Wednesday, March 11, 2009


Making the Trains Run on Time

"...the Mammography Quality Standards Act... had little if any precedent in the history of medicine. Never before had the federal government claimed a role in the regulation of medical practice."
-NYTimes: June 27, 2002

As I said in my previous post:


1. Women’s imaging is booming – competition for business is brisk
2. Women’s centers are being built everywhere with parquet floors and vaulted ceilings, furnished with overstuffed chairs and couches providing a private, comfortable milieu
3. Medical device manufacturers are eagerly in the game, developing stereotactic minimally invasive biopsy machines; MRI of the breast and digital mammography are both rapidly being developed to advance sensitivity and specificity of diagnosis
4. Diagnostic Imaging residencies open a new subspecialty: Women’s Imaging. Interest among radiology residents is high

What is the Situation Today? What Did We get From Government Regulation?

1. Women's imaging centers are closing at the rate of about 20 per month--
2. The wait for screening mammograms is 6 months in many areas and in lower population areas or areas of high liability--there are no radiologists available to interpret mammograms--the tests are shipped out for remote interpretation
3. No one wants mammography business except large hospitals who are banking on the spin-off money from surgery and therapy for the 1 in 1000 screening patients with cancer-- in other words, the only businesses interested in doing mammography now are businesses hoping women have a cancer ...
4. Medical device manufacturers have fled the field. Stereotactic biopsy devices, MRI of the breast and Digital mammography are all dead in their first or second iterations--without profits, no one is buying new technology, which therefore remains fallow
5. Radiology residents eschew women's imaging and most fellowships go unfilled and without applicants--despite the fact that at least 30 million mammograms will be done each year in the U.S.

Did MQSA Improve Quality in Mammography?

In mammography, improvement should = greater number of cancers found in any given 100 mammograms in 2009 vs 1993.

No matter what the unintended consequences, if MQSA resulted in MORE cancers found per 100 screening mammograms, then the price of this"reform" might be worth what it cost.

Not With a Bang

The sensitivity and specificity of mammography remain unchanged 1993 vs 2009. This means that for every 100 mammograms the same number of cancers would be found today as would be found in 1992--before the government seized mammography with MQSA.

Despite millions of dollars spent in compliance
Despite hundreds of pages of federal regulation
Despite education and training mandates
Despite licensing requirements, yearly requalifications, and mandated QA

Despite all of this, mammography today is no better at finding cancer than it was in 1993

What MQSA has done is to standardize the procedure of taking a breast x-ray and the machinations of the women's mammography facility--akin to Mussolini making the trains run on time in Italy in the 1940's --without ever addressing or even understanding why mammograms cannot do any better after reforms than before!

They threw everything they had at mammography -- anecdotes, laws, regulations, Congressmen, feminists, actresses --everything they want to throw at health care today; but, because they started with bad assumptions and a faulty premise, all the rules and dogma and laws could not repair what they perceived as wrong.

And the main reason is because it was not broken. Just like the medicine and surgery of our health care system today. And after such reform, what knowledge?

STILL...a mammogram is an insensitive test for many women

STILL...mammography remains the second most dangerous thing a doctor can do in all of medicine

STILL...jury awards for missed cancers on mammograms represent the largest liability awards in all of medical practice.

Government takeover of mammography has not improved quality, has not reduced liability, and has not saved one life...
But it HAS

...Caused massive closing of women's centers
...Chased physicians from the field
...Cost hundreds of millions of dollars
...Destroyed business initiative
...Stymied technology that might actually produce better methods of finding and diagnosing cancer

Nowhere Train

Is this what we want in health care reform today? Reform the system, reform the process, address social grievances and perceived injustices while satisfying special interest groups and politicians? Because the system then faces the same fate as mammography.

You will reform insurance. You will reform distribution. You will address costs, but in the process, you will vitiate the services, chase away the best practitioners, and create a great a void where once the world's best health care resided.

You want the train to run on time but to be going nowhere?

...this is what the government will bring us.

1 comment:

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