Dr. David Gratzer: Medicine isn't perfect, Obamacare is even less perfect
By: Dr. David Gratzer
November 25, 2009
Pay for the blue pill that works, not the red one that doesn't. That's the president's simple prescription for improving American health care, one that relies on government panels and committees to set guidelines for doctors and patients alike.
At least, that's the theory.
The theory met messy reality last week when the U.S. Preventive Services Task Force recommended that women in their 40s shouldn't get mammograms. But the secretary of health and human services — who, incidentally, oversees this panel — thinks women probably should. And the American Cancer Society believes that they definitely should; major private insurance companies, for the record, will continue to fund the tests.
Recommendation from a largely unknown government panel hardly seems like typical material for national headlines. But when it involves breast cancer and the announcement is made in the heat of debate over health reform, people are — understandably — concerned.
The U.S. Preventive Services Task Force, as it turns out, is not part of a larger Obama White House rationing conspiracy, as some would have it. Task force members were appointed by President Bush, and they voted on this recommendation before Obama's inauguration.
As for cost considerations, the task force had none: Members are mandated not to weigh dollars and cents when considering the risk and benefits of recommendations.
That's not to suggest that their conclusion isn't highly controversial. For starters, it seems counterintuitive: Early screening for cancer makes sense.
No wonder, then, that a full 87 percent of Americans believed that routine scanning was "almost always a good idea" in a 2004 poll published in the Journal of the American Medical Association.
Today, American panels and doctors groups are moving away from the "scan first, ask questions later" philosophy. We aren't the only ones having second thoughts.
In Japan, all newborns were screened for neuroblastoma starting in 1984, but the program was scrapped a few years ago when more babies died from unnecessary surgeries than the obscure cancer.
For many, such reversals are deeply unsettling, a reminder that medicine is far from an exact science.
"The history of medicine is a record not only of brilliant success and stunning progress," Theodore Dalrymple, a British physician, wrote in 2002. "It is also a litany of mistaken ideas and discarded treatments, some of which came to appear absurd or downright dangerous after having once been hailed as unprecedented advances."
As a physician myself, I know a thing or two about going by the book and getting it wrong. When I was in residency, the standard treatment for bipolar patients suffering depression was Prozac or its sister drugs. It turned out that Prozac intervention was not only highly problematic, but also bested by placebo.
For those on the left, the answer to the chaos of medicine is to establish government panels. With Obamacare, for instance, White House officials propose a commission to cut hundreds of billions from Medicare by improving the quality of care.
How? By setting up an Independent Medicare Advisory Commission that would guide clinical decisions for doctors and patients alike.
The controversy over breast cancer screening, however, shows the political and practical limitations of this one-size-fits-all approach: Medical organizations have difficulty in setting and agreeing upon clinical guidelines, and patients are apt to resent mandates from bureaucrats.
Leaving health verdicts in the hands of centralized authorities is a sure way to keep making mistakes in a field where re-examination and reversal are an unavoidable reality.
David Gratzer, a physician, is a senior fellow at the Manhattan Institute and author of "Why Obama's Government Takeover of Health Care Will Be a Disaster" (Encounter Books, 2009).