The recent report by the Agency for Healthcare Research and Quality modifying the recommendations for breast care screening has created a firestorm. I address the issue here from two perspectives. As a simple engineer at heart I look at the numbers in a quick back of the envelope manner and show that the increased deaths in this now uncovered group is substantial. Second I look at what this recommendation is really all about. Bottom line it is the beginning of the new health care regime under HR 3962 and its progeny. Namely reduction in care, increased mortality, and thus lower costs. One need merely think how many women would be removed from Medicare if proper care was removed at earlier ages.
In contrast the Dean of Harvard Medical School has stated that the current Bill will most likely make things worse.
To do a simple analysis one need spend no more than an hour getting data from NCI SEER and then doing a few calculations. We use that data and do them here.
1. First we look at the demographics of women in various age groups obtained from the census projections. These are shown below.
This is our base. Our target will be the group removed by AHRQ. Namely the under 50 group of women. The number in that group from 2010 to 2050 is shown above.
2. Then we look at incidence data taken from SEER. We did this quickly so we have grouped data but that is reasonable for what we need to do. We show this below.
The above is over time which shows a decline. We will neglect that decline in incidence on an ongoing basis which is not unreasonable for this analysis.
Thus we use the 2006 incidence as shown below.
3. Now we ask what is the mortality rate and what had mammography done to reduce mortality. This we show in the following Figure.
Namely for this group it has reduced mortality by 50%. Not a bad result. Namely we can state that in the early 1970s with no mammography and the treatment at that time the mortality was twice as high. We can also say that if we remove mammography we increase mortality by a factor of two in this group.
4. Thus what can we conclude. If we take the population data and use mortality rates with and without mammography we can plot the total mortality over the next forty years with and without mammography and the excess deaths as a result of this recommendation. We do so below.
5. The conclusion is that many more women will die needlessly. Simple, 45 minutes on the computer, no brainer! So why would anyone want this to happen, since almost all of us have women in our families who have suffered through this. Dumb.
The AHRQ argument is that it leads to false positives and makes women uncomfortable. So does a high PSA for men, and so does a colonoscopy. Yet the benefits to survival and quality of life are tremendous.
My fear is that AHRQ is the camel's nose in the tent for Comparative Clinical Effectiveness and Government control over health care procedures. If every procedure becomes mandated then we need less physicians and we can have a nurse practitioner say "no" just as much as we can a physician. If we loved the HMO days I suspect we will just love CCE and Government controlled health care.
As Dr. Flier states in his aforementioned WSJ article:
"In discussions with dozens of health-care leaders and economists, I find near unanimity of opinion that, whatever its shape, the final legislation that will emerge from Congress will markedly accelerate national health-care spending rather than restrain it. Likewise, nearly all agree that the legislation would do little or nothing to improve quality or change health-care's dysfunctional delivery system. The system we have now promotes fragmented care and makes it more difficult than it should be to assess outcomes and patient satisfaction."
What especially concerned me was seeing an interview with a Dr. Gregory, one of the AHRQ panel members, last night and her less than lucid and knowledgeable responses to objections to the conclusions. It was a terrifying interview, for people like that can dramatically change health care to the worse.
In contrast the Dean of Harvard Medical School has stated that the current Bill will most likely make things worse.
To do a simple analysis one need spend no more than an hour getting data from NCI SEER and then doing a few calculations. We use that data and do them here.
1. First we look at the demographics of women in various age groups obtained from the census projections. These are shown below.
This is our base. Our target will be the group removed by AHRQ. Namely the under 50 group of women. The number in that group from 2010 to 2050 is shown above.
2. Then we look at incidence data taken from SEER. We did this quickly so we have grouped data but that is reasonable for what we need to do. We show this below.
The above is over time which shows a decline. We will neglect that decline in incidence on an ongoing basis which is not unreasonable for this analysis.
Thus we use the 2006 incidence as shown below.
3. Now we ask what is the mortality rate and what had mammography done to reduce mortality. This we show in the following Figure.
Namely for this group it has reduced mortality by 50%. Not a bad result. Namely we can state that in the early 1970s with no mammography and the treatment at that time the mortality was twice as high. We can also say that if we remove mammography we increase mortality by a factor of two in this group.
4. Thus what can we conclude. If we take the population data and use mortality rates with and without mammography we can plot the total mortality over the next forty years with and without mammography and the excess deaths as a result of this recommendation. We do so below.
5. The conclusion is that many more women will die needlessly. Simple, 45 minutes on the computer, no brainer! So why would anyone want this to happen, since almost all of us have women in our families who have suffered through this. Dumb.
The AHRQ argument is that it leads to false positives and makes women uncomfortable. So does a high PSA for men, and so does a colonoscopy. Yet the benefits to survival and quality of life are tremendous.
My fear is that AHRQ is the camel's nose in the tent for Comparative Clinical Effectiveness and Government control over health care procedures. If every procedure becomes mandated then we need less physicians and we can have a nurse practitioner say "no" just as much as we can a physician. If we loved the HMO days I suspect we will just love CCE and Government controlled health care.
As Dr. Flier states in his aforementioned WSJ article:
"In discussions with dozens of health-care leaders and economists, I find near unanimity of opinion that, whatever its shape, the final legislation that will emerge from Congress will markedly accelerate national health-care spending rather than restrain it. Likewise, nearly all agree that the legislation would do little or nothing to improve quality or change health-care's dysfunctional delivery system. The system we have now promotes fragmented care and makes it more difficult than it should be to assess outcomes and patient satisfaction."
What especially concerned me was seeing an interview with a Dr. Gregory, one of the AHRQ panel members, last night and her less than lucid and knowledgeable responses to objections to the conclusions. It was a terrifying interview, for people like that can dramatically change health care to the worse.
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