Tuesday, April 7, 2009

Mammography Faces A New Foe: NNT


This Door is Closed
DATA IDENTIFICATION AND ANALYSIS: Literature search of English-language studies reported from January 1966 to October 31, 1993, using MEDLINE, manual literature review, and consultation with experts. A total of 13 studies were selected, and their results were combined using meta-analytic techniques based on the assumption of fixed effects

CONCLUSION: "Screening mammography significantly reduces breast cancer mortality in women aged 50 to 74 years after 7 to 9 years of follow-up"
--JAMA Vol. 273 No. 2, January 11, 1995

The efficacy of screening mammography in reducing breast cancer mortality is not really any longer statistically debatable; unless you have a new meta-analysis or multi-center trial with tens of thousands of patients to refute what has been a done deal for quite a while. So why would Kevin, M.D., a notable and widely-read blogger title a post: "How Much Do We Really Need Mammograms." And why would he attempt to validate this proposition by adducing the "Number to Treat" statistical evaluation, saying that NNT is "a statistic that is gaining increasing relevance in mainstream health reporting." ?? Sheesh.

Market Tops
A wizened investor analyst once told me that at market tops, when people no longer have a rationale for explaining the market distortions that lead to overvalued assets, they invent new definitions for value. So when Internet stocks rose to the heavens on vapor profits, analysts began to tout the theory that the standard of value measurement, the price to earnings ratio , was no longer valid. Instead we would look at a new valuation method: price to sales ratio. Of course, sales were an estimate (as opposed to earnings); and, when sales failed to materialize as predicted by overzealous and greedy stock analysts (duh), millions of people lost billions of dollars as the Internet stock bubble exploded.

Lets not even talk about real estate.


Measuring Out Your Life


The Number Needed to Treat is the "price to sales" ratio of this debate. It's how we are going to redefine your life in the era of nationalized health care and how the coming regime intends to measure out your care with coffee spoons. According to Wikipedia, the NNT:

... is an epidemiological measure used in assessing the effectiveness of a health-care intervention... The NNT is the number of patients who need to be treated in order to prevent one additional bad outcome (i.e. to reduce the expected number of cases of a defined endpoint by one).

The importance of "the number of patients who need to be treated" translates to COST. This is what all you Obamaphiles should get through your heads. We intend to make the measure of health care what it costs to get it done, not how many fewer people die. What does it COST to save a life? It is not a measure that is used in our courts where the Tort system projects the value of life into millions; obviously. See my previous post here.


So, theoretically, even if screening mammography reduces deaths from breast cancer, if you have to do too many mammograms to prevent one death, then...it isn't worth it to the system


Who is the system? Whoever pays the bills.


Who make s the rules? Whoever pays the bills.


Who's paying the bills in the future of your heath care? The government.


So, if they want to question the value of mammography not in relation to death reduction but rather on how much it costs to actuate as compared to the eventual cost to the system...as Arnold Swartzeneger says in almost every movie he makes: "GET DOWN!"


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