Late last year, when the Preventive Task Force advised primary care physicians against recommending mammograms to women under 40 years of age, I defended the ruling. While physicians should take every patient’s unique medical history into consideration, if the science shows that for the average woman the test only raises raises stress levels without improving health outcomes, then the guidelines should reflect this. No health care system can accommodate an environment in which doctors order CAT scans for simple headaches or complicated surgeries for problems that can be solved with a regimen of medication, particularly when those treatments often lead to more harm than good.
Yesterday, Emma Sandoe pointed to data which showed that Minnesotans have a higher than average rate of using MRIs for lower back pain, “despite professional guidelines advising doctors” to try other treatments first. Today, NPR’s Scott Hensley reported on a study which found that “most men with low-risk prostate cancer get aggressive treatment, even though the therapies carry big risks”:
Most of these men turned out to have low-risk, slow-growing cancers, yet the great majority of them got aggressive treatment anyway. The findings appear in the Archives of Internal Medicine.
The researchers say that many American men with prostate cancer aren’t likely to benefit from this aggressive treatment. Instead, their cancers could be monitored and many would never pose a threat.
An accompanying editorial calls the nation’s experience with the PSA test a “cautionary tale.” More bluntly, the authors of the commentary write, “Unfortunately, some 2 decades into the PSA era, the promise of early detection has been tarnished.”
Widespread PSA testing and early identification of prostate cancer have led to an epidemic. Aggressive treatment of the many low-risk cancers found is the bigger problem because men who probably won’t get many benefits can suffer life-changing side effects.
This is the kind of unnecessary and harmful overtreatment that the health care law (and Don Berwick) should discourage, despite the politics or optics of the debate. Congress may have overruled the Task Force’s mammogram decision in December and then promptly politicized Berwick’s views on care quality just last month, but any serious discussion about controlling health care costs is meaningless if it doesn’t develop techniques to discourage unnecessary and harmful treatments. Hopefully, Berwick will engage in this debate once he finally testifies before Congress.