ABC's Robin Roberts Grills Govt Official: Was Breast Cancer Decision Rationing?
Published: 11/19/2009 10:50 AM ET
ABC's Robin Roberts on Thursday pressed a government official on rationing and a new recommendation that women under the age of 50 shouldn't get regular mammograms. Talking to one of report's authors, she chided, "Dr. [Thomas] Wilt, you know many are feeling that this is trying to save money, that this is a political move."
Roberts challenged Wilt, who is with the U.S. Preventative Services Task Force. Although she didn't specifically use the word rationing, the implication was clear: "You are an independent panel, but federally funded independent panel. How do you respond to those who feel that this is nothing more than a cost-saving measure?"
On Wednesday's GMA, the program featured a clip of Dr. Peter Jokich, of Rush University Medical Center. Making a similar point, he derided the report: "I think it's totally ridiculous. I may not be politically correct, but I think this is really about money and politics. It's about the beginning of rationing care and I don't think it's really about the health of individual women."
In a follow-up question on Thursday, Roberts, who is a survivor of breast cancer, pointed out the organization's own numbers don't seem to support the change in screening recommendation. She explained that mammographies for women between 40 and 49 prevented one death per 1904 person and one death per 1339 for females 50 to 59. Questioning the suggestion of less screenings, she protested, "Doesn't seem like that big of a difference, statistically, to make such a drastic change in the recommendation of a decade."
Hopefully, more reporters will follow Robert's lead. As journalists discuss the health care debate and government-run coverage, they shouldn't ignore the connection between that subject and the possibility of rationing.
A transcript of the segment, which aired at 7:14am EST, follows:
ROBIN ROBERTS: Now, back to that growing controversy over the new breast cancer guidelines. The Obama administration now running interference, trying to tamp down concerns over those new recommendations by an independent medical panel that is funded by the government that say most women under the age of 50 should not get regular mammograms. Here's what Health and Human Services Secretary Kathleen Sebelius said on Wednesday.-Scott Whitlock is a news analyst for the Media Research Center.
KATHLEEN SEBELIUS (Secretary, Health and Human Services): The United States Preventive Services Task Force have done what they've been asked to do, which is routinely review data and look at preventive services across the board and make recommendations. They don't make policy. Do what you've always done. Talk to your doctor. Figure out your own health situation with your doctor, your family history. Those are the really important ingredients.
ROBERTS: And earlier this morning I talked to one of the people behind the report that has caused so much controversy this week, Dr. Timothy Wilt. Dr. Wilt, I'd like to begin with your reaction to what Secretary Sebelius just said about women should at the age of 40, instead of 50, get their mammograms but did go on to say they should have an ongoing discussion with their physicians about this.
DR. TIMOTHY WILT (U.S. Preventative Services Task Force): Well, our recommendations support an individualized decision making process with the women so that they have knowledge about the risk and benefits associated with mammography screening and help make that based on their values and informed discussion with their health care provider.
ROBERTS: Dr. Wilt, you know many are feeling that this is trying to save money, that this is a political move. You are an independent panel, but federally funded independent panel. How do you respond to those who feel that this is nothing more than a cost-saving measure?
WILT: Costs are not considered at all. This is all about providing high-quality health care for individuals, allowing them to provide the information that they know, that they need to know to make a well-informed decision. We do not provide any or- assessed costs at all in our decision making about this. It is the most rigorous- the recommendations were based on the most rigorous, peer reviewed, comprehensive, up-to-date accurate information about the evidence about the harms and benefits of treatment. And then that was peer reviewed and- to provide that information for women and the physicians who take care of them is good medical care. That's informed medical care.
ROBERTS: Looking at the number, and that's what you said you are basically doing, taking the emotion out of it and looking just at the number. Well, we see that between the ages of 40 and 49, one death prevented per roughly 1,900 women screened. Between the ages of 50 and 59, one death prevented per roughly 1,300 women screened. Doesn't seem like that big of a difference, statistically, to make such a drastic change in the recommendation of a decade.
WILT: Well, first I don't think that changes are that drastic. If you look to see what our recommendations were in 2002, we stated that the age for which the benefits of screening outweigh the harms are unclear but change with age and that women should be informed of the benefits and harms.
ROBERTS: Let me ask you, Dr. Wilt, about self-exams, that the panel has also recommended that it's unnecessary for doctors to treat their patients how to properly do a breast self-exam. I and many others detected their cancer through a self-exam. What's the harm?
WILT: Well, what we have from that, let me make clear that our recommendation on breast self-exam is different than the one for mammography for women age 40 to 49. The recommendation for 40 to 49, is that they choose what they want based on information. The information about breast self-exam, there have been several large well-designed trials that have looked at teaching breast self-exam. Women did more breast self-exams, did them with high quality, found more lumps, had more biopsies and had more surgeries, but did not have reduction in breast cancer or overall mortality. It did not work. To routinely do that. That does not mean to say that if a woman feels a lump that she shouldn't bring it to the attention of her physician. But that is the information that we have out there from the best available evidence.
ROBERTS: There were women on the panel?
WILT: There were women on the panel. Many in our evidence group that provided the information now consisted of experts in the field and their documents and their reports have been extensively peer reviewed with revisions and comments made back about those peer reviews.
ROBERTS: Thank you so much.