As I note in my article in the American Spectator today, (spectator.org/archives/2009/11/18/breast-cancer-follies) the US Preventive Services Task Force www.ahrq.gov/CLINIC/uspstfix.htm (bet you didn't know it was effectively a mouthpiece for AHRQ comparative effectiveness research and -- based on AHRQ research -- the final word on what and will be covered under all health care reform bills) has pulled the plug not only on the most reliable tool for breast cancer screening thus far, but also what is becoming an important test for determining whether women are at risk for heart disease.
The rationale given in both cases: What we know about the limits and net benefit of screening for everybody is precise - based on a review of studies that we decided are good enough to review -- and that we don't know enough about new tests and tools to use them.
www.forbes.com/2009/11/16/mammograms-cancer-screening-business-healthcare-mammogram.html
The result? Less screening now and delayed use of newer tools based on scientific advances for years to come.
Follow the logic of the Task Force members:
"Dr. Kerlikowske counters that the new USPTF guidelines are based on a far more detailed and rigorous analysis of the mammography data than has ever been done before. (The USPSTF reviews its guidelines every five years.) "There is new evidence to precisely quantify benefits by age. It didn't exist before," says USPSTF's Diana Petitti. "Those lines of evidence came together to a conclusion that the net benefit of starting earlier rather than later was small."
Precisely quantify benefit? Are we to presume that the benefit is exactly the same for all women without family history of breast cancer? What about those who have not been screened for genetic inclination? And what is net benefit? Sort sounds like a collective benefit to me. Meanwhile, what started all this is the untested assumption that too much screening leads to too much treatment. Is that true? Where is the precision for that number?
The decision to ditch the use of CRP to predict heart disease risk in women of the same ilk. The concern is not public health, but what such tests do to generate "too much" treatment. And again the evidentiary standard is one that ignores the very individual or subpopulation differences necessary to real precision in order to obtain a "net benefit" for a health system. The willful disregard of the JUPITER data as it pertains to women is shocking. Setting aside the real benefits of treating women with high CRP levels with statins in the trial, the study demonstrates that testing for CRP is an important predictor of and precondition to reducing death from heart disease.
online.wsj.com/article/BT-CO-20091117-715499.html
At the very least, the Task Force decisions should factor in the impact on compliance. Ironically, the administration had no problem yanking adjuvant out of H1N1 vaccines to appease Mercury moms and others for whom believing vaccines poison children is a new religion. Or as an administration official said in a recent hearing explaining the mounting delays in vaccine availability, which in turn has lead to doubts, cynicism and apathy about immunization:
The rationale given in both cases: What we know about the limits and net benefit of screening for everybody is precise - based on a review of studies that we decided are good enough to review -- and that we don't know enough about new tests and tools to use them.
www.forbes.com/2009/11/16/mammograms-cancer-screening-business-healthcare-mammogram.html
The result? Less screening now and delayed use of newer tools based on scientific advances for years to come.
Follow the logic of the Task Force members:
"Dr. Kerlikowske counters that the new USPTF guidelines are based on a far more detailed and rigorous analysis of the mammography data than has ever been done before. (The USPSTF reviews its guidelines every five years.) "There is new evidence to precisely quantify benefits by age. It didn't exist before," says USPSTF's Diana Petitti. "Those lines of evidence came together to a conclusion that the net benefit of starting earlier rather than later was small."
Precisely quantify benefit? Are we to presume that the benefit is exactly the same for all women without family history of breast cancer? What about those who have not been screened for genetic inclination? And what is net benefit? Sort sounds like a collective benefit to me. Meanwhile, what started all this is the untested assumption that too much screening leads to too much treatment. Is that true? Where is the precision for that number?
The decision to ditch the use of CRP to predict heart disease risk in women of the same ilk. The concern is not public health, but what such tests do to generate "too much" treatment. And again the evidentiary standard is one that ignores the very individual or subpopulation differences necessary to real precision in order to obtain a "net benefit" for a health system. The willful disregard of the JUPITER data as it pertains to women is shocking. Setting aside the real benefits of treating women with high CRP levels with statins in the trial, the study demonstrates that testing for CRP is an important predictor of and precondition to reducing death from heart disease.
online.wsj.com/article/BT-CO-20091117-715499.html
At the very least, the Task Force decisions should factor in the impact on compliance. Ironically, the administration had no problem yanking adjuvant out of H1N1 vaccines to appease Mercury moms and others for whom believing vaccines poison children is a new religion. Or as an administration official said in a recent hearing explaining the mounting delays in vaccine availability, which in turn has lead to doubts, cynicism and apathy about immunization:
If adjuvants were added to the vaccine supply, many of the unadjuvanted doses would need to be taken out of the supply she said.
Also, public confidence in vaccines, in particular vaccines with adjuvant is low, she said. "And we didn't really want to rock the public confidence in a new vaccine with adjuvant."
http://www.medpagetoday.com/Geriatrics/Vaccines/17081
