Thursday, September 23, 2010

Women Stand To Lose The Most Care Under Obamacare

Since comparative medical effectiveness studies (see excerpts from NY Times article below) show that mammograms are not a useful preventive care medical diagnosis tool, is there any doubt that if ObamaCare would not pay for a woman's mammogram, the law would not pass today, unless it had an exception to allow for the payment of mammograms.

If you will have to put a special provision in the law to pay for mammograms, what other commonly accepted treatments and diagnosis tools will be eliminated.

Women as a group are the biggest users of medical care in the US. The treatment that they are used to receiving and expect to continue to receive under ObamaCare is the medical care most threatened by the new law. Many common procedures from mammograms to Papp smears to regular gynecological visits will be subject to more and more medical effectiveness studies. More and more of what a women considers basic medical care will be at risk and many commonly expected procedures will be found comparatively unnecessary as the new law is phased in.

From The New York Times article, "Mammograms’ Value in Cancer Fight at Issue" by Gina Kolata:
A new study suggests that increased awareness and improved treatments rather than mammograms are the main force in reducing the breast cancer death rate.
Nonetheless, the new study is “very credible,” said Dr. Barnett Kramer, associate director for disease prevention at the National Institutes of Health.

"This is the first time researchers used real populations to compare the effects of treatment and mammography in the modern era of treatment," Dr. Kramer said. "It shows the relative impacts of screening versus therapy in an era in which therapy has been improving."
That means, Dr. H. Gilbert Welch of Dartmouth wrote in an additional analysis in an accompanying editorial, that mammography could have reduced the breast cancer death rate by as little as 2 percent, an amount so small that it is not really different from zero.

Two percent is an estimate, Dr. Welch said. But, he said, whatever the effect of mammograms is, "all the signals here are that it is much smaller than we believed."

Dr. Laura Esserman, a professor of surgery and radiology at the University of California in San Francisco, said it tells her that "if you get the same treatment and the outcome is the same if you find it earlier or later, then you don’t make a difference when you find it early."

And screening has a cost, Dr. Welch said. Screening 2,500 50-year-olds for a decade would identify 1,000 women with at least one suspicious mammogram resulting in follow-up tests. Five hundred would have biopsies. And 5 to 15 of those women would be treated for cancers that, if left alone, would have grown so slowly they would never have been noticed.

When the study was planned, the scientists expected that screening would be even more effective than it was in studies from decades ago. After all, mammography had improved and, in Norway, each mammogram was independently read by two radiologists, which should make it less likely that cancers would be missed. The researchers expected mammograms to reduce the breast cancer death rate by a third.


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