it.