The folly of breasts and politics

The folly of breasts and politics

This blog is about freedom and personal responsibility.  I have opined that cigarette smokers should not be permitted to transfer total responsibility for the consequences of their choices to the tobacco companies, even if this industry has committed legal and ethical improprieties.  I do not support the politically correct beverage ban in New York City, sure to spread elsewhere, where the government decides the content and dimensions of beverages that the public desires to purchase.  With regard to Obamacare, don’t get me started or I’ll never get to the intended subject of this post.

First, let me refute a point in advance that is sure to be leveled against me by the pro-breast crowd.   I am zealously pro-breast and want all breasts foreign and domestic to remain free of disease. I am against breast cancer and support the goal of striving for early detection of this disease and medical research to prevent it.  Indeed, I am against all cancer and boldly express this controversial view in print for all to see.

Breasts and politics have been intertwined for years.  Many medical advocacy groups admire and envy the huge amount of research money that is garnered for breast cancer research.  Some argue that breast cancer, while worthy, receives a disproportionate share of research dollars at the expense of other crippling and deadly diseases.

There is no clearer example of the contamination of breast cancer with political interference than Mammogate, when the federal government cowardly rejected the sound and impartial recommendations of its own expert panel for political reasons.

Now, a new scene in the government’s Breast Fest has appeared where our elected legislators play doctor.  States are passing laws that require medical facilities to inform patients who have undergone mammograms if they have dense breast tissue and that they should discuss with their physicians if additional testing is necessary. More details are found in the New York Times report on this issue.

I will defer expressing a medical view if women with dense breasts are adequately protected by conventional mammography. If medical professionals, unelected but presumably trained in actual medicine, believe that ultrasound exams or M.R.I. scans are necessary to illuminate dense breast tissue, then brace yourself for an avalanche of unnecessary scans which will generate anxiety, cost a few zillion dollars and identify false positive lesions which are entirely innocent and lead to a breast biopsy bonanza.  This cascade will be fueled also by the medical malpractice system, the raptor present in every mammography suite that is ready to sink talons into its prey.  Am I exaggerating here?  Ask any radiologist why he has stopped reading mammograms.  The guys that still do are scared stiff. These breast images are not sharp iPad images with futuristic resolution.  Instead, they look like grainy collages where it can be agonizing for a doctor to decide if a small smudge is nothing or everything.  Understandably, in today’s litigious climate, radiologists join OperationOVERCALL, rather than risk the opportunity to serve as a defendant years later.

The government are not physicians and should not legislate medical advice.  It’s hard enough for actual doctors to sort through conflicting and controversial medical data and evidence to determine what is best for our patients.  We struggle with this every day.  Will the clumsy axe of government be a helpful player in this effort?   Do we want folks who are beholden to lobbyists and are political animals by definition to force physicians to practice in certain way?

Why stop at breasts?

Pass laws that will require physicians to:

  • Obtain a CXR if a patient has a cough and a fever
  • Tell every patient who has a negative cardiac stress test that the patient can drop dead of a heart attack within a week and that a cardiac catheterization should be considered
  • advise patients who are scheduled for surgery to obtain a second opinion in case surgery is silly
  • advise patients to pursue the probiotic promise of a panacea.

Sure, there’s dense breast tissue out there.  But, not nearly as dense as the government.  I suppose we should trust them with our lives and our health judging by the sterling performance they demonstrate as legislators.  Congress’ approval rating is now soaring at 21%.

Michael Kirsch is a gastroenterologist who blogs at MD Whistleblower.

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  • boucains

    With all due respect to Dr. Kirsch, who is free to speak about whatever he wishes – why does a gastroenterologist post so strongly about breast cancer screening? I do have to admit that I read a lot of articles just to find that they have been written by people without the level of expertise I assumed from the tone of the missive. I hope that Dr. Kirsch or another person with a reasonable answer pops in here to respond.

  • Brian Stephens MD

    Dr Kirsch,
    the pendulum swings.
    Physicians used to be leaders, judges, and confidants. Medicine was paternalistic and the Doctor’s decision was not questioned.

    Now we have come to the other extreme.
    Physicians are thought to be civil servants and foul-able to the point of not trusted. Society and politicians have stripped physicians of social leadership rank and we are now seen as cogs in the machine and nowhere close to decision makers.

    it is good that we are no longer in the extreme paternalistic style of medicine, however, the current healthcare system suffers terribly by a lack of medical leadership.
    just look at Obamacare. the TRUE leaders of healthcare is quit clear.
    Insurance companies
    and medical device makers.

    doctors had and cont to have no seat at the table.

  • Ann Silberman

    Because it doesn’t matter if he specializes in the breast or the gut. He is a doctor, and his point is the government is deciding what should take place privately between a doctor and his patient and what treatments should be offered. Medicine as politics is a bad thing and it is particularly prevalent in the world of breast cancer.

    And, it is not just this one thing.

    I spent quite some time in my oncologist’s office just today – I have the aforementioned breast cancer. Mine is of the terminal variety. The government has my doctor doing clerical work- going through software, answering stupid questions (one of them is when my cancer will end – which will be when I die and is a question nobody can answer for anybody), spending time clicking here and there so they can track our cases, no doubt justifying my use of pain killing drugs, etc. He spent quite a bit of time doing this, once I’d gotten past the things I needed to tell him. I would say at least ten minutes and it might have been more.

    Multiply that by the number of patients he sees each day, and you have an issue.

    I believe my doctor’s time, after I share my concerns and he addresses them, is best spent studying journal articles, reading new research, learning about new trials. Instead, he has to ask me questions the government wants to know and put it into a computer system and spend significant time doing so.

    Now they want doctors to share information that may, or may not, be an issue with patients who may, or may not, be able to put this information into perspective. Laws like this can force physicians to offer suggestions that may make their patients’ lives worse and add little health benefit.

    Do I think, as a woman with metastatic breast cancer, that women should know that mammograms may not be effective at reading denser breasts? Sure. Do I expect my doctor to read the literature and parse this information for me without the interference of the breast cancer lobby,, and give me what I need? Yes.

    Doctors are not there to be tools of the government. But the government is telling them, more and more, what tests and tools and information should be handed out based on political lobbying by powerful groups, such as Komen. That is not good for anybody, whether it be a gastroenterologist or an ENT.

    • southerndoc1

      “I believe my doctor’s time, after I share my concerns and he addresses them, is best spent studying journal articles, reading new research, learning about new trials.”

      Add to that 5 minutes at the end of the day, your chart open in front of him, staring off into space and thinking analytically, synthetically, creatively, imaginatively about you and your disease . . . that time has definitely been taken away from him.

      Thank you very much for your post.

  • MKirschMD

    Appreciate comments. I don’t think one needs to be an oncologist or a radiologist to offer informed views on the limitations of mammography. One could argue that an ‘outsider’ might be more objective.

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