A little rant about health care, mammograms, paranoia and unfounded faith in technology

When someone blames Obamacare for their high  health insurance premiums, I want to scream.

It’s not politics that increased my health insurance premium by $78.37 in the middle of the year (yeah, I didn’t know they could do that either, but my monthly premium  — for the exact same plan that covers me alone — went up 34% in July, the equivalent of nearly $1,000 a year).

At least, it’s not only politics. It’s wiz-bang innovations that patients demand and/or doctors recommend for no reason other they sound good.

Image by Prevention magazine

Image by Prevention magazine

Need an example? How about computer-aided-detection, aka CAD, for mammography. Computers do everything better, right?

Wrong.

CAD for mammography, which aims to double-check radiologists’ screening results, didn’t improve accuracy by any measure, according to the largest study to date of the controversial tool, published Sept. 28 in the journal JAMA Internal Medicine. I’ve been seething about the report shared in the Star Tribune ever since.

The JAMA Internal Medicine report found that CAD for mammograms added at least $400 million to the nation’s annual health care tab. Someone is paying that $400 million, people, and if you think it’s not you, you don’t know how insurance premiums are set. Insurance companies are out to make money, and they don’t pay for procedures out the goodness of their hearts — they pay for them out of your premiums.

You might be tempted to blow off that $400 million number, but think of it this way: There are about 35 million women in the U.S. between the ages of 50 and 74 (the age frame of women recommended to get mammograms). That $400 million means $11 every year for every middle-aged woman in the country. For just one unnecessary type of procedure among dozens, if not hundreds.

Not only does CAD not improve a radiologist’s accuracy in finding cancers on mammograms, it actually reduces it, probably because they’re depending on the computer as a crutch. “Radiologists’ sensitivity, or the proportion of times they correctly identified cancer, was 83 percent when they used CAD — and nearly 90 percent without it,” reporter Jonel Aleccia wrote.

Aye yi yi.

I’ve been suspect of mammograms since my last one three years ago, preformed after I found a lump in my breast (it was more of a bump, actually). It turned out to be a harmless bruise, but I paid $517 for an unnecessary ultrasound that discovered nothing except peace of mind (read that outrage here). In most cases — not all, I get it — but in most cases, a woman or her partner finds the lump first and the mammogram just confirms and pinpoints it. It’s one of the reasons breast cancer screening guidelines changed a couple of years ago from beginning routine screening (i.e. mammograms) for women of average risk at age 40 to age 50 and from being performed annually to every two years. Mammograms simply aren’t the be-all, end-all of breast cancer detection.

Some women are still insisting they want mammograms more often than the guidelines. The science just doesn’t back it up for healthy women (i.e., no family history, not taking hormone therapy, not at high-risk of carrying the BRCA gene, etc.). News flash: If you want a mammogram before age 50 or more often than every other year, you can still get one — pay for it yourself! Why should my insurance premium bear the cost of your paranoia?

So what can a logical woman do about health care procedures that do nothing to actually improve her health? Well, for starters, we can take control of our health care by being informed. Ask how much a procedure is going to cost before going ahead with something just because you’ve met your deductible for the year. As for CAD for mammograms, you  have a right to ask for a CAD-free mammogram, which is not only good for the community bottom line, it’s good for you because it encourages the radiologist to be more careful.

And the next time you’re tempted to blame politics for the cost of your health care, look in the mirror. I’ve seen the enemy, and it is us.

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One response to “A little rant about health care, mammograms, paranoia and unfounded faith in technology

  1. Um….I disagree a bit. I pay insurance premiums to COVER my health care. Whatever that may be. I agree it’s a scam, but I blame greedy insurance companies not the patients.

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