Grasping the Third Rail

I'm pretty sure I don't have to tell anybody how I feel about the explosion of idiocy occasioned by the new recommendations on screening mammography from the Preventive Services Task Force. Said idiocy extended across the full political spectrum and included many people -- from Dick Durbin to Debbie Wasserman Schultz -- who really, really ought to know better. Is it really smart politics to endorse Sarah Palin's depraved rantings? Because that's what they're doing.

This just proves how deeply embedded in our culture is the faith that more medical services must be better. Detecting "cancer" -- and by the way applying that label to many of the lesions found using screening mammography is debatable -- and treating it is equal to "saving lives," in the collective consciousness, so passing up a chance to do it means killing people. That someone could look at reality -- you know, the actual true world out there that we inhabit -- and do calculations, in good faith, that demonstrate that you do more harm than good by one or another form of medical test or intervention, and make a reasonable recommendation not to do so, is just inconceivable to people.

Norton Hadler's first rule of rationing is pretty simple: "If some medical or surgical act does not advantage me or my family or my patients, it shouldn't be done. I don't care how well it is done, how cheaply it is done, how efficiently it is done; if it doesn't work, don't do it." Yet we can't even accept that seemingly obvious advice. Comparative effectiveness research, which only aims to answer the question of whether an intervention does any good at all, or is better than alternatives, is equated by a large segment of the political class with Nazi eugenics, a position with which the corporate media does not, generally, take issue.

There is the occasional exception, I am happy to say. You may have seen or read about the pretty good 60 Minutes story last night on end of life care. They actually tell the tale of a dying woman who was given a pap smear. Well, it's the standard of care, right?

The basic moral proposition that death is the greatest enemy of humanity, that death can and should be conquered, and that we can and must spend unlimited resources to conquer death in the case of any given identifiable individual, no matter how desperate the straits, is the essential basis of political opposition to any form of health care reform. Even if this made sense, of course, it would not be a logically defensible reason to oppose any current legislation, but we don't even get that far with many people because their judgment is obliterated by the specter of somebody "rationing" life. How very odd that this delusional and anti-humanist position is associated most strongly with people who believe that death is an illusion and they are all going to eternal paradise.

I don't get it.

Update: Regarding the screening mammography issue, Kathy's story in the comments is actually a good illustration of an underappreciated reason for the growing caution among experts about screening. The most dangerous, aggressive cancers are unlikely to be detected early by screening because they grow too fast, in other words you're likely to have a negative mammogram and then come down with a palpable tumor a few months later. Most of the tumors detected by screening are of unclear importance: they might some day cause life threatening disease, they might just sit there and do nothing, they might in fact disappear. But when we find them we have to treat them, for better or for worse. Therefore finding more of them earlier is not necessarily a good thing. Now, the day may come when we have ways of distinguishing among lesions that will and will not become dangerous; or very quick and easy ways of eliminating early stage tumors without side effects or risks. When that day comes, early and often screening will make more sense. But that day isn't here. Medicine isn't miraculous, it's just a lot of stuff that we know and a lot more that we don't know. Sometimes, it's best to leave well enough alone.