Monday, January 18, 2010

Jama January 13th 2010

About half of the total pages in this episode of the Journal of the American Medical Association is taken up with discussions about the most recent screening mammogram recommendations from the US Preventive Task Force and the media and political controversy that followed.  

It's refreshing to see that JAMA is attempting to cut through the political drama and misinformation, commonly referred to as "spin", and get down to the actual risks and benefits of screening for breast cancer with mammography.  They actually point out that the real harms from screening mammography don't come from the false positives but from all the unnecessary diagnosis.  In one article they have a tiny table of the benefits of this screening test followed by the harms.   

If you can get your hands on this Jama edition,  take a look.  If you want to borrow mine,  drop me an email

They even mention the senate getting involved much like they did in 1997 but this time instead of passing a non-binding resolution supporting screening mammography,  they passed an amendment to the so called health care reform bill forcing insurance companies to pay for screening tests.  This reportedly includes testing for ovarian and lung cancer which are even more fraught with harms of unnecessary diagnosis, surgery chemo etc.  

All this press coverage and medical journal coverage will at the very least prompt more thorough discussions in exam rooms all over the country as women again decide whether it is in their best interest to under this screening test this year.  At the same time large institutions and hospitals are budgeting for an increase in revenue from their mammography centers.  It is easy to see how this seemingly routine decision affects the health care industry's bottom line.  This effect is magnified during a recession.  

Is more information helpful or harmful to the bottom line of these institutions?  

Do the interests of the average patient overlap with the financial interests of these institutions who respond to these so called controversies with more advertising?  

With the swine flu mirage and with screening mammography we can clearly see the political apparatus align itself with the medical industrial giants.  Based on the number of patients who chose not to accept the swine flu vaccine,   it is obvious that credibility is slipping. 

It will be interesting to see the rates of screening mammography for 2010 to judge whether the best efforts of industry and government will continue to prop up a harmful, expensive practices.  

Never a dull moment.  

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