"Lessons from the Mammography Wars" is a terrific commentary by physicians Kerianne Quanstrum and Rodney Hayward that appears in today's New England Journal of Medicine. After recapitulating the now-familiar controversy that ensued last November when the U.S. Preventive Services Task Force determined that the decision to begin breast cancer screening for a woman in her 40s should be an individual choice rather than a mandatory requirement, the authors succinctly explore the concept of "gray areas" in the assessment of the net benefit of a health intervention and suggest that a policy of separating self-interest from guideline creation (which does not occur when breast imaging societies make guidelines regarding mammography) would be most likely to benefit patients. Here are two of my favorite passages:
Recent proposals to increase spending on comparative-effectiveness research are certainly laudable, but it is unrealistic to think that an investment in research alone will have a sizable effect on the practice of medicine without a concomitant investment in a credible process for vetting medical evidence and clinical care guidelines.
If there is overutilization in health care, we can be sure that it will continue unabated as long as those with a vested interest are allowed to win the public-relations wars by shouting about "rationing" or "death panels" whenever anyone suggests that more health care, in fact, may not be better.
The entire article, in fact, should be required reading for health policy makers, clinicians, and informed patients.