In one of the most brutal political comedy skits ever, Saturday Night Live has found it's voice on President Obama. After bending over backwards to avoid criticism of the President due to their political leanings, SNL is back with it's fangs out. Obama is now forever going to be rightfully caricatured as the milqetoast technocrat rather then some trans formative figure. You wonder if there's any buyer's remorse they cast Hilary Clinton aside?







The suggestions of the United States Preventive Services Task Force (USPSTF) regarding mammograms and breast self-exam have touched off a hornet's nest (to say the least). The new guidelines recommend that women in their 40s no longer have annual mammograms and that women ages 50 to 74 have them only every other year instead of annually. After having the message drummed into American women that they HAVE to have a mammogram annually starting at age 40, why the change in advice?


The task force report explains that for every 1,000 women in their 40s who receive routine mammograms, only two cases of cancer are detected. Alongside this is the fact that 98 women will also have "false positives" mammograms which will detect something that possibly looks like cancer, but that further testing shows actually is not. The cost and morbidity of routine mammography of the population (and the subsequent workup of such lesions) therefore brings the issue of cost-effectiveness of the program into question.

Last month I wrote a post "The Return of the weregild" discussing how the cost of healthcare gets into the accounting practices of establishing how much a life is worth to society and how much we can afford in support of such a life. Although downplayed by the USPFTF, this actuarial view played some role in the decision. It is my opinion that this is actual the thoughtful way we'll have to address health care spending. Although no one wants the heath care curve "bent" at their expense, you have to look at cost/benefit of practices to the system to control spending and give yourself the biggest bang for the buck for your tax dollars.

If you step back from the hysteria, I don't particularly find the recommendations controversial. It actually reflects the world consensus re. mammograms that mammograms in younger women (<50) are a poor way to affect how many women actually die from breast cancer (the whole point of screening). No other western nation practices routine mammograms under 40 that I'm aware of (and hasn't for some time) looking at this same data. If you're going to screen younger women it needs to be done more selectively to those with strong family history or palpable abnormalities that require further workup. This is exactly what's endorsed by USPFTP and should be a model of thoughtful care for patients going forward.

My first though re. this report was actually that "I wonder how long it's going to be before insurers adopt this" and require certain guidelines be met for women less then 50 perscribed a mammogram. It didn't take long as some HMO's have said they're reviewing their policies in light of this. If you're interested there's a short article on that issue in today's New York Times.

Rob Oliver Jr.

Oh Canada! - excellent NY Times letter response on health reform


I read an extroidinarilary good comment on this article  in the "Prescriptions Blog" NY Times today that I thought was worth reprinting. It was a response to another comment from a Canadian chastising the United States and pointing out what an absurd and misleading benchmark it is to compare the systems and problems of Canada to the United States in many respects:
“Let me tell you about my life. We (Canadians) have health care that is equal to that which an insured American gets for about 1/3 the cost. ”



Let me tell you about Canada. It is 1/10 the size of the US. There is this thing called scaling. Take any program and scale it up 10x and see what happens.


First off it is about 1/2 the cost, not 1/3. US is 2.2x more expensive per capita.

Healthcare is not equal. The infamous study that ranked the US so low overall grugding concluded it was tops in choice and quality. Per capita spending is about double for Canada.
But guess what, the US is top in a number of things that add to that cost. Some examples:
#1 in teen pregnancy (20 times more than Canada)
#1 in obesity (more than twice that of Canada)
#2 in abortions (about 15 times more than Canada)


“We pay about 1/2 the cost for prescription drugs.”
Because the US is in effect subsidizing the Canadian government’s negotiated prices.


“We have about 1/10 the level of gun violence in our country”
Which means healthcare in the US has to be higher to cover those violence related injuries. Which are treated in emergency rooms so they are very expensive.


The US has about, at low estimate, 12M illegals. Canada, by high estimate, has 120K. That is 100x more in the US.

So, once you tried to scale the Canadian system into the US with its differing problems, but trying to keep the same high choice and high quality levels, I would not be surprised to see that medical costs per capita would be very similar to what they are today. Single payer being cheaper per capita in the US than what we have now has NEVER been substantiated. What single payer in the US would do is make it APPEAR cheaper (how many post here have talked about FREE Canadian or English healthcare) to many by placing a higher burnen on higher income earners. The Dems don’t want single payer because it will reduce overall costs, they want it because it can easily be turned into the most progressive payments system around.

Announcing the birth of the Birmingham Breast Blog


Just a note to frequent readers. Due to requests by some of the audience to address some specific topics about breast cancer and cosmetic breast surgery, I started a "companion" blog to Plastic Surgery 101 titled the "Birmingham Breast Blog". Put it on you check in list for some content that will be a little more focused then the stream of consciousness topics I get around to here.

http://birminghambreast.blogspot.com/


FYI, At right is a photo of the statue of Vulcan, symbolizing my hometown.

Lady GaGa - as performed by Christopher Walken

Whimsy post today! No groaning over politics and mediceine (I promise).

Actor, Christopher Walken has such a terrific deadpan that I could listen to him read the phonebook and laugh. He made a classic star turn on the BBC's 'Friday Night with Jonathan Ross' this past weekend, where he killed the audience with a dramatic reading of Lady GaGa's disco ditty, 'Poker Face'


top