The Dread of Changing Health Policies

A couple of weeks ago, the government set up new guidelines for breast cancer screening – and provoked a storm of protests.  The evidence, carefully sifted by the U.S. Preventative Services Task Force, showed that a mammogram every second year was sufficient to protect women in their forties, not the once yearly test previously recommended.  But they did not reckon on the emotional fallout from their announcement.

For many people, it looked like the Task Force was taking a crucial protection away from women.  That view was shared by the American College of Radiology, not surprisingly as that group obviously did stand to lose income from less testing.  A number of politicians as well as The American Cancer Society, closely aligned with public opinion, joined in the protests.

In this political climate where stakeholders are bitterly contesting congressional healthcare proposals, the new policy aroused fears of rationing and other forms of government interference.  Everyone is on edge about the charges and counter-charges, up to and including the notorious allegations of “death panels.”  But that actually did not seem to be what was at stake.

A follow-up story this week told more of the reasoning behind the policy change.  While there was a very slight but statistically significant increased risk of some cancers going undetected with the new policy, there was also a greater risk of over-diagnosis.  The Times noted that “Dr. Barnett Kramer … of the National Institutes of Health described over-diagnosis as ‘pure harm’ because it means that women are treated with measures like chemotherapy, radiation and surgery for tumors that do not need treating.” (See, “Behind Cancer Guidelines, Quest for Data.”)

Interestingly, those who did the research and prepared the new recommendation were surprised that the Task Force dared to accept their proposal.  They knew, of course, what a tempest was likely to be stirred up.  Maybe the congressional discussions on health care reform this year emboldened them to act, hoping to participate in a new climate of rationality.

But the rest of us got another lesson in how charged with anxiety healthcare issues are – and just how difficult it is to bring about change.  What we don’t know we know is how easily rational thinking becomes a casualty of dread.