18 Nov 2009

Born under the NHS, I find US healthcare perplexing

Sarah Smith blogs that debate over breast cancer treatment in the US is being driven by arguments over whether women are being given so much treatment that it’s actually bad for them.

The latest healthcare debate in America isn’t about the “public option” or when the senate will vote on healthcare reform – instead this week everyone is up in arms about new advice over breast cancer screening.

An independent panel, the US Preventive Service Task Force, has recommended against routine screening for breast cancer for women under 50.

They say there is insufficient evidence to suggest it’s worth screening women in their 40s unless they have a family history of the disease or other risk factors.

It sounds exactly like the kind of debate over healthcare we are very used to hearing in the UK. Except that here the cost of the treatment is apparently not the issue.

There is no equivalent of NICE in the US
. In fact the British National Institute of Clinical Excellence, which evaluates the cost effectiveness of various NHS treatments, is the example Republicans use when they are talking about “death panels” in America.

Instead the breast cancer debate is being driven by arguments over whether women are being given so much treatment it’s bad for them – that it is not a good idea to subject women to unnecessary biopsies, stress and, most importantly, the radiation from the mammograms which many women are given every year after age 40.

Any Brit who starts to use the American healthcare system, assuming they have good health insurance coverage, is immediately shocked by the amount of treatments and diagnostic procedures they are prescribed.

A full MRI is performed, it seems, if you complain of the slightest discomfort, and it’s impossible for any non-doctor to know whether this contrast shows how few of these procedures the NHS is able to offer or whether a privatised system inevitably produces unnecessary but highly profitable treatments.

There has been a huge outcry here from women who are used to getting screening from 40, and experts say they have been trying to change the advice to testing from age 50 since 1997 but haven’t been able to because of the political uproar such a suggestion causes.

My own reaction to this confusing debate has been a very personal one. Just last week I received a very joyous email from a good friend in America who was able to announce to the world that after a successful mammogram she was now completely breast cancer-free because the disease had been caught early enough.

But she pointed out that if she had been living in the UK the outcome might have been very different, as routine screening does not start in Britain until age 50.

Many doctors here say they intend to ignore the new advice and keep screening women in their 40s, which means I will probably have to soon decide whether I want to join in myself.

The degree of choice offered within American healthcare can be deeply perplexing for someone born and brought up under the NHS.