A note from Greg: Dr. Jim Schroeder is an old friend of mine, a wonderful oncologist who has been saving lives for three decades or more. I know him to be a top-notch clinician and a cutting-edge physician who knows this whole landscape.
Dr. Schroeder sent me this email regarding the recently-released report on mammography.
Greg,
I am not often inclined to “go public” with my opinions on matters that often are not clear cut.
In the case of the recently released report on mammography, the numbers are there for all to see. What is not obvious in the presentation is the driving force behind the implied conclusions.
I have practiced Medical Oncology for 37 years, beginning in 1972. At that time 90% of ladies presenting with breast cancer found the lumps themselves, often at a relatively advanced stage.
Over the years as mammography improved and self exam was taught lesions have been discovered earlier and earlier. That has resulted in a 30% or greater reduction in breast cancer mortality.
A small part of this has been from improved treatments. We reached a point where 60% of lesions are found on mammography before they are palpable.
Surprise, surprise -- self exam has played less a role in detection in recent years. If in fact we revert to the status of years past, it seems likely the numbers will trend back toward the “good old days.”
The current report focuses on lives saved per dollar spent. This is the issue, when health care dollars are arbitrarily fixed and allotted by committee. Did someone say “death panels?”
As I was writing this, I am listening to your show and the current discussion of allocation of health care which is coming. This reinforces the point which has been made regarding the “death panels,” although everyone bristles at the term.
I was in medicine when kidney dialysis first began. Because of limited resources, panels were established to determine which patients would receive this life sustaining treatment. It was easy for groups sitting in think tanks to issue guidelines.
When it became necessary to apply these guidelines to individual patients being considered by the multidisciplinary committee (including physicians, nurses, social workers, chaplains, non medical members) there were many stressful times for the panel members. Think of telling a 42-year-old diabetic mother of little children that she didn’t qualify for this life-prolonging therapy.
Ultimately, as both physical and financial resources became more available, treatment was extended to virtually everyone, under the Medicare program (regardless of age).
We are now at a crossroad in American medicine where, after all the “fat” has been trimmed from the system, we as a society have to decide how we will allocate the dollars (or yen as the case may be) to our health care system.
These ramblings illustrate the problems to be faced. In the meantime, ladies get your mammograms as before until the situation becomes more clear cut.
Jim Schroeder, MD