In last week's newsletter I discussed the most recent recommendations from the US Preventive Services Task Force concerning mammography. Although health is front-page news every day, this issue seems to have really generated a lot of debate and near-hysteria. This article will provide further commentary and address some of the questions I have been asked in the last week.

Is the recommendation for women between the ages of 40 and 49 not to get mammograms; to have mammograms every other year instead of every year after age 50, and to discontinue them after age 74 a first step in rationing health care by the government?

It is important to remember, as I pointed out in my previous article, that research concerning the risks and lack of benefit from mammography has been appearing in the medical literature for years, long before universal health care was being seriously discussed.

The US Preventive Services Task Force is a group of experts in prevention who are appointed by the Department of Health and Human Services. As much as I rant about conflicts of interest in government agencies and committees, this is one of the most independent. The committee's report was based on an analysis of the scientific research, not the individuals' opinions about screening for breast cancer.

The USPSTF stated that only one woman in 1904 would benefit from having mammograms. Shouldn't we be concerned about that one woman?

I'm concerned about all women, including the 480 women out of every 1000 screened who have to deal with false positives as a result of regular screening. These women are faced with several days or weeks of fear and anxiety, additional exposure to radiation from follow-up mammograms, painful biopsies, and over-treatment for conditions like Ductal Carcinoma in Situ (DCIS). DCIS is not cancer and not life-threatening, but patients diagnosed with it are treated like cancer patients with surgery, radiation and drugs.

What should women do now if they are not going to have mammograms? Isn't early detection important?

The problem is that early detection does not work. It detects "pseudo-cancers" like DCIS that would be better left alone, while missing aggressive cancers that progress rapidly in between screenings.

It is time for the medical profession to be honest with Americans. The only proven way to prevent breast and other cancers is to practice dietary excellence (a Wellness Forum-style diet) and optimal habits. Anyone who does not do this is at higher risk of developing cancer and other common degenerative conditions like heart disease and diabetes.

If a person has not been practicing dietary excellence and optimal habits until now, is screening necessary because of increased risk?

Again, screening has not been proven to be effective in reducing the risk of dying from breast cancer. Start practicing dietary excellence and optimal habits today, and you may be able to stop currently non-detectable cancers from progressing.

Will this report be used to deny payment for women who are between the ages of 40 and 49 and want to have mammograms?

Federal authorities are insisting that the decision to have mammograms should remain between a woman and her doctor, and there is no plan to change the reimbursement schedule at this time. Insurance companies have not issued any statements indicating that they are changing their reimbursement policies yet either.

However, I would have to side with insurance companies and government agencies if the decision was made not to reimburse for mammograms for any age group because there is no evidence that mammograms save lives.

One of the reasons why health care costs have spun out of control is the insistence that everything should be paid for by insurance companies or the government. These expenses include:

• Annual physical exams, which cost the health care system $7.8 billion per year. A report in the October 2007 issue of the Archives of Internal Medicine examined the costs and outcomes associated with annual exams and concluded that there is little evidence to indicate that these visits help prevent disease and disability for adults.
• Some cancer treatments, many of which extend life for a few days or a few weeks, and often cost between $100,000 and $250,000 or more.
• Bypass surgery, which costs close to $100,000 per patient; annually we spend tens of billions of dollars on these procedures. Yet, according to three major studies, bypass surgery does not reduce the risk of death from heart attack or all-cause mortality.
• And, of course mammograms, on which we spend over $5 billion per year with minimal, if any benefit.

Today's debate about health are reform involves delivery of and payment for these ineffective and often unsafe tests and treatments, and the discussion is being led by lobbyists and special interests, including some well-meaning cancer survivors and other patients who are telling stories, not analyzing science.

One of those individuals is Congresswoman Debbie Wasserman Schultz (D-FL), a cancer survivor, who said "I am very concerned that these guidelines conflict with many of the well-established recommendations from the American Medical Association, the National Comprehensive Cancer Network, the American Cancer Society, and Susan G. Komen for the Cure. This conflicting information will inevitably lead to confusion among providers and women, resulting in fewer women getting screened for breast cancer." The problem is that the fact that the recommendations are "well-established" does not make them right.

At this time, medical services for which there is no evidence of efficacy consume 30% of all Medicare dollars¹. We must take the emotion out of our discussions about health care and focus on science, if anything is going to change for the better. Health care is focused on doing more and more things, and offering them to more and more people. We pay for treatments and procedures; we don't pay for results. Yet research shows that health is not improved by access to more care. The Dartmouth Atlas Project reported that in areas of the country where there were more doctors, more hospitals, more diagnostic equipment and more services and care offered, health outcomes were worse in spite of the fact that costs were an average of two times higher².

We must focus on doing the right things. We must insist on quality instead of quantity. We can't just keep doing the same things and trying to pay less for each ineffective drug and procedure and expect that our health outcomes or our costs will change. Futility is doing the same thing again and again and hoping for different results.

¹Fisher ES, Wennberg DE, Stukel TA, Gorrlieb DJ, Lucas FL, Pinder EL. "The implications of regional variations in Medicare spending." Part 2: health outcomes and satisfaction with care. Ann Intern Med. 2003;138(4):288-298

²The Dartmouth Institute for Health Policy and Clinical Practice. Health Care Spending, Quality and Outcomes. February 27, 2009. www.dartmouthatlas.org/atlases/Apending_Brief_022709.pdf

Article printed with permission from Dr. Pamela A. Popper and taken from Newsletters Vol 7 Issue 47 November 30, 2009. Dr. Popper is the founder and Executive Director of The Wellness Forum, a chain of health and wellness centers located throughout the United States and the Far East.