Medicine
Ironically, my Viewpoint on public health and screening mammography appears in JAMA the day after I turned 40. Written with Georgetown law professor Lawrence Gostin, it articulates the reservations I expressed last week about Congress preemptively overruling the recently finalized U.S. Preventive Services Task Force breast cancer screening recommendations. Make no mistake: like the members of the USPSTF, I don't have a problem with ensuring that women who make informed decisions after considering the potential benefits and harms can undergo screening mammography at any time after age 40. What troubled me was the process that legislators chose to do this: rather than adding a coverage benefit on top of the Affordable Care Act's evidence-based preventive care mandate, Congress undermined the Task Force's scientific credibility by claiming that 14 year-old clinical guidance (the USPSTF's 2002 recommendations on breast cancer screening) is still relevant to women's health today.
Professor Gostin and I conclude: "The ACA improved the public's health by guaranteeing that insurers provide uniform, cost-free access to preventive services based on modern evidence of effectiveness. The public's health is best served when women's personal decisions about screening are informed by evidence rather than political considerations. Congress's paternalistic response to USPSTF mammography screening recommendations vividly illuminates the social costs of politically mandated care. Rather than benefiting women, political interference with science can discourage shared decision making, increase harms from screening, and foster public doubt about the value and integrity of science."
- 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...
- Mammograms And Death Panels: Why The Preventive Services Task Force Keeps Pulling Its Punches
Health reform was supposed to have been good news for the U.S. Preventive Services Task Force. Until 2009, this independent panel of federally-appointed experts in primary care and preventive health was not particularly well known, and its evaluations...
- "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
This is 40: evidence-based vs politically mandated care
Ironically, my Viewpoint on public health and screening mammography appears in JAMA the day after I turned 40. Written with Georgetown law professor Lawrence Gostin, it articulates the reservations I expressed last week about Congress preemptively overruling the recently finalized U.S. Preventive Services Task Force breast cancer screening recommendations. Make no mistake: like the members of the USPSTF, I don't have a problem with ensuring that women who make informed decisions after considering the potential benefits and harms can undergo screening mammography at any time after age 40. What troubled me was the process that legislators chose to do this: rather than adding a coverage benefit on top of the Affordable Care Act's evidence-based preventive care mandate, Congress undermined the Task Force's scientific credibility by claiming that 14 year-old clinical guidance (the USPSTF's 2002 recommendations on breast cancer screening) is still relevant to women's health today.
Professor Gostin and I conclude: "The ACA improved the public's health by guaranteeing that insurers provide uniform, cost-free access to preventive services based on modern evidence of effectiveness. The public's health is best served when women's personal decisions about screening are informed by evidence rather than political considerations. Congress's paternalistic response to USPSTF mammography screening recommendations vividly illuminates the social costs of politically mandated care. Rather than benefiting women, political interference with science can discourage shared decision making, increase harms from screening, and foster public doubt about the value and integrity of science."
- 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...
- Mammograms And Death Panels: Why The Preventive Services Task Force Keeps Pulling Its Punches
Health reform was supposed to have been good news for the U.S. Preventive Services Task Force. Until 2009, this independent panel of federally-appointed experts in primary care and preventive health was not particularly well known, and its evaluations...
- "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...