A HHS panel recommends going from 40 to 50 and from every year to every other year. Another outfit now says PAP smears in the 20 somethings can go to every 2 years instead of every year.

Well, it seems others were correct when they said ObamaCare would include "death panels" and care rationing.

This is the first step to that end. There can be no doubt after these stories.

What screening procedures are next?

And HHS Sec Sibelius seems to not know what her own panels are recommending since she had to come out and try to stop the bleeding.

H1N1 vaccine is STILL pretty much nonexistent after promises of hundreds of thousands of doses and they have about 20% of what they said.
And you want THESE people to make the health decisions for your children?

Poor children!

The problem illustrated by this faux crisis is that I see NO ONE pointing out how these annual scheduled and "maintenance" types of exams inflate the cost of the same HI policies everyone is so desperate to have pay for them.

It is circular logic.

The FEWER of these that are run through insurance the greater your personal control over your life is, the LOWER your HI premium will be, and in all likelihood the LOWER your cost for these same exams will be.

Snap out of it people!
LESS Insurance (government or corporate) is the ONLY way to lower cost.

http://talk.baltimoresun.com/showthread.php?t=224510

Just who is the U.S. Preventive Services Task Force. What is the professional make-up of this body. What are the political affiliations of those involved.

Just who is the U.S. Preventive Services Task Force. What is the professional make-up of this body. What are the political affiliations of those involved.

Yes there is already a rationing of health care in the country with the uninsured and denied coverages. But what about those who have great health plans? Now insurance companies will have the ammo to decrease coverage by cutting preventative tests like pap smears, prostate screening and mammograms due to the ACOG and USPSTF reports released (not coincidently) this week.
Concernedconsumer

The U.S. Preventive Services Task Force can be seen here. It contains NOT ONE cancer specialist (oncologist).

http://www.ahrq.gov/clinic/uspstfab.htm

"The U.S. Preventive Services Task Force (USPSTF) makes recommendations about preventive care services for patients without recognized signs or symptoms of the target condition.

It bases its recommendations on a systematic review of the evidence of the benefits and harms and an assessment of the net benefit of the service."

RATIONING BOARD!

"This line of reasoning ignores the fact that rationing already exists in the American medical system. Millions of low- and middle-income women are rationed out of mammograms because they lack health insurance."

This line of reasoning falls short - and shows your bias. Am I to apply this same reasoning for understanding why it is that I do not drive a Rolls and wear a Rolex. Have I been rationed out of these items? Although it is true that many are currently denied or can not afford insurance, there are also many that choose not to be insured because it is a cost they would rather not pay.

I find it troubling that mammography testing is outlined in HR 3962 to "provide for screening as follows: ... Other cancer screening that receives an A or B rating as recommended by the United States Preventive Services Task Force"

So now scientific evidence isn't worth anything when "women"s issues" are in play?
If one assume no ulterior motive in the panel's presentation and recommendations, then we can and should depend on doctor/patient consulations to discuss what should have been discussed all along; family history, individual potential based on lifestyle and habits, BRAC tests when appropriate, then exams as needed.
The other side, the unnecessary testing, invasive testing (how many needless deaths and procedure-related injuries occur?) and debilitating treatments from False Positives all point to the need for pragmatism in considering these results.
Pointing to a cost motive is a knee-jerk reaction.
When wholesale revision of Prostate invasive testing guidelines, and much more pragmatism in enaluating PSA test results was offered by a similar panel resulted in a more realistic approach, men appear to be gratified. The shakeout appears to be working to create more informed health care options for men.
Women should view these results in a similar fashion.
The climate of fear created by some in the women's health field has resulted in too much pressure on women to push for unnecessary testing; doctor's take note.

I'm fine with using the limited resources to maximum benefit but I believe this recommendation was based on opinion as much as fact.
How can you measure the worry they cite as harm? What are the units? How much worry is not worth saving a life?

