Breast Cancer Screening

One of the central cost containment ideas in “health care reform” got tested this week, and it failed miserably. I’m talking about using the idea of “best practices” to eliminate waste in the medical system.

The idea behind best practices, also known as evidence based medicine, is to do studies of what works and what doesn’t work in treating various medical conditions. Once the most effective protocol is determined, insurers will only pay for the approved protocol. Other treatments will not be reimbursed. The goal is to prevent overuse of medical testing and procedures that enrich doctors, but do little to improve overall outcomes.

It’s not a bad idea in theory. Too bad it doesn’t work in the real world.

The case in point from this week’s news is the new breast cancer screening guidelines. A group from the United States Preventive Services Task Force (USPSTF) studied the data, and concluded that as a nation, we are doing way too many mammographies. Instead of testing every woman over 40 every year, they are now setting a guideline of every woman over 50, every two years. The few additional live spans increased did not justify the extra biopsies, unnecessary lumpectomies, and related stress and anxiety caused by false positive screenings.

In exchange for doing a difficult job, loaded with hard technical analysis, the USPSTF was promptly thrown under the bus. You may substitute metaphors involving running into buzz saws or being fed to wolves if you prefer.

Katherine Sebelius, the Health and Human Services cabinet secretary, disavowed the findings of the Task Force, even though they were working for her when they did the study.

This does not bode well for the ability of any health care reform plan under consideration to lower costs if enacted into law.