Thursday, November 19, 2009

Keeping Abreast of Health Reform: Government in a Clash All by Itself

Preface: Reprinted below are excerpts from a KevinMD.com medical weblog, dated November 19, on the current furor on mammography guidelines. Kevin Pho, MD, America’s best known medical blogger, makes a valid point: how is government reform going to work if government doesn’t even listen to its own non-partisan experts. The answer, I suppose, is : there’s nothing objective about politics.

"What if a non-partisan, authoritative entity wrote a robust, evidence-based guideline, but nobody followed it?"

"That is precisely what’s happening with the USPSTF’s recent revision of their breast cancer screening recommendations. The change most find problematic is their recommendation that women younger than 50 not undergo any breast cancer screening, such as with a mammogram."

"What’s fascinating is how mammogram screening has now turned rabidly political, with conservatives making the ridiculous link to “rationing.” And Kathleen Sebelius, the secretary of health and human services, tried to distance herself from the USPSTF, stressing that, “I would be very surprised if any private insurance company changed its mammography coverage decisions as a result of this action,” and that, 'our policies remain unchanged.' ”

"What, then, is the point of making any guidelines at all, if our government urges everyone to ignore them?"

"Progressive reformers, who generally espouse comparative effectiveness data and evidence-based medical practice as a means to control costs, should be very worried about the backlash these guidelines are eliciting.
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"If recommendations from an entity like the USPSTF – as non-partisan and robust as it gets – gets so much resistance from doctors, patients, and even the government itself, findings from a comparative effectiveness body stand absolutely no chance of changing medical practice."

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