Monday, March 23, 2009

Breast MRI and The Coming War Against Medical Technology

Flak: noun
1. antiaircraft fire, esp. as experienced by the crews of combat airplanes at which the fire is directed.
2. criticism; hostile reaction; abuse: Such an unpopular decision is bound to draw a lot of flak from the press.

The Rising Tide
I came across this headline on the website of Kevin, M.D.: "Does Breast MRI have any benefits for patients with breast cancer?" Being a big fan of breast MRI (and the lives of the women I've seen it save), this headline took me aback somewhat.

Kevin, M.D. referenced another blog by a general surgeon, Jeffery Parks, who titled his piece "Breast Cancer and MRI," and used the phrases: "Finally some news on the use (or overuse) or MRI in breast cancer;" and "There are situations where MRI could potentially be useful ..." (italics mine).
Both blogs are good ones, worth reading, and full of useful information (including these entries); the blogs and their authors are not my pursuit here. What does interest me is the PRESS that breast MRI (BMRI) gets not because it is a fantastic technology and head and shoulders above mammography, ultrasound and breast exam combined; rather, its the consistent repetitive criticisms that BMRI is expensive and too sensitive. These nonmedical criticisms overwhelm the real message: BMRI saves lives. It can save your life.

That's a Fact Jack
Let's start with two facts as demonstrated by multiple studies over the past 15 years:

1.The sensitivity of MRI of the breast is very high -- as high as 95-97% -- in detecting invasive cancer, no matter the size of the lesion.

2. The sensitivity of mammography in dense breasts can be as low as 45% ...................(otherwise known as a coin flip); and when a cancer is identified on a mammogram it can frequently be found on last year's mammogram, as often as 70% of the time

There are LOTS of studies that document the power of MRI in making the diagnosis of breast cancer.

Why then all the FLAK?

Share it fairly but don't take a slice of my pie

It seems to me that there is a lot of hostility out there as regards BMRI and this is symptomatic of the overarching strategy of the health care reform movement, magnified in this burgeoning era of limiting costs for health care. Since we seem to spend too much then we need to cut back. Where to cut back? Expensive treatments, diagnostics, drugs, and therapies.

MRI gets a lot of flak because of 2 reasons:
1. It's expensive
2. It finds a lot of things that aren't cancer resulting in more biopsies and follow-ups that...cost more money

A lot of people lobby against routine breast MRI because they feel it is an elitist form of care that most people cannot afford or for which most people are not insured. The case against extra biopsies and follow-ups also usually complain that this creates COSTS. Some authors now applaud President Obama's search for cost effectiveness via the stimulus package as a welcome effort aimed at optimizing care while reducing costs.

Demand What Ted Gets

In systems where the government is in charge of distributing limited tax dollars between different budgetary demands--one of which is health care--bureaucrats and their medical claque need to decide how to make maximum use of minimum dollars. As Canada and England and others have discovered, it is ideal to placate the 95% of people who never need more than simple remedies, homeotherapy, adjustments, zinc tablets, and laughter therapy.

The other 5% -- the people in the ICU's and in the trauma ward; the severely burned, the patients with rare chronic diseases and those who would benefit from high-end diagnostics -- those 5% don't make a potent voting block and don't seem significant in surveys that affirm "satisfaction with the health care system."

These are the patients who will be left behind in the future of Ted Kennedy's Health Care America.

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