Bad Medical Reporting, Denialism, and Public Health
This month’s perfect storm — poor medical reporting, denialism, and public health. Marketplace yesterday:
For years, our medical system focused on the individual. The thinking was, even if only one life was saved, everyone should get tested. But the new studies show not everyone needs screening. In fact, too much screening can do more harm than good.
Dr. Louise Russell studies preventive care at Rutgers University. She says patients have to change their mind sets. Think about the odds of finding lethal cancer… She says patients need to trust the odds and not get screened if they’re not at increased risk — if they don’t, say, have a family member with cancer.
Doctor Otis Brawley is the chief medical officer of the American Cancer Society. He disagrees with the mammogram recommendations. He says even if one life in a thousand is saved, it’s worth it… A lot of patients feel the same way. They don’t care about the big picture.
Doctor Robert Aronowitz teaches the history and sociology of science at the University of Pennsylvania. He says it’s hard to change that way of thinking. But people can put themselves in danger. Unnecessary cancer treatment can cause anxiety and even death… Aronowitz says that applies to all kinds of preventive treatment — from screenings to drugs that are supposed to prevent disease.
There is reason for optimism.
6 Responses to “Bad Medical Reporting, Denialism, and Public Health”
The recent study on breast cancer screening has really been misused by both the right and left – the right claiming it as a sign of death panels to come and the left using anecdotal evidence to claim the more mammograms the better. Both are wrong.
What both sides miss is that decisions on screening have to be based on populations, not individuals. Invariably there will be individuals that will have cancers missed if the new study guidelines are adopted. Neither “side” can accept that. What they are missing is that there will also be cancers avoided by less exposure to radiation, less unnecessary biopsies with less complications and anesthesia risks, and finally less cost.
The cost aspect has to be a factor. The government can not afford to have the attitude that if only one life is saved, any cost is worth it. There is a finite amount of money and there is not enough money for that attitude.
You are so right DaGoat. We have this from an NYT article yesteray:
“This week, the science of medicine bumped up against the foundations of American medical consumerism: that more is better, that saving a life is worth any sacrifice, that health care is a birthright.”
There is big money to be made in health care and as a result it is marketed like a consumer product. More is not always better.
“What both sides miss is that decisions on screening have to be based on populations, not individuals.”
You have that correct, though the recent event does constitute an ironic backblast on the people in denial about rationing and denial of care (as well as backfiring on leftist politics and the entitlement mentality). Cost-effectiveness and rationing and denial of care are serious concerns, and can be anti-PC (aside from the ages-old criticism of leftist politics that has tainted and corrupted this topic and created intelligent concerns from the outset of this year's “reform” attempt).
Aside from the realism missing not only with screening and with preventive care (which is over-hyped), yes, of course, the central issue here isn't so much “appropriateness,” but cost-effectiveness, and (as I've written before), this was a great example of a generalist, epidemological, public health approach to the issue of interest (which is extendable to many other kinds of tests or preventive or prophylactic measures, and which applies to the population in general, in the broadest terms). Note that specificity here, in the form not so much of individual anecdotal illness cases but with specialists involved with the issue at hand (in this case, breast cancer as well as mammography), introduces bias and a tendency toward special pleading.
Cost-effectiveness (more than a more general “appropriateness” viewpoint) is so obvious it is a subject in and of itself, even as a literary and academic field of interest.
http://www.resource-allocation.com/
Note that nomenclature and concepts related to this subject have long been on the minds of many (including me, as a patient with a chronic illness, familiar with this as well as the “ocean” of ethical issues and other related issues with organ transplantation and other life-saving measures), namely quality of life, remaining quantity of life, and the famous (or should-be-famous-by-now statistic), the QALY (Quality-Adjusted Life Years, the concept that quality of life as well as expected remaining or additional lifespan should be considered when allocating or judging the appropriateness of intervention).
Among other related subjects, this (life-years after transplant, going down with increased recipient age) is used as a rationalization for allocating organs of varying quality themselves (using Expanded Criteria Donor or ECD organs to try to allay the shortage of organs used for transplantation), formalizing the common-sense notion of allocating older, sicker, lower-quality organs to older, sicker recipients on the basis of matching organ quality to remaining-life quanity-quantity “value” or “product.”
Related:
[QALY statistic]
http://www.ispor.org/news/articles/oct07/pwtq.asp
[Cost-effectiveness approach]
http://online.wsj.com/article/0,,SB107205985174…)
[Allocation -- the companion of cost-effectiveness of each service or therapy -- a good introduction and overview here]
http://econopundit.com/ezekiel_emmauel.pdf
[Material related to revisions of allocation and waiting-time and priority criteria for renal transplantation]
http://www.unos.org/SharedContentDocuments/Kidn…
It's difficult as well as fascinating enough as it is, without being made incompetent and malevolent, as normal people fear, by politics.
“that health care is a birthright”
The whole misuse of the word “right” with health care is facing blowback (backfire) right now.
Serves those people right.
All the details have been missed. The critics who have long known about rationing and denial of care are simply being proven right again the way the earth is “discovered” to be round rather than flat, again; this is no biggie (though the GOP would be remiss, actually not to seize this). What this issue does is bring to light (in the darker, emptier heads) that the rationalization with this subject is inescapable. That the smallest details, including the level (level C, level D, I statements) of the findings, and that this is not the last word on the issue, is lost in the emotional overreaction to it (and intellectually remiss common reaction, to date, to it). Welcome to reality.
“though the GOP would be remiss, actually not to seize this”
Aren't they also remiss to promise seniors that Republicans would never ration their care, when they know for a fact that that's inevitable? I think we call that a bold-faced lie.
the rich will get all the mammos and psa tests and pap tests they want. This entire faux science is a red herring. It's still about rich vs poor.