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Healthcare must be rationed, including mammograms, doctor says

November 25, 2009 |  2:01 pm

Yet another doctor has come out with a critique of the new breast cancer screening guidelines released last week by the U.S. Preventive Services Task Force.

Mammo Writing in the New England Journal of Medicine, Dr. Robert Truog of Harvard Medical School says routine screening for women between age 39 and 49 has cut the risk of death from breast cancer by 15%: “Clearly, screening mammography does offer an identifiable survival benefit to women in this age group.”

But he doesn’t necessarily oppose the task force’s final result. Though the expert group explicitly left cost out of the equation, Americans as a whole can’t afford the same luxury, Truog writes.

“Screening mammography for women in their 40s is clearly effective. The problem is that the benefit is tiny and expensive. … Statistician Donald Berry has calculated that for a woman in her 40s, a decade’s worth of mammograms would increase her lifespan by an average of 5 days – and this survival advantage would be lost if she rode a bicycle for 15 hours without a helmet (or 50 hours with a helmet).”

The Obama administration – supposed backer of cost-cutting “death panels” – doesn’t want to invoke what Truog calls the “R” word, and neither do Americans. But healthcare reform will never succeed if we don’t own up to the reality of rationing, he writes.

“Rationing is not a four-letter word. No health care system in the world, including our own, is free from the necessity of rationing. As long as a health care system has anything less than an infinite budget, there is a need to decide which types of health care will be funded and which will not.”

Seen in this light, the vitriol directed at the task force is understandable, but misguided, Truog writes:

“The choice is not between health care rationing and some undefined alternative, since there is no alternative. Rather, the choice concerns what principles we will use to ration health care. In the United States, we have traditionally rationed health care in the same way we ration expensive cars: those who can afford to pay for them are those who can have them. The alternative currently being considered in health care reform would involve a shift to other principles, such as those rooted in considerations of fairness, efficiency, and efficacy.”

-- Karen Kaplan

Photo: Are mammograms for women in their 40s with an average risk of breast cancer the best use for limited healthcare dollars? Credit: Rui Vieira/AP Wire

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