Before I try to leave this topic for a while (which, like so may topics in the past, has temporarily taken over the blog for the last few days), one of the comments I’ve kept hearing since I started blogging about the new USPSTF mammography guidelines is something along the lines of, “Well, if the government runs health care, naturally politics will impact any attempts at science-based guidelines. That may be true, but in fact excessive politicization has always been a problem in that area, particularly for breast cancer. There’s a good interview with to Dr. Barron Lerner, associate professor of medicine at Columbia University College of Physicians & Surgeons and author of The Breast Cancer Wars: Hope, Fear and the Pursuit of a Cure in Twentieth-Century America. The whole interview is worth reading, but here’s one point that I’ve discussed before:
In the early 1990s, there was some suggestion that if you did something called a bone marrow transplant, or stem cell transplant – which was a very aggressive treatment for metastatic breast cancer – that women live longer. The studies were very, very preliminary but word got out and women started coming to doctors, essentially demanding the procedure because they thought it might save their lives, or at least prolong their lives. The power of that lobby was so strong that insurance companies began to pay for the procedure, even though it was still experimental and its value hadn’t been proven. Again, you’d be very hard pressed to find examples like that in many other areas.
It turns out that when the randomized studies came through and we got good data — at the end of the 1990s — that treatment was, in fact, no better than standard chemotherapy and caused more harm along the way. So it was not indicated at all. But, again, this was an example of Congress, or the government, sort of sticking its foot where it shouldn’t — trying to do the right thing, trying to insure access for all women who have a serious disease. But if you don’t look at the data and you’re acting based on your heart, or your gut instinct, you often make the wrong decision.
I wrote about the issue of bone marrow transplantation for breast cancer before as a cautionary tale in the context of criticizing a bad article about the swine flu in which it was used as an example. I think Dr. Lerner underestimates the impact of quite a few prominent breast cancer oncologists who promoted the therapy, but his point is clear. Politics has trumped science before.
Now, as I’ve pointed out, the new USPSTF guidelines are more of a case of how much one values risks versus benefits and how far we want to go to save one life from breast cancer, because, when it comes down to it, even the critics of the guidelines really don’t question the studies and data used to derive to those guidelines. However, as much as my thoughts have evolved recently regarding whether the government should fund universal health care (remember, I used to be pretty conservative, politically speaking), one thing that does bother me about injecting more government into paying for health care is just what happened with the USPSTF guidelines. Instead of a sober, science- and policy-based discussion, we have seen moronic hyperbole and doctors who should know better calling the USPSTF brain dead sobriquets like “soft death panels.” The potential effect on science-based medical practice worries me.
On the other hand, it may come down to weighing the benefits and costs. In order to bring about universal health care coverage, it may be necessary to put up with periodic political rows like this whenever the science evolves treating common diseases.