From their data it appears that difference comes between 1 life saved for 1300 screenings and 1 life saved in 1900 screenings.
I think that is a pretty bold statement considering harm they cite is not that quantifiable. This is hardly a lopsided risk/reward ratio.
The data shows these Screenings save lives just not enough in their opinion.

Casting more doubt on these recommendations CNN DR GUPTA said they used the same data as last time and came up with a different result.
He also mentioned that many of the lives saved are not from high risk groups.

Also consider that these recommendations came from a board of 16 in a vacuum. Their were no cancer doctors on the task force and several of the task force members had connections to the insurance industry. The report also says that they did not take into effect digital mammography which would reduce the number of false positives.

If the board said the x$ from not performing these screenings could save x more lives by being used to feed starving children it might make more sense.

Millions don't have insurance because they don';t want to pay for it when they can get it free from the government. They can buy cellphones, new cars, all kinds of electronic toys for their children but no insurance. I have seen people getting free medical thru the state and driving fancy cars and taking big trips. So don't give me that song about millions don't have insurance. Plus, ER;s can't turn them away so they always get their medical there and women can get free mamograms thru the health department.

Mikulski just proved that she didn't read or care to read the 2000 plus pages of the Obama Bill. After Emails, and phone calls to her office, she then decided to add an amendment to pay for mamograms for women uder 40. Her last adement adding federal funding for abortions. My she certainly is a good catholic. As time goes by bits & pieces of this health care bill will come to light, and people will continue not to want it. This Bill is nothing but another Entitlement for the poor. Welfare, Food stamps, free breaksfast, lucnh and pick up and delivery to school, and medicaid isn't enough. Mikulski has got to go in November 2010.

If you live in another country and have spent any time in the States as well....the excess in your system stands out a mile. I can only speak for women's health. US women have been brainwashed to believe asymptomatic women need their breasts and reproductive organs examined every year, often from teens...legs in stirrups every year, thinking this is all essential to their health.

As a healthy foreign woman, I know this is unnecessary and very likely to harm you, mentally and physically.
Given women are convinced they need annual pelvic, rectal and breast exams, it's hardly surprising they get annual smears as well and the highest number of biopsies in the world PLUS one in three will have a hysterectomy. This is frightening stuff.

Asymptomatic women do not need routine gyn exams at all...ever. They should be optional at best and women should be advised of the risks. Our doctors believe they are of very low clinical value in the absence of symptoms and can be harmful, as they often lead to more, possibly harmful, testing.

Annual or biannual smears amounts to over-screening and this leads straight to over-treatment. Less is more with cancer screening - more ends up harming you.
Cervical biopsies can leave you with health problems...infertility, problems during pregnancy, pre-term delivery, psychological/psychosexual problems. Women not yet sexually active don't need smears at all. There are also very high risks testing women before 25 or 30. (it leads to high rates of over-treatment while cancer in this age group is extremely rare)

Low risk women are also advised in my country, that they are unlikely to benefit from smears...it's an uncommon cancer and this test is unreliable...these woman may choose not to be screened or screened infrequently to reduce the risk of a false positive and unnecessary biopsies.
All women need to provide their informed consent for cancer screening....after considering their risk profile and if they choose to have screening, adopting a schedule that protects them from harmful over-treatment. The more frequent the testing, the more likely you are to have a false positive and colposcopy/biopsy with very little extra benefit.

The evidence does not back up the need for routine clinical breast exams or self-examination...our doctors do not routinely examine our breasts...there is no evidence it reduces the death rate from cancer, but there is evidence it leads to unnecessary biopsies.
In Finland and the Netherlands, smears are offered (not demanded) from age 30 and then 5 yearly to 50, 55 or 60.
In most countries, mammograms are offered from 50 and 2-3 yearly, although about 40-50% of women will decline their invitation. The risks associated with testing are a concern for many women. The Nordic Cochrane Institute have produced a leaflet showing the benefits AND the risks of mammograms - be very careful having mammograms and especially before 50 or 55.
(their leaflet is available on-line)

Is all this examining and testing helping American women?
You have more pap smears than any other women in the world...a 60+ woman might have had 50+ by now and probably a biopsy or other treatment, quite a few mammograms, 50+ pelvic, rectal and breast exams. You have a massive excessive colposcopy industry worth one billion dollars a year.
AND, so many diagnostic tests.
I was shocked at the testing, biopsies and treatments that younger women were having...I can't imagine what older women might face.
It was very upsetting, all so unnecessary and so harmful.
These practices caused so much distress and worry.

