After giving a talk to a group of students recently, during which the long waiting lines for surgery and medical care in Canada were discussed, one of the students defended the Canadian system, saying that Canadians received the same care as we did here- just after longer waits. I encouraged her to rethink her discounting of the time during which much pain and suffering occurs during these “waits.” I told her how eye-opening it has been to meet many of these Canadian patients who have been told that they or their children must wait 2-3 years for life-changing, pain-eliminating procedures. What the student then said is the genesis of this blog: ”These individual cases should be considered in the aggregate, though.”
In medical school I was taught that a certain number of unnecessary appendectomies, for instance, was a good thing, as the surgeon who was never taking out a normal appendix was missing some of the diseased appendices that presented more subtly. This made sense to me then and now, as the risk for missing a needed appendectomy far outweighed the risk of undergoing this procedure unnecessarily. Each and every one of these patients presents themselves differently and the decision to operate or not is an individual one, one which includes the patient’s assessment and acceptance of the risk/benefit picture.
As my dad once told me, “whatever the percentage of folks in the population get cancer, it’s 100% for those who do.” His insight makes things clear, doesn’t it? Neglecting individual suffering for the aggregate, greater good, doesn’t feel statistically justified by the victims of this type of thinking. Which brings me to my point.
Thousands of people are wearing the pink ribbons these days to raise awareness of breast cancer, many of them women, many of these women supporters of the man in the white house and his health care plan. Part of Pharaohbamacare is an emphasis on “wellness,” with mandatory suspension of copays and deductibles for many preventative health procedures like colonoscopies and mammograms. Sounds great, doesn’t it? Maybe- until you realize that “scientists” employed by the government are declaring in their “studies” that too many mammograms are being done, resulting in unnecessary breast biopsies. Just as with appendectomies, some normal breast tissue should be removed to insure that the fewest number of cancers are missed. The recent recommendation by “The U.S. Preventive Services Task Force” and “The National Cancer Institute” (both federally funded) serves to undermine Obamacare’s wellness promise. To believe that there isn’t intense pressure on these “scientists” to find what their boss wants them to find, is naive.
“Official” discounting of the importance of mammograms also demonstrates the true intent of “evidence-based medicine:” a rationing tool. After all, if “studies show” that mammograms should be done less often, government and other third party payers will balk at payment for these “unnecessary” diagnostic studies. More cancer for you, but less strain on the budget! Still thrilled that the government is getting more involved with health care?
Female supporters of Obamacare should be protesting this obvious attempt to ration care for breast cancer. I’m surprised that women aren’t burning their bras in mass riots, insisting that any of these government “scientists” and those in the political machine who control them be barred from wearing the pink ribbons on their lapels.
G. Keith Smith, M.D.