Many of us might rather move on and end all of the discussion about the US Preventive Task Force's mammography recommendations last week. But I think it's essential that we reflect on ten things that stand out from last week:
1. Many in the general public (most of those quoted in news stories) are not prepared for evidence to be used in making health care recommendations. They haven't been prepared by the health care industry, by their physicians, or by the news media.
2. Many in health care (many of those quoted in news stories) are too invested in their own preferences to allow evidence to make a difference in their practices.
3. There is an undeniable and clear bias in many news stories, reporters and news organizations for promoting screening - evidence be damned. I've reported on this before and last week provided overwhelming new evidence. (Mind you - I said "many", not "all.")
4. The USPSTF, which is a collection of independent experts, has no public relations arm. They simply review the evidence and publish their recommendations.
5. The public relations machinery of the American Cancer Society, the American College of Obstetrics and Gynecology - and other groups that opposed the USPSTF recommendations - helped the anti-USPSTF message rule the media all of last week.
6. Politicians chimed in - sometimes distorting the evidence beyond all recognition. The clash between politics and science at such times is predictable and disgusting.
7. The rhetoric used to oppose the USPSTF recommendations was the ugliest and most ill-founded I can remember.
8. There was some excellent journalism done on the issue last week, but it was overwhelmed by and drowned out by the drumbeat of dreck shoveled out by many news organizations - including in much (not all) of what was provided on network TV.
9. The week may have caused harm to the nation's discussion of health care reform.
10. The week was certainly a setback for the nation's understanding of science, of evaluation of evidence, of the potential harms of screening tests.
Kirsten Boyd Goldberg writes in this week's Cancer Letter:
"In the past three decades, attempts to develop rational, evidence-based screening guidelines for breast cancer in the U.S. have always generated intense controversy.
What happened this week with the new U.S. Preventive Services Task Force recommendation has happened many times before:
An independent panel of experts is assigned to rationally assess the data and evaluate the level of evidence for screening in order to minimize the role of commercial and political interests in promoting a test that might or might not reduce cancer mortality.
The moment the panel's document is released, political combat ensues. The result is a cacophony. The resulting cacophony angers politicians who don't understand why "the experts" can't agree on "one simple message."
The anger of politicians frightens federal health officials who want to protect their budgets and their ability to run programs without meddling from Congress.
The federal health officials bob and weave and distance from the expert panel's recommendations.
The expert panel becomes the focal point of the anger. Commercial and political interests make accusations about the panel's composition, experience, and potential conflicts of interest. The panel must have been politically influenced, critics charge. The specter of "rationing" health care is raised.
The beleaguered panel members either defend their recommendation or say nothing.
Rational assessment has always had a tough road to travel in the U.S., starting with the dawn of randomized clinical trials, when doctors didn't accept trial results as being valid. But that's another story."
She's absolutely correct. Those who don't learn from the past are doomed to repeat it.