Making the case for annual mammograms is Marisa Weiss, president and founder of Breastcancer.org and director of breast health outreach and breast radiation oncology at Lankenau Medical Center, Wynnewood, Pa. Arguing against routine annual screenings is H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice and an author of “Overdiagnosed: Making People Sick in the Pursuit of Health.”
I think it is just perfectly clear that the government has forced a needless and completely avoidable confrontation and has knowingly put many religious believers in an impossible situation. It is no secret that most of America’s largest religious denominations are opposed to abortion, and that some are opposed to contraception as well. And there are many alternative means by which the government can (and does) make abortive and contraceptive drugs and procedures available to people. The purpose of refusing to provide a religious exemption from this rule would therefore appear to be to force religious employers themselves to make those drugs and procedures available—to bend a moral minority to the will of the state. It is not only a failure of statesmanship and prudence, it is a failure of even the most minimal toleration.
There may be a debate over whether Obamacare’s individual mandate is a penalty or a tax, but there is no debate among doctors and their patients about the fact that Obamacare will be bad for America’s health.
Democrats and Republicans share a fundamental misconception about medical care. Both assume that, as in mathematics, there is a single right answer for every health problem. These “best practices,” they believe, can be found by gathering large amounts of data for experts to analyze. The experts will then identify remedies based strictly on science—impartial and objective.
Yet in medicine, there are many contrary opinions about “best practices.” You cannot pick up a newspaper, turn on the TV or surf the Internet without encountering conflicting reports about various tests and treatments. Medical experts disagree about many issues, often dramatically.
As appealing as it is – as useful as it is – to imagine that there exists a gold-standard way to practice medicine, and a single-best way to approach most human ailments, the reality is considerably more complex and messy, as Hartzband and Groopman’s (continued) critique of so-called “best practices” makes clear.
The heart of their argument is this: “For patients and experts alike, there is a subjective core to every medical decision. The truth is that, despite many advances, much of medicine still exists in a gray zone where there is not one right answer. No one can say with certainty who will benefit by taking a certain drug and who will not. Nor can we say with certainty what impact a medical condition will have on someone’s life or how they might experience a treatment’s side effects. The path to maintaining or regaining health is not the same for everyone; our preferences really do matter.”
White Coats and Straightjackets: Why Planned Cost-Saving Measures Will Reduce Your Healthcare Options — The American MagazineMarch 7, 2012
Before we proceed with the Independent Payment Advisory Board, we should carefully consider the pernicious impact that similar structures have had on patient care.
So the question becomes: who will do a better job of deciding whether and when hip replacements or antibiotics or Viagra are “medically necessary?” Regulators? Or patients choosing health plans (in part) based on how those plans define medical necessity?