More Tests Doesn't Mean More Saved Lives
On Friday, Sarah Palin intervened in the debate over new cancer recommendations. Referring to recent changes in cancer screening guidelines, she wrote: “There are many questions unanswered for me, but one which immediately comes to mind is whether costs have anything to do with these recommendations” and then again “We need answers: Is early screening not saving lives? Why do doctors’ groups disagree? Did costs play any role in these decisions to change the recommendations on breast and cervical cancer screenings?” If this was written by a liberal, conservatives would (correctly) denounce it as demagoguery. But since this is written by Sarah Palin (or whoever is writing for her), NRO provided a link on its daily briefing.
Let’s try to look at the questions. Is it that hard to imagine why lobbies like the American Cancer Sociey (ACS) disagree with the new guidelines? For a long time tobacco lobbies denied that smoking was bad for health!
Yes, early screening saves lives. So would a motorcycle ban, a 20 MPH nationwide speed limit, changes to the constitution and the legal system to make it easier to catch and punish criminals, withdrawal of all troops from Iraq and Afghanistan, safety enhancements for school buses (such as seat belts and airbags for all seats) and a lot of other measures. Is saving lives the only thing that matters in evaluating whether something is a good idea?
As it happens, mammograms have side effects, especially in the case of false positives (of which there’s a huge number), and provide very few benefits to women in their 40s who are not at high risk for breast cancer. So the decision was probably purely medical. But what exactly is wrong with taking costs into account? Of course, the costs should have everything to do with recommendations! For decades now, it was liberals who insisted on doing everything that felt good while conservatives insisted on cost-benefit analysis. Even if there were no medical arguments against early screening, mammograms for low-risk relatively young women should have probably been nixed because of costs alone. The costs per each live saved are in the millions of dollars, probably in the tens of millions. For that much money we could alternatively hire dozens of policemen and firemen, or install sprinklers in a lot of buildings, or put many miles of guardrail along roads, or change some dangerous level railroad crossings into overpasses, or teach thousands of children how to swim, or implement other measures which could save lives, perhaps a lot more lives. If we are going to spend some resources on saving lives, what exactly is wrong with trying to maximize the number of lives saved?! Even if you want to use those particular resources (billions in mammography costs) to save the lives specifically of those women and nobody else, there’s a better way. If those women buy healthier food instead of paying for mammograms, they will collectively gain a lot more QALYs (quality adjusted life years). Furthermore, the benefits will be very widely distributed among the entire group rather than accruing to a tiny percentage.
Poorly justified tests (often promoted for P.C. rather than medical reasons) raise the cost of health insurance for all of us and reduce our real wages. The unnecessary mammograms alone shave a couple of bucks off each monthly paycheck of an average American worker. I shudder to think about the total bite of all the modern near-equivalents of snake oil (and how much it will soon increase with more and more new and expensive tests). I thought the GOP was the party that fought to uphold the general interest in economic wellbeing against the special interest hucksters?