Thanks for commenting. There's room for advocates of all stripes on the See First Blog!

I agree wholeheartedly with your point that one of the great ironies of modern medicine is that we have the best treatments and technologies at any time in history. And yet, the values of high quality medical care are being corroded away. I agree it is because of a misguided focus on money over medicine.

The only suggestion I would make to you on the single-payer concept is that this problem doesn't magically disappear if you replace dozens of payers with just one. That one payer still has to deal with the issue of cost, and still has to make the same trade-offs. Now, if that single-payer could be of the enlightened sort that will focus on the quality of medicine, rather than its unit cost, who could be opposed to it. But alas human fallibility seems to suggest this may not be the case.

It is still a fair point and I very much appreciate you raising it here.

Evan

I don't intend to disagree with the work of the USPSTF on this important subject. Rather, to point out that once their recommendations have been made, they will inevitably become political, as they have. Politics and health care do not mix well. In spite of the valid public health rationale you raise, what will happen is that the politicians will not allow these recommendations to underpin public policy.

And it will be precisely because the idea that someone is denying someone's mom a potentially “life saving” mammogram is a whole heck of a lot easier to understand that the idea that someone is preventing mom from having a potentially “life threatening” mammogram.

But all of this the reformers have wrought by their fixation on cost cutting rather than improving the quality of medical care.

Thank you for your thoughtful comment and the opportunity to correct my error and clarify my point.

Evan

Thanks for commenting. There's room for advocates of all stripes on the See First Blog!

I agree wholeheartedly with your point that one of the great ironies of modern medicine is that we have the best treatments and technologies at any time in history. And yet, the values of high quality medical care are being corroded away. I agree it is because of a misguided focus on money over medicine.

The only suggestion I would make to you on the single-payer concept is that this problem doesn't magically disappear if you replace dozens of payers with just one. That one payer still has to deal with the issue of cost, and still has to make the same trade-offs. Now, if that single-payer could be of the enlightened sort that will focus on the quality of medicine, rather than its unit cost, who could be opposed to it. But alas human fallibility seems to suggest this may not be the case.

It is still a fair point and I very much appreciate you raising it here.

Evan

I don't intend to disagree with the work of the USPSTF on this important subject. Rather, to point out that once their recommendations have been made, they will inevitably become political, as they have. Politics and health care do not mix well. In spite of the valid public health rationale you raise, what will happen is that the politicians will not allow these recommendations to underpin public policy.

And it will be precisely because the idea that someone is denying someone's mom a potentially “life saving” mammogram is a whole heck of a lot easier to understand that the idea that someone is preventing mom from having a potentially “life threatening” mammogram.

But all of this the reformers have wrought by their fixation on cost cutting rather than improving the quality of medical care.

Thank you for your thoughtful comment and the opportunity to correct my error and clarify my point.

Evan

On your comment posted on the NY Times website about Mammography for breast cancer screening, you say that “and the options are either deny my mom a potentially life-saving mammogram”. There is a clear error in the statement. According to the 2009 Cochrane Systematic Review on the effectiveness of breast cancer screening using mammography, screening between the ages of 40 and 49 is associated with a Risk Ratio (or Relative risk) for Overall Mortality of 1.07, with a 95% confidence interval of 0.98 to 1.16. This means that our best estimate is a non significant INCREASE in mortality. So your assertion should be : the options are either deny my mom a potentially life-threatening mammogram, which I would say it is rather logical when you are making population-level decisions, as the USPSTF aims to.

I would be happy to continue this discussion by email

On your comment posted on the NY Times website about Mammography for breast cancer screening, you say that “and the options are either deny my mom a potentially life-saving mammogram”. There is a clear error in the statement. According to the 2009 Cochrane Systematic Review on the effectiveness of breast cancer screening using mammography, screening between the ages of 40 and 49 is associated with a Risk Ratio (or Relative risk) for Overall Mortality of 1.07, with a 95% confidence interval of 0.98 to 1.16. This means that our best estimate is a non significant INCREASE in mortality. So your assertion should be : the options are either deny my mom a potentially life-threatening mammogram, which I would say it is rather logical when you are making population-level decisions, as the USPSTF aims to.

I would be happy to continue this discussion by email

Thanks for pointing me to this post — you are of course spot on! I actually happen to be an advocate for a single payer system, where the “productivity” of a physician, measured by the quantity rather than the quality of the encounters, is taken out of the equation. I believe that one of the bigger problems we are seeing in the medical profession is that of demoralization because everything has been reduced to money. What happened to professional pride and compassion as values? I wrote about it in one of my early blog posts here, if you care to read more of my rants:

http://evimedgroup.blogspot.com/2009/06/reduce-…