Administration seeks to distance reform effort from cancer screening fallout

Nov 23 2009

As the intense debate continues over new cancer test guidelines, the Obama administration is trying to protect health care reform from the controversy's fallout. The Washington Post reports: "President Obama's vision for making health care in America more effective and efficient collided for the first time last week with the realities and peculiarities of the nation's health-care system. As the Senate moved toward its first floor vote on the health-care reform bill, two independent expert groups coincidentally released new guidelines for mammograms and Pap tests aimed at improving treatment for two forms of cancer in women. ... Although neither set of recommendations was aimed at cutting costs, both were based on the kind of objective analysis of scientific research that the Obama administration has embraced in its bid to make care better and more economical" (Stein, 11/22).

The Associated Press: "Lawmakers broke along party lines on a new aspect of the health care debate Sunday as a former National Institutes of Health chief urged women to ignore guidelines that delay the start of breast cancer screenings. Republicans pointed to the guidelines as evidence the Democrats' proposals for a health care overhaul would yield limits on mammograms and a rationing of care. Democrats dismissed those worries and said Republicans were stoking fears without facts. Under the Democratic plan, a new independent institute would advise the health secretary. However, the health secretary would not be required to deny or extend coverage in a government-backed health plan based on recommendations from the institute" (Elliott, 11/22).

NPR/Kaiser Health News: "The recommendations come from something called evidence-based medicine, and are being met with resistance from some consumer groups and physicians. ... Evidence-based medicine can be used to determine how often someone should be screened for cancer, and it can be used to determine what sort of treatment is best. But people don't always want to do what the data say to do. ... Insurers already use evidence-based medicine to some degree. The current health overhaul bills under consideration encourage it without any strict requirements. The Senate bill, for example, uses the U.S. Preventive Services Task Force as a baseline, but not as a limit, for some parts of Medicare. Both bills provide money for more research" (Silberner, 11/22).

In a separate piece, Kaiser Health News reports: "This is not the first time that breast cancer has become a big political issue, according to Dr. Barron Lerner, associate professor of medicine at Columbia University College of Physicians & Surgeons and author of 'The Breast Cancer Wars: Hope, Fear and the Pursuit of a Cure in Twentieth-Century America.'" KHN discusses the historical politics and science of breast cancer with Lerner, who says, "I do hope that other doctors will be more eager to raise the issue that mammograms for women in their 40s is not as good a test as we once thought" (Girshman, 11/20).