Right to a mastectomy?

“The 1998 Women’s Health and Cancer Rights Act allows women to choose double mastectomies without personal financial loss.”

This is correct to some extent. but the author goes on to explain the real deal. As Austrian economists know, there is always a cost. And that cost makes something, somewhere, more expensive. So… personal cost, yes. It can be tiny and barely felt. Or it can be in another medical procedure that doesn’t get done because all those “rights” were granted, and depleted resources just enough.

The letter writer goes on to explain this well. But in an economic science way I bet the washed brains of the boobwahzie totally missed it.

I commend Dr. Nathanson for trying to point out the economic impact of these fool-hardy laws.

July 17, 2015 6:31 p.m. ET
0 COMMENTS
“The Double Mastectomy Rebellion” (page one, July 11) highlights a troubling national trend for patients who, by selecting their most comforting routes to happiness, increasingly believe that they can identify for themselves the best options for breast-cancer management. Patients ignore the pleas, warnings and hard data that experienced breast-cancer experts provide. Double mastectomy (and, sometimes, even unilateral mastectomy) for treatment or prevention of recurrent or new breast cancer most often doesn’t make scientific or economic sense.

Seeking the right physician, perhaps even getting a second opinion, is important for patients who have a recent diagnosis of breast cancer, but only to the extent that face-to-face clinical knowledge and experience should be carefully evaluated together with the vast knowledge base of the Internet. Can laymen, with only a passing scientific understanding, come up with the “right choice” of surgical treatment? Is it appropriate to base the choices on powerful emotions and feelings, reinforced by friends, family, anecdotal stories and mastectomy support groups?

The 1998 Women’s Health and Cancer Rights Act allows women to choose double mastectomies without personal financial loss. However, the effects on people with other diseases are more than economic. Money spent on statistically unjustifiable treatments may result in limited availability of resources, sometimes preventing patients with potentially life-threatening illnesses from receiving promising new drugs that could save their lives. Perhaps it is time to ask patients who seek prophylactic mastectomies against the advice of their doctor and when their risk of future breast cancer is low to pay for that privilege themselves.

S. David Nathanson, M.D.

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One response to “Right to a mastectomy?

  1. This points out, glaringly, one of the fundamental problems with applying economics and statistics to healthcare, and until we figure out how to properly navigate these waters, the subject will continue to be fraught with contention.

    The fact is, when it comes to healthcare, it’s personal. It’s easy enough for a distanced doctor to say, “you don’t need this scan, it’s not warranted by what we know”, and to feel justified that he’s controlling costs based on evidence and statistics, but for the *person* involved at the other end of the conversation, they only have one life. One health. And once that’s gone, PFFFT! That’s it. When you put it in that perspective, is it any surprise that they turn around and push for a CT scan to be done, “just to be sure”?

    And we’ve all heard anecdotes about, “Well, the doctor said I was just fine but I pushed for a scan and lo and behold, there was an alien curled up asleep around my spine — lucky that I made them do the scan!” And it only takes ONE of those statistical anomalies to convince everyone else that doing “unnecessary” medical procedures may very well be justified in the end if they, too, happen to be in that 2% category of edge cases.

    It’s tough. I totally get the, “skin in the game”, aspect of medical care, and largely agree with it. But on the other side, if my child was sick, I would happily break out the fishnet stockings and troll the corners for cash and any number of other despicable things if it meant that he’d get the treatment he needed. And it might throw me into financial destitution because of it — or might have prior to the ACA abolishing limits on benefits.

    Yes, someone has to pay for it. But of all the things in the world where we can be annoyed at, “spreading the costs”, healthcare is probably at the top of the list of things we, as caring humans, ought to not be quite as miffed about as other things.

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