Tuesday, January 12, 2010

The Politics of Mammography and What It Tells Us About Population-Based Care Management and the Importance of Patient Empowerment

According to the Wall Street Journal, it is likely that the final version of Congress' health reform legislation will disown the mammography guidelines of its United States Preventitive Services Task Force's (USPSTF) recommendations against routine screening for women aged 40-49 years. Rather than stick with the published science that has failed to conclusively show that mammograms reduce death rates from breast cancer, Congress has apparently taken HHS Secretary Sebelius' perspective into account: it's up to insurers to cover women who 'talk to your doctor about your individual history, ask questions, and make the decision that is right for you.'

'Bravo!' says the applauding Disease Management Care Blog.

'What!?' you ask? [Zounds!] This is the same DMCB that typically links more peer-reviewed literature in single posting than most blogs offer in a year? [Sputter!] The evidence-based DMCB that is distrustful of anedcotes, likes to read the original studies and even then, demands methodological transparency and statistical rigor? [Gasp!] The DMCB is okay with Congress jettisoning traditional effectiveness research and letting lay people [Egads!] decide for themselves?

Not only does the DMCB think that is a good idea, but so does the entire disease management industry. In fact, helping patients talk to their doctors and decide for themselves has been a bedrock principle of population-based care coaching for more than ten years. At one level, advocates of disease management argue that patient engagement is far more likely to result in compliance with phyisican recommendations. At a deeper level, empowering patients will result in some persons making a 'wrong choice,' but, in aggregate, lead far more to getting it right. In fact, there's really no such thing as a 'wrong choice' in rigorous care management, because at its core, it assures each patient can decide what to do based on his or her own values and a uniquely personal assessment of the advantages and disadvantages of the proposed testing or treatment. Radical you say? It can be, but this has been around for quite some time.

The DMCB heartily welcomes Ms. Sebelius and a majority of Congress to our fold. Hopefully, they won't stop there, and allow the same approach across all ages and genders in other conditions, such as (for example) cardiovascular disease, depression, prostate cancer screening, and asthma.

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