I also found it unethical that women are forced to have screening in the States, if they want the Pill. The exams and test are required in exchange for the Pills. Doctors routinely refuse women the Pill UNTIL they agree...

Cancer screening has nothing to do with the safe use of the Pill..this is just a tactic to dismiss a woman's right to choose and protect herself from harm. I was disgusted to see women being blackmailed and coerced into exams and tests that so often led to unnecessary biopsies and other treatment. I thought the US system was abusive...and in violation of women's civil rights.
Other countries have problems as well...but I've never experienced anything as bad as the States. There is a general need for more honesty with testing and the risks and more respect for informed consent. In the States, the problems go much deeper than that...

Finland has the lowest rates of cervical cancer in the world and sends FAR fewer women for biopsies. A 60+ woman in Finland may have had 5 to 7 smear tests in total...my mother as a low risk woman had just 3 tests in total.
My mother (and the same applies to other female relatives and friends) has never had a routine breast or pelvic exam and has never had a rectal exam.

I don't believe women need this extremely high level of medical surveillance and interference in their lives.
I firmly believe it is much more likely to hurt you and I know, I certainly would not like to present for these exams every year...it would detract from my quality of life.
I really question the motives of the doctors that keep these annual and excessive gyn exams going - Is it defensive medicine or just cashing in on healthy women? Or, healthy at the start anyway...
These recent changes are a start, but you have a long way to go...
I'll keep my fingers crossed for American women...you need to change a very bad "healthcare" system.

As a physician (though not an oncologist), but with some expertise in clinical trials and epidemiology (that is, "evidence-based medicine"), I'm in thorough agreement with Andy Green's thoughtful editorial. He pointed out, quite correctly in my opinion, that the guidelines recently recommended by the U.S. Preventive Services Task Force are just that -- guidelines -- but they do not have the force of law, and they have no bearing on pending Congressional health care legislation. What is regrettable, as Green points out, is that these guidelines have been inappropriately politicized by opponents of the proposed legislation. He notes that the committee itself stated the difficulty they had in reaching these recommendations, and they recognized that the long history of guidelines for breast cancer screening, since the 1960s, has occasioned many changes in the guidelines, often involving 180 degree shifts, as new data accumulated. The guidelines are only recommendations, not rules. What is most unfortunate is, that the Preventive Services Task Force, despite its clear medical expertise, seemed completely lacking in political astuteness, to propose its guidelines at a time of heated national, and Congressional, debate on historic, but highly controversial, health-care legislation. It's also unfortunate that the task force raised the issue of "patient anxiety" as a possible adverse effect of too much breast cancer screening. Unlike other endpoints of clinical studies, anxiety is hard to quantify, and may occur with too much, or too little, screening or therapeutic intervention. I've never yet seen anxiety listed as an adverse event in any clinical trial in which I've participated.
Andy Green's editorial is a level-headed and thoughtful discussion on an issue that has been the subject of too much uninformed and irrational commentary designed to frighten people into opposing the most important, and beneficial, change in the American health care system in our time.

What Andy Green and Bob the doctor forget is this: the task force's recommendations will be followed to the letter by the insurance companies because it places a bonanza in their lap. No mammograms please will be the reply to women of certain age groups and the fight for survival will be on for those who need the test. The task force has inadvertently helped the insurers and to say there is no constraint on doctors to follow the guidelines or that the guidelines should not be politicized is an ingenuous response that leaves the insurers out of the equation.
Caravan