I'm looking at the news and, above all, the comments about the latest recommendation that women under 50 don't need routine mammograms. I know it's early in the news cycle, but I'm already discouraged at the lack of depth in the discussion and the knee-jerk reactions. Don't get me wrong: This is a serious subject and one that touches close to home for me and every woman that I know, but I can't hop on the outrage bandwagon. Instead, I see this episode revealing some ugly truths about the U.S. health care crisis and causing Americans on all sides of the reform debate to abandon their talking points. Funny how boobs can be so distracting.
First, I'm amazed at the number of people who rail against universal health care but are appalled by this report and its recommendation. Yep, it's quite a different story when they have to think about paying for these services out of their own pockets, isn't it? Suddenly, it's their God-given right to have a mammogram whenever they want it, and paid for by health insurance. All I can say is -- wow.
Second, the mammogram controversy sums up the American approach to health care consumption in a nutshell. We want to consume more and more care, regardless of the cost or the actual outcome. But the one common ground that both parties were able to reach on health care reform is cost control -- and that is exactly what this new recommendation is. Digest that for a moment. This is what cost control looks like: It's not rationing, it's not socialized medicine, it's cost control. What are the real outcomes, and what are the real costs? Do the math. Cover what makes sense. Leave the rest up to the patient - they can pay for additional treatment if they care to do so.
Third, if you can get past the headlines and the screaming, you see that the word "routine" is really important. The doctor's decision -- in consultation with the patient -- determines whether a mammogram is necessary (and therefore covered under health insurance -- if the patient has health insurance, that is). This requires that doctors know more about their patients. It requires women to be knowledgeable about their history and honest about their behaviors (such as smoking). And it requires doctors and patients to discuss things in detail, which might take more than 5 minutes.
Funny, these are the things that people can agree on about what they want from health care, but here it is happening and everyone suddenly thinks it is a terrible idea.
Most of all, the sudden focus on mammograms should remind us how little attention we really pay to advancing women's health care. The current technology for mammograms was invented in 1986, more than 20 years ago. That's back in the dark ages, before cell phones could fit in your purse, let alone your pocket, and before you used e-mail. Yes, it was developed sometime after Atari and Commodore 64s, but let's be serious. Mammograms are not the most effective form of detection -- but, like sheep, we have gone for years to be squeezed in a vise and prodded and biopsied and tested... and we never stopped to question why there hasn't been a cost-effective technological advance in years for this basic screening process. MRIs and ultrasound together are much more effective, but costly. Here's basic supply and demand in action. There is no demand for a better product because we have blindly accepted that mammogram is the only option.
My family has dense breast tissue. We have fibroids. I don't want to have the invasive biopsy that my mom had -- which turned out to be a cyst, by the way. I want something better. I want something more effective.
I don't discount the fact that many women are living today because of early detection through mammograms, but I believe that there is something better out there. The market has been distorted by attachment to an ineffective technology.
If you feel you're at risk, talk to your doctor; demand a mammogram if that's what you want. Be prepared to pay for it if it's important to you. But more important, advocate for the development and deployment of technological advances that can save women's lives. We deserve better.