CodeBlueBlog: NEW YORK TIMES AGAIN IN CODE BLUE BLOG'S WAKE

April 2005

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On June 11, The New York Times picked up on a story that CBB covered a month ago: MAMMAVTIVISTS KILLING THE MAMMOGRAM As I said in CBB then:

"There is a reality radiologists have faced for several years: Mammography, performed and interpreted by experts, cannot survive. It is a technology besieged by conglomerate forces that will drive it into extinction, with many other important procedures and technologies to follow. Radiologists see four major reasons for this destructive phenomenon: HMOs, government regulations, special interest groups ( THE MAMMACTIVISTS) and trial lawyers."

It is no news that physicians no longer consider it worthwhile to interpret mammograms. I have an anecdote that may be illustrative.

A colleague of mine worked at a Kaiser organization hospital on the West Coast. At that time Kaiser had a policy that radiologists were paid $5 extra for each mammogram they interpreted. Being that the hospital did about 100 mammograms a day, this equated to a substantial sum.

Needless to say, all the mammograms were read every day; in fact, there was quite a war in the department over who actually got to read the mammograms. Often times a lottery system was used to dole out the studies.

Then, suddenly, Kaiser stopped awarding the $5 stipends. No extra money was provided for interpretation of mammography.

Within two months there was a room full of unread mammograms. Literally, a thousand mammograms lay without interpretations.

We have two choices if we want mammography to continue. We can either increase the professional reading fee or we can limit malpractice risk. Those are your choices.

This problem, I predict, will be repeated on a grander scale with MRI of the breast. A breast MRI is a super mammogram. It is extremely sensitive, but the specificity of the procedure lags the sensitivity (translation: it is good at finding abnormalities, but it is not as good in revealing which abnormality is cancer and which is a noncancerous lesion). In reality, women should be getting yearly MRIs, instead of mammograms; however, this concept remains highly unpopular because MRIs are ten times more expensive; and, with the increased sensitivity, the liability risks are magnified greatly.

And don't let's respond to all of this by claiming that a national health insurance plan will solve the problem. Suffice it to say that that type of system in England lead to mammograms being done cheaply (one view of each breast -- missing countless lesions with this technique) with a screening schedule of a mammogram every-other-year, all to save money; which, with a national system, the public had no recourse to protest or to change.

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CodeBlueBlog

health care also health·care (hlthkâr) n. :efforts made to maintain or restore health especially by trained and licensed professionals -- usually hyphenated when used attributively

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