Government Gone Wild!
Recently the U.S. Preventive Services Task Force made some egregious recommendations regarding Pap smears which should not go unchallenged. In essence, this supposed advisory body stated that women over thirty could go five years without a Pap if they have a negative prior Pap and a negative HPV test. Let me say at the outset, so there is no confusion, that this recommendation has about as much validity as an Elvis sighting in Afghanistan. Let me explain.
Any recommendation, whether it is to brush your teeth everyday or not to pull on the cape of the Lone Ranger, is only as reliable as the organization issuing it. You can’t separate the message from the messenger in this respect. The Preventive Services Task Force Cabal consists of 16 primary care doctors, nurses, epidemiologists and statisticians that was originally established in 1984 to “develop recommendations for primary care clinicians on the appropriate content of periodic health examinations.”1 Since then, this government appointed “advisory” council has morphed into a ridiculously powerful de facto regulatory commission that issues edits that make presidential proclamations look like casual suggestions. In other words, these 16 ivory tower, number crunching bureaucrats set policy that is adopted by Medicare, Medicaid, and many private insurers as gospel. They have been granted new and yet undefined power with the passage of President Obama’s new health care law as they now wield Czar like status when it comes to what the government deems appropriate for your health. This group is never far from controversy as they are the same fun bunch that recommended a reduced frequency for mammograms and scoffed at PSA screenings for prostate cancer. From breasts to behinds, it seems these guys have their finger in everything. Let’s just say it is a bit scary for 16 strangers to determine what is in your best interest about anything, much less your health.
As to not be accused of beating a straw man or tossing out an ad hominem attack, what about the actual recommendations? The PSTF says that any woman over 30 who has a normal Pap and a negative test for Human Papillomavirus can elect to not have any additional testing for 5 years. This is based on population studies that in their own words include a “cost/benefit analysis.” In bureaucrat speak that means a “can the government save money if we do it this way” analysis. Lost in this analysis is the law of unintended consequences. One of the main reasons a woman has a yearly exam is to undergo a Pap smear. In the minds of many women no Pap means no exam, and this is not only wrong thinking but dangerous. During an annual well woman exam there are a number of assessments and screenings that are done that have nothing to do with a Pap smear. The American Cancer Society has long championed a yearly breast exam as an early detection tool for breast cancer. Millions of lives have been saved by the early detection of a variety of illnesses from breast cancer to heart disease found or prevented by a yearly check up. Studies show that many of these illnesses would have gone undetected or progressed to a dangerous stage if not for regular exams, which would drastically decrease if you follow the wisdom of the health Czars. (unintended consequences) Yearly exams for both men and women save lives and the government can’t debate that.
It is critical to make the distinction between cancer detection and prevention. Mammograms do nothing to prevent cancer. They can detect it if it already has occurred and that dramatically improves the survival rate, but mammograms haven’t ever prevented a single breast cancer. On the contrary, Pap smears do prevent cervical cancer, a cancer that kills 4000 women every year. The Pap is one of the few screening tests that detect a pre-cancer stage where the treatment is relatively minor and can prevent an abnormal cell from ever becoming a cancer. A Pap is true prevention and has been lauded as one of the greatest public health successes of the past 100 years. Is it worth rationing this preventive tool to help meet government budgets?
The one kudo I can give this committee is recognizing the importance of HPV in the screening for cervical cancer. Substantial numbers of cervical cancers are caused by HPV, yet I have an issue with their recommendations even regarding this. If a woman is sexually active she can contract HPV at any point; it is literally epidemic in people under 50. Waiting 5 years between testing is giving this virus way to much time to reek its havoc on cervical cells.
What’s the take home message? Simply don’t fall prey to the government rationers and discuss your individual situation with your doctor. Together you can decide what is in your best interest.
Recently the U.S. Preventive Services Task Force made some egregious recommendations regarding Pap smears which should not go unchallenged. In essence, this supposed advisory body stated that women over thirty could go five years without a Pap if they have a negative prior Pap and a negative HPV test. Let me say at the outset, so there is no confusion, that this recommendation has about as much validity as an Elvis sighting in Afghanistan. Let me explain.
Any recommendation, whether it is to brush your teeth everyday or not to pull on the cape of the Lone Ranger, is only as reliable as the organization issuing it. You can’t separate the message from the messenger in this respect. The Preventive Services Task Force Cabal consists of 16 primary care doctors, nurses, epidemiologists and statisticians that was originally established in 1984 to “develop recommendations for primary care clinicians on the appropriate content of periodic health examinations.”1 Since then, this government appointed “advisory” council has morphed into a ridiculously powerful de facto regulatory commission that issues edits that make presidential proclamations look like casual suggestions. In other words, these 16 ivory tower, number crunching bureaucrats set policy that is adopted by Medicare, Medicaid, and many private insurers as gospel. They have been granted new and yet undefined power with the passage of President Obama’s new health care law as they now wield Czar like status when it comes to what the government deems appropriate for your health. This group is never far from controversy as they are the same fun bunch that recommended a reduced frequency for mammograms and scoffed at PSA screenings for prostate cancer. From breasts to behinds, it seems these guys have their finger in everything. Let’s just say it is a bit scary for 16 strangers to determine what is in your best interest about anything, much less your health.
As to not be accused of beating a straw man or tossing out an ad hominem attack, what about the actual recommendations? The PSTF says that any woman over 30 who has a normal Pap and a negative test for Human Papillomavirus can elect to not have any additional testing for 5 years. This is based on population studies that in their own words include a “cost/benefit analysis.” In bureaucrat speak that means a “can the government save money if we do it this way” analysis. Lost in this analysis is the law of unintended consequences. One of the main reasons a woman has a yearly exam is to undergo a Pap smear. In the minds of many women no Pap means no exam, and this is not only wrong thinking but dangerous. During an annual well woman exam there are a number of assessments and screenings that are done that have nothing to do with a Pap smear. The American Cancer Society has long championed a yearly breast exam as an early detection tool for breast cancer. Millions of lives have been saved by the early detection of a variety of illnesses from breast cancer to heart disease found or prevented by a yearly check up. Studies show that many of these illnesses would have gone undetected or progressed to a dangerous stage if not for regular exams, which would drastically decrease if you follow the wisdom of the health Czars. (unintended consequences) Yearly exams for both men and women save lives and the government can’t debate that.
It is critical to make the distinction between cancer detection and prevention. Mammograms do nothing to prevent cancer. They can detect it if it already has occurred and that dramatically improves the survival rate, but mammograms haven’t ever prevented a single breast cancer. On the contrary, Pap smears do prevent cervical cancer, a cancer that kills 4000 women every year. The Pap is one of the few screening tests that detect a pre-cancer stage where the treatment is relatively minor and can prevent an abnormal cell from ever becoming a cancer. A Pap is true prevention and has been lauded as one of the greatest public health successes of the past 100 years. Is it worth rationing this preventive tool to help meet government budgets?
The one kudo I can give this committee is recognizing the importance of HPV in the screening for cervical cancer. Substantial numbers of cervical cancers are caused by HPV, yet I have an issue with their recommendations even regarding this. If a woman is sexually active she can contract HPV at any point; it is literally epidemic in people under 50. Waiting 5 years between testing is giving this virus way to much time to reek its havoc on cervical cells.
What’s the take home message? Simply don’t fall prey to the government rationers and discuss your individual situation with your doctor. Together you can decide what is in your best interest.
