Politics Beats Science in Cancer Screening Debate

Mara Gay 46 Views Nov 21, 2009

First, they came for the mammograms. Now, scientists have come for the pap smears. Just days after a government panel provoked outrage by recommending that women under the age of 40 no longer receive annual mammograms, another panel of experts issued a new set of guidelines for cervical cancer screening. The American College of Obstetricians and Gynecologists recommended Friday that women receive their first pap smear — the exam that tests for cervical cancer — at the age of 21 instead of 18. They also advised women age 30 and under to get tested every other year instead of annually. According to the panel, the timing of the new pap smear guidelines is entirely coincidental. But politicians — already taking steps to distance themselves from the obviously unpopular mammography guidelines — seemed wary Friday. The anger from women, doctors, and advocacy groups over the relaxed screening guidelines is revealing, pundits say. They argue that it reveals a divide between the hard science of cancer screening and the explosive, personal politics of health.

A Culture Clash Kevin Sack of The New York Times says Americans have a hard time understanding how less screening could be healthy. "This week, the science of medicine bumped up against the foundations of American medical consumerism: that more is better, that saving a life is worth any sacrifice, that health care is a birthright." In fact, he seems to think they're a little frightened by the notion. " The backers of science-driven medicine, with its dual focus on risks and benefits, have cheered the elevation of data in the setting of standards. But many patients - and organizations of doctors and disease specialists - find themselves unready to accept the counterintuitive notion that more testing can be bad for your health." As a result, Sack says the new guidelines have been met by "political posturing."

It Feels Like We're Retreating in the Fight Against Cancer Ezra Klein says he believes the scientists, but that "disproving the assumed protection offered by mammograms feels like a step backward." Klein says cancer screening is not just about the science. "The presence of mammograms was psychologically important. Yesterday, we had this big weapon in the war against breast cancer. Today, we're being told that it's not that big of a weapon, and shouldn't be used as often. In point of fact, this data is a medical advance. But it feels like a retreat. And people don't like to retreat against a hated foe, even if the retreat is strategic."

Scientists Lost to Politics This Week Arthur Caplan of MSNBC, himself a doctor, said sound science got lost in the heated politics of the debate. "Did you hear an enormous thud around 3 p.m. yesterday? That was the sound of Secretary of Health and Human Services Kathleen Sebelius throwing her scientists under a bus."

The (Cervical Cancer) Science Stands David Dayden of Firedoglake says the science should be taken out of the political context, at least on the pap smear guidelines. "The American College of Obstetricians and Gynecologists has absolutely no role in the health care bill whatsoever, and they don’t agree with the USPSTF recommendation on mammograms," he writes. "They find that there are more potential pitfalls to overscreening on pap smears than on mammograms. In addition, the findings of either group are not binding on doctors or patients; as the Health and Human Services Secretary made abundantly clear the other day, even the USPSTF recommendations are little more than advisory – though I still maintain they may effect cost sharing gudelines."

Politics Won At Daily Kos, DemFromCT says "data will drive the discussion eventually. Politics will drive the discussion now. Publication of the guidelines generally decides the timing of these announcements (not the WH) and there's often a six month lag between submission and publication, and a longer time frame for panel discussion and research."

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Sources

Science, Politics Clash, Kevin Sack, The New York Times
Mammograms and Leeches, Ezra Klein, The Washington Post
Advice Accurate But Not Right, Arthur Caplan, MSNBC
Silly Rationing Fears, David Dayen, FireDogLake
Health Care Friday, DemFromCt, Daily Kos

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Topics: Health Care

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