On Friday, Sarah Palin intervened in the debate over new cancer recommendations. Referring to recent changes in cancer screening guidelines, she wrote: “There are many questions unanswered for me, but one which immediately comes to mind is whether costs have anything to do with these recommendations” and then again “We need answers: Is early screening not saving lives? Why do doctors’ groups disagree? Did costs play any role in these decisions to change the recommendations on breast and cervical cancer screenings?” If this was written by a liberal, conservatives would (correctly) denounce it as demagoguery. But since this is written by Sarah Palin (or whoever is writing for her), NRO provided a link on its daily briefing.
Let’s try to look at the questions. Is it that hard to imagine why lobbies like the American Cancer Sociey (ACS) disagree with the new guidelines? For a long time tobacco lobbies denied that smoking was bad for health!
Yes, early screening saves lives. So would a motorcycle ban, a 20 MPH nationwide speed limit, changes to the constitution and the legal system to make it easier to catch and punish criminals, withdrawal of all troops from Iraq and Afghanistan, safety enhancements for school buses (such as seat belts and airbags for all seats) and a lot of other measures. Is saving lives the only thing that matters in evaluating whether something is a good idea?
As it happens, mammograms have side effects, especially in the case of false positives (of which there’s a huge number), and provide very few benefits to women in their 40s who are not at high risk for breast cancer. So the decision was probably purely medical. But what exactly is wrong with taking costs into account? Of course, the costs should have everything to do with recommendations! For decades now, it was liberals who insisted on doing everything that felt good while conservatives insisted on cost-benefit analysis. Even if there were no medical arguments against early screening, mammograms for low-risk relatively young women should have probably been nixed because of costs alone. The costs per each live saved are in the millions of dollars, probably in the tens of millions. For that much money we could alternatively hire dozens of policemen and firemen, or install sprinklers in a lot of buildings, or put many miles of guardrail along roads, or change some dangerous level railroad crossings into overpasses, or teach thousands of children how to swim, or implement other measures which could save lives, perhaps a lot more lives. If we are going to spend some resources on saving lives, what exactly is wrong with trying to maximize the number of lives saved?! Even if you want to use those particular resources (billions in mammography costs) to save the lives specifically of those women and nobody else, there’s a better way. If those women buy healthier food instead of paying for mammograms, they will collectively gain a lot more QALYs (quality adjusted life years). Furthermore, the benefits will be very widely distributed among the entire group rather than accruing to a tiny percentage.
Poorly justified tests (often promoted for P.C. rather than medical reasons) raise the cost of health insurance for all of us and reduce our real wages. The unnecessary mammograms alone shave a couple of bucks off each monthly paycheck of an average American worker. I shudder to think about the total bite of all the modern near-equivalents of snake oil (and how much it will soon increase with more and more new and expensive tests). I thought the GOP was the party that fought to uphold the general interest in economic wellbeing against the special interest hucksters?
5 responses so far
1 sinz54 // Nov 23, 2009 at 9:35 am
In general, there’s nothing wrong with taking costs into account.
The problems with the breast cancer screening recommendations are threefold:
1. It represents a reversal of a 20 year mindset that “early detection saves lives.” We’ve had this propaganda campaign to get screened early. So this sudden U-turn in policy disturbs folks.
2. There’s an feminist angle here: Women had organized in their “pink ribbon” campaigns to raise consciousness about breast cancer. So now, some of them are taking these new recommendations as some kind of male chauvinist dismissal of women’s concerns. (Even though there were plenty of female scientists on the panel.) The recommendation that women shouldn’t bother with breast self-examination was taken by many women as they shouldn’t be aware of their bodies, which goes against a whole generation of feminist-tinged books like “Woman’s Body: An Owner’s Manual”. Breast cancer had become politicized, a feminist crusade, which is making rational discussion more difficult.
3. In his proposals for health care reform, Obama had made the (incorrect) claim that more intensive prevention measures can lower national health care costs. In fact, it won’t, as epidemiologists could have told him.
If you have to screen 1,300 women to find one case of breast cancer, leading to hundreds of unnecessary expensive biopsies and other tests (some of which can have fatal side effects), it frankly pays to not screen and just treat that one woman for breast cancer after she develops it. Besides, we all have to die of SOMETHING eventually. Early detection of an aggressive cancer may enable treatment to start sooner–but she may still die of the cancer despite treatment. Statistically, it looks like her life expectancy was extended with early screening; but in reality all you did was find out years in advance how and when she was going to die.
2 MI-GOPer // Nov 23, 2009 at 10:24 am
Well Andrew, your article sounds a lot like “You can take the Soviet out of Russia, but you can’t take the Soviet thinking out of an emigre”.
While sinz54 is correct… there’s nothing wrong with a close look at the best utilization of scarce health care resources to determine what works and what doesn’t… but the right place to do that is the private sector or a think tank informing public opinion and doctors –not the govt turning short-sighted math quizs into public policy and rationing.
You reduce the argument to one of “pure math” fighting against the corrosive effects of “special interest hucksters”? What a crock! Ir reminds of the attitude that informed the debate about global warming… in the global warmerists’ mind, it was somehow science versus ignorant masses. Science must win! And now we find that science wasn’t all that scientific and mostly politically motivated.
I see your ideas as an example of a Soviet govt mindset telling –not informing– people what’s is best for the interests of the Borg… ohh, I mean best for the interests of govt… oooh, I mean best for the interests of society. Yeah, that’s the ticket behind every math geek trying to use math to answer society’s problems. It’s the people we are concerned about… yeah, if they fit on a slide ruler.
You really do have that whole “Mother Russia, Soviet” mindset down pat. Chilling –and it seems perfectly insync with the Democrats these days. Take da banks. Take da GM. Take da AIG. Take over da deficit. Give world to enemies. Do it now for Mother Russia… I mean, Mother Democrats.
Thankfully, this latest entre of the geek utilitarian component into the debate will likely help derail the Democrat’s health care “reform” plans. I know in our family the females are very angry over proposed govt cutbacks in mammograms and other health screening tests they’ve come to expect as a way to protect their life… and like with Immigration Reform, the list of opponents will grow as information spreads like a cancer through the body politic.
Thank God we haven’t yet turned over the levers of power on health care to the Democrats. Well, not this week anyway.
3 teabag // Nov 23, 2009 at 10:57 am
It was the Acornz that did it. Teh Marxist, Leninist GapllopZ that wit the Liberalz main strem media and Alinsky with the help of Soros and Emmanuel. Also
Take to the streets with our great leader Glen Becks and take back our country. Also
4 LFC // Nov 23, 2009 at 3:20 pm
MI-GOPer said… While sinz54 is correct… there’s nothing wrong with a close look at the best utilization of scarce health care resources to determine what works and what doesn’t… but the right place to do that is the private sector or a think tank informing public opinion and doctors –not the govt turning short-sighted math quizs into public policy and rationing.
The private sector, who has a profit motive, is going to be the bastion of objectivity? Guess what. The private sector produced over 300 “scientific” papers that tried to cast doubt on the dangers of cigarette smoking. Ditto for second-hand smoke.
Right now, Congress is using the CBO to score the cost of health care reform plans. Maybe we should go to a private think tank for “objective” instead?
This is the type of answer you get from dogmatic people who can’t see any evidence that they’re little ideas are wrong, no matter how overwhelming the facts are against them.
5 jakester // Nov 24, 2009 at 3:04 am
The radiation from the mammograms is a cancer risk
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