Quack-o-grams R Us

February 14, 2014

Despite flawed recommendations, patients will still demand screening mammograms. Let it become an optional – and unregulated – service, then, and see what happens.

We just had another round of the “let’s rehash old medical research and call it news” game. Screening mammography, never one to disappoint in terms of getting people’s gums in an uproar, has yet again been proposed as being a massive waste of everybody’s time and resources.

As uninvolved with breast imaging as I have become since entering the world of teleradiology, I still pay a little attention to this stuff, since one or two pre-telerad jobs tried to reinvent me as their primary breast imager, and (perish the thought) I could wind up doing that stuff again someday.

So I glanced over the BMJ article, and then at some commentary. And feel free to fault my reading comprehension, but it seemed to me that the current fuss, as well as some previous iterations, centers on data regarding patients from the 1980s.

As in, three decades ago.

Now, when you are trying to reasonably debate an issue, and all of the opposition’s points of argument depend on a single source (in this case, the Canadian screening study, but you might as easily substitute various versions of the Bible or any number of TV talk shows), I daresay your chances of making any ideological headway are slim to none. At best, you’ll wind up agreeing to disagree - which is fine, except for when the opposition is on a crusade to besmirch your profession, its benefit to customers if not society as a whole, and (God forbid) your livelihood.

Thus, you’re forced to stand up and vocally fight back to maintain the status quo, lest some bewildered governmental types get swayed enough to make the next rules modification against your interests - or those more devious simply use the presented “evidence” against you to justify unfavorable policies they had already wanted to enact. For instance, cutting mammo reimbursements, or only covering screening in older or higher-risk populations.

Maybe, considering that the anti-screeners aren’t any likelier to back down now than previously, our digging in and continuing to fight the good fight ad infinitum is a mistaken expense of effort and heartache. Suppose we just collectively shrugged, and went with the flow. Embraced it, even.

After all, if screening mammography is determined to have no meaningful benefit on a societal scale, we can ditch the notion that people need it. They might want it, of course, but that should no longer warrant the massive level of governmental and insurance company involvement that currently exists.

Let insurance, from Medicaid through Blue Cross, no longer cover the service since it’s so pointless. Let it become a purely optional, pay-out-of-pocket service like aromatherapy or ear-candling. And surely, something so inconsequential would no longer merit the vast regulatory machine that currently exists; let the FDA, ACR, and others allocate their personnel and funding somewhere more meaningful.

Meanwhile, this could be the answer to our tort reform prayers; if it is agreed that screening mammo has no effect on survivability of breast cancer, nobody should ever be sued again for failure to diagnose - we now have the scientific evidence that finding a cancer would not have improved the outcome!

But patients will still come to us for it. Because we could talk epidemiology and statistics all day long, and some laypeople might even care and/or understand us. But at the end of the day, if people know they might be walking around with a cancer, even a low-grade or in-situ lesion, and we’re offering the as-yet best way to detect it before it grows or spreads? They’re going to want it discovered, and will pay out of pocket for it, even if insurers and the government do not.

And then, sans outside entities telling us how much we’re allowed to charge for the service (no more being forced to operate at a loss!), how to do it and document our compliance, and how many hoops we must jump through to remain in their good graces, heck, I might actually want to requalify for MQSA. Assuming any regulators are still paying attention to us snake-oil salesmen at that point.