THE BLOG
11/21/2009 04:54 pm ET Updated May 25, 2011

The War on Evidence-Based Medicine - 60,000 Needless Casualties

This week saw what happens when an ugly little thing like empirical evidence collides with what might best be called faith-based health consumerism, which dictates that more is always better. The Federal Preventative Service Task Force, a non-partisan, non-political group founded during the Reagan administration was accused of encouraging health care rationing because it made a non-binding recommendation, based on empirical evidence, a/k/a science: women should start having mammograms later and less frequently.

Announcing this finding generated some very predictable results. Large organizations that had fought for the rights of women to obtain mammograms were very confused and expressed knee-jerk opposition. Equally, the American College of Radiology felt deeply threatened: mammograms generate a lot of revenue for their membership. And of course, political opponents to health care reform used this as 'proof' of rationing (something already practiced by insurance companies).

What is shocking, however, are the implications of statements made by many but concisely expressed by Senator Kay Bailey Hutchinson. She said, "One life out of 1,904 to be saved, but the choice is not going to be yours. It's going to be someone else that has never met you that does not know family history... This is not the American way of looking at our health care coverage."

Senator, I beg you, think about the implications of your statement. First, we should not ignore the findings that current practice needlessly kills one woman out of 1,904. Had we known that two decades ago, current practice would already be considered unethical and probably illegal. Fortunately, we now have evidence that allows us to make better decisions for the common good.

Second, these numbers are not rounding errors. The US Census Bureau estimates that there will be about 116.5 million American women over the age of 19 in 2010. Do a little math, and you realize that we're talking about 61,000 preventable deaths. That's almost 20x the number of US soldiers who have died in Iraq and Afghanistan since 2001. (Even if I'm off by a factor of two or three, the numbers are still in the tens of thousands.)

Three, we should not let these women die so that our crumbling health care system can spend vast sums of money on testing that will not make the great majority of women healthier. (Sure, it's easy to put a 'face' to the exception who lives because of more frequent testing, but then we should also give a 'face' to the woman who died as the result of the excess.) Advocating useless spending is hardly the talk of a fiscal conservative who would like to be governor of the great state of Texas.

And finally, we should not hide behind, "American way of looking at health care coverage..." Unless you've been under a rock, you already know that we spend at twice the rate of other industrialized nations but are sicker and die younger. That's not a 'way' that deserves respect.

Senator Hutchinson, I do not believe that you want to encourage the needless deaths thousands of women. I think that you simply want to win the next election. But every time you encourage people to selectively ignore solid, empirical evidence, you do real harm to the public that you are supposed to serve.