RALEIGH — Recent headlines concerning new rules on access to mammograms — changing the previously recommended regime from regular screening beginning in one’s 40s to reducing the frequency of screenings by half for women beginning in their 50s, is no mystery whatever. This is not a health science debate. It’s not about the credentials of people on the new federal panel, though in a real debate it would be. It has nothing to do with the science, but is and will be repudiated soundly by same.
This is about money. More precisely, this is about the abuse of economics to support moral judgments about what a life is worth, and in cases of preventive medicine, what we can save in dollars by waiting until it’s too late to justify intervention or bring about a successful cure. By reducing timely detection of breast cancer the federal government will save many dollars, both up front (in mammography and diagnostic consultation costs), in denial of treatment for cancers “too far gone,” and for patients too old to justify the extraordinary expense and physical demands of treatments for advanced breast disease.
They will have, in parlance I think completely fits this life-and-death scenario, “passed their health care expiration date” on this disease. When you are counting on federally directed dollars to make the decision for you, this is the logical extension of the power of the purse. A more perverse application of economics I cannot imagine.
Do we think the wives and family of federal officials — the president’s wife, legislators, and other federal officials — will be bound by this new restriction? Don’t make me laugh (or cry).
The federal task force that is advancing changes in access to breast cancer screening claims that 1,900 women in their 40s must be screened to prevent one cancer death, while misdiagnoses create undue anxiety, lead to additional testing, and create unnecessary costs.
That may be accurate, but it is surely misleading as well. The good news is that 1,899 women’s anxieties are assuaged by the knowledge that detected tumors are either benign, pre-cancerous — or that women appear to be clear of tumors entirely.
Against the hindsight of perfect knowledge, missed diagnoses and misdiagnoses seem frightening and unacceptable. For exactly this reason, medicine devotes enormous attention to improving human and technological capabilities.
But new federal proposals take a different tact. They reduce diagnostic error by taking many women in their 40s out of the testing pool entirely. The logic here is scary: you can’t be misdiagnosed or frightened by your test results if, for an entire critical decade, you are never tested or diagnosed at all. Diagnostic errors will obviously drop; an instant success for ‘new health care.’
Every organization that raises money for breast cancer research, every women’s organization, and every thinking individual who realizes that the federal government is about to deliberately increase the risk of death for about half of the U.S. population, should be raising their voices against this proposed federal (not medical) dictatorship.
Finally, let’s be frank. Did we really think that we could authorize and even demand government funding for the process of aborting unborn children, and not think that that license would pave the way for expeditious elimination of care for the living?
This is the culture of death. We invited it in. We insisted that life and death be included in the range of acceptable policy choices. And now we have to live with it.
Don’t make me cry.
Dr. Karen Y. Palasek is Director of Educational and Academic Programs at the John Locke Foundation.