Medicine
"Lessons from the Mammography Wars" is a terrific commentary by physicians Kerianne Quanstrum and Rodney Hayward that appears in today's New England Journal of Medicine. After recapitulating the now-familiar controversy that ensued last November when the U.S. Preventive Services Task Force determined that the decision to begin breast cancer screening for a woman in her 40s should be an individual choice rather than a mandatory requirement, the authors succinctly explore the concept of "gray areas" in the assessment of the net benefit of a health intervention and suggest that a policy of separating self-interest from guideline creation (which does not occur when breast imaging societies make guidelines regarding mammography) would be most likely to benefit patients. Here are two of my favorite passages:
Recent proposals to increase spending on comparative-effectiveness research are certainly laudable, but it is unrealistic to think that an investment in research alone will have a sizable effect on the practice of medicine without a concomitant investment in a credible process for vetting medical evidence and clinical care guidelines.
If there is overutilization in health care, we can be sure that it will continue unabated as long as those with a vested interest are allowed to win the public-relations wars by shouting about "rationing" or "death panels" whenever anyone suggests that more health care, in fact, may not be better.
The entire article, in fact, should be required reading for health policy makers, clinicians, and informed patients.
- Financial Conflicts Of Interest Have No Place On Guideline Panels
In a series of editorials in the New England Journal of Medicine earlier this year, Dr. Lisa Rosenbaum stirred controversy by suggesting that policing of pharmaceutical conflicts of interest in medicine had gone too far. These editorials and...
- Should Women Start Having Mammograms Before Age 50?
The best answer to this question, I tell both my patients and loved ones, is: it depends on you. As the U.S. Preventive Services Task Force affirmed this week in its updated draft recommendations on breast cancer screening, "The decision to start screening...
- Screening Mammography: Growing Costs, Shrinking Benefits
Providing preventive services is a core responsibility of family physicians, and, consequently, American Family Physician devotes many pages to keeping readers up-to-date with the latest studies and recommendations on breast cancer screening....
- Should Screening Mammography Always Be A Shared Decision?
In the February 15th issue of American Family Physician, Dr. Maria Tirona reviews areas of agreement and disagreement in major organizational guidelines on screening for breast cancer. There is widespread consensus that annual or biennial mammography...
- "politics Trumped Science": Breast Cancer Chemoprevention
On November 17, 2009, in the same issue of the Annals of Internal Medicine that contained the U.S. Preventive Services Task Force's controversial new recommendations on screening for breast cancer, the journal also published a report on the comparative...
Medicine
Required reading
"Lessons from the Mammography Wars" is a terrific commentary by physicians Kerianne Quanstrum and Rodney Hayward that appears in today's New England Journal of Medicine. After recapitulating the now-familiar controversy that ensued last November when the U.S. Preventive Services Task Force determined that the decision to begin breast cancer screening for a woman in her 40s should be an individual choice rather than a mandatory requirement, the authors succinctly explore the concept of "gray areas" in the assessment of the net benefit of a health intervention and suggest that a policy of separating self-interest from guideline creation (which does not occur when breast imaging societies make guidelines regarding mammography) would be most likely to benefit patients. Here are two of my favorite passages:
Recent proposals to increase spending on comparative-effectiveness research are certainly laudable, but it is unrealistic to think that an investment in research alone will have a sizable effect on the practice of medicine without a concomitant investment in a credible process for vetting medical evidence and clinical care guidelines.
If there is overutilization in health care, we can be sure that it will continue unabated as long as those with a vested interest are allowed to win the public-relations wars by shouting about "rationing" or "death panels" whenever anyone suggests that more health care, in fact, may not be better.
The entire article, in fact, should be required reading for health policy makers, clinicians, and informed patients.
- Financial Conflicts Of Interest Have No Place On Guideline Panels
In a series of editorials in the New England Journal of Medicine earlier this year, Dr. Lisa Rosenbaum stirred controversy by suggesting that policing of pharmaceutical conflicts of interest in medicine had gone too far. These editorials and...
- Should Women Start Having Mammograms Before Age 50?
The best answer to this question, I tell both my patients and loved ones, is: it depends on you. As the U.S. Preventive Services Task Force affirmed this week in its updated draft recommendations on breast cancer screening, "The decision to start screening...
- Screening Mammography: Growing Costs, Shrinking Benefits
Providing preventive services is a core responsibility of family physicians, and, consequently, American Family Physician devotes many pages to keeping readers up-to-date with the latest studies and recommendations on breast cancer screening....
- Should Screening Mammography Always Be A Shared Decision?
In the February 15th issue of American Family Physician, Dr. Maria Tirona reviews areas of agreement and disagreement in major organizational guidelines on screening for breast cancer. There is widespread consensus that annual or biennial mammography...
- "politics Trumped Science": Breast Cancer Chemoprevention
On November 17, 2009, in the same issue of the Annals of Internal Medicine that contained the U.S. Preventive Services Task Force's controversial new recommendations on screening for breast cancer, the journal also published a report on the comparative...