"The most high-priced of all follies is to believe passionately in the palpably not true."
Hl Menken
A recurring theme of mine is the maddening, confounding and captivating complexity of human health and disease. Base sense, unifying principles, and single-explanation theories cannot encompass the diversity of the human organism. well understandable, Base sense approaches to health care can often be ineffective or counterproductive. Lay people and their political representatives rarely grasp these intricacies, which leads to poor private choices and social policy.
Obamacare panders to these tendencies by stressing "preventive care" as a core principle. What could be more sensible and cost-effective than preventing disease by looking it early? Two papers published last week seriously examine these basic assumptions and raise basic issues about the integrity of the healing foundations of Obamacare.
The first paper is about prostate screening. The end is that looking tumors early has no impact on the life or health of the people screened. This counter-intuitive outcome is based upon the unusual behavior of some of the prostate cancers found. It appears than many cancers never improve far adequate to cause any actual problems. Screening finds these safe tumors, and treating them results in no benefit, and greatly increased cost. Waiting to treat those cancers which well do cause problems is just as effective. Needless to say, this kind of supervene is difficult for many people, even some physicians, to accept.
The second paper is about mammography (disclosure: I procure wage from billing for radiologists performing mammography). This detailed study questions the role of mammography in the discount of breast cancer mortality. Although there has been a grand discount in breast cancer mortality since mammography has become widespread, there has also been dramatic correction in discrete therapies. The study questions the portion of survival benefit attributable to mammography, which may be smaller than either easy thinking or prior studies suggest. Again, this looking is strongly counter-intuitive. Base sense would dictate looking a cancer earlier would be of great benefit, but Base sense might be wrong.
Other "preventive" measures, mandated by Obamacare, together with weight loss and smoking cessation counseling, are also essentially worthless. A strong anti-smoking lobby and weight loss manufactures has influenced Congress to consist of expensive counseling and instruction programs in the mandated assurance coverage, which have been proven by many studies to be ineffective. Demanding assurance associates pay for such services will be high-priced and of petite benefit to all but those selling the services.
From a health care policy viewpoint, the money, time, and attempt spent on these "preventive" measures will be wasted. Compelling assurance associates to cover such services, cost free under Obamacare, is not supported by "evidence based" medicine. Obamacare's backers hypocritically reject wonderful evidence if it does not sustain their political agenda. However, they are quick to accept borderline data in order to malign therapies not so politically popular. Removing Tonsils and Adenoids was singled out by President Obama as a wasteful and expensive therapy. In actuality, the evidence about this surgery is not conclusive, and many children (including my own) demonstrate great benefit. It seems the political connections of the supporters of a therapy are more leading than the healing evidence.
These ill-conceived policies recite the triumph of politics and lobbying over healing science. Obamacare is not about health, but reflects the economic and political power of the constituencies trying to manipulate the dollars behind it. The process has also additional eroded what petite trust Congress held for the American people. Costly, useless, fanciful, and doomed to fail, not a good analysis for Obamacare, or the health of America.
- Eva von Schaper, "Prostate Screening Fails to Cut Cancer Deaths, Study Says. Bloomberg news, September 14, 2010
- Anthony B. Miller, Mb, Frcp; Teresa To, PhD; Cornelia J. Baines, Md; and Claus Wall, Msc, "The Canadian National Breast Screening Study-1: Breast Cancer Mortality after 11 to 16 Years of Follow-up - A Randomized Screening Trial of Mammography in Women Age 40 to 49 Years," September 3, 2002, Annals of Internal Medicine, Volume 137, whole 5 (Part 1) E-315
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