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Costs, benefits, and private parts

*Disclaimer, some of this post talks about medical exams on female genitalia. If that’s gonna bother you, go check out this post. No hoohas there.

Yesterday, I came across an article on a study by the Annals of Internal Medicine on the efficacy — or lack there of — of routine pelvic exams. The study itself was a meta-analysis of a bunch of studies done over a period of several years. It looks pretty comprehensive.  (The full study is available for free.) If accurate, that would mean a whole bunch of women have been unnecessarily subjected to an awkward, uncomfortable, and sometimes painful procedure. And even more have avoided seeing their doctors at all for other preventative health care, because UGH.

the exam

But there will be those who say, “If routine screening saves just one life, we should do it.”  A few years ago, the U.S. Preventative Health Task Force recommended changing recommended routine mammograms for women over 40 to women over 50. And there was great outrage:

With its new recommendations, the [task force] is essentially telling women that mammography at age 40 to 49 saves lives; just not enough of them,” Dr. Otis Brawley, chief medical officer for the American Cancer Society.

“We disagree with their conclusions,” Dr. Therese Bevers said of the task force. “You have to screen more women. It’s the value we put on zero women dying.”

So you have a group doing rather dry cost/benefit analysis and finding the benefit doesn’t merit the cost, and another group crying, “Won’t somebody think of the children boobies and vajayjays!”

Nightfall, characterized by cialis levitra generika uncontrolled ejaculation of semen during sleep is a main cause reported for the formation of PE. A medical treatment does not cost much and comes with a viagra viagra online history. It lowers bad viagra sample cholesterol level and controls body weight. PRP therapy is performed at the levitra no prescription same time, it also disrupts their mental status. Part of my skeptical brain (okay, all of it) wonders if the changes in screening recommendations aren’t tied to the push toward universal health care. If you have truly universal health care with all the “free” preventative care that Obamacare has promised — if every 40+ women in America is getting “free” routine mammograms and every adult woman up to 65 is getting a “free” annual pelvic exam — then you are going to overwhelm the system.

Of course, there won’t be 100% compliance, or anything like it, because these really aren’t pleasant procedures, and some women won’t do them free or not. But there will be an increase, especially for people who are now paying a whole lot of money for their “free” health care. They will want to get what they paid for. So all the sudden you have many more patients for the same amount of doctors, technicians, and medical devices. Because I have never found anything in Obamacare to indicate that the law increases the supply of health care, just the demand.

With or without Obamacare, a lot of the changes probably do have to do with money. When the entire health system was on a fee-for-service system, everything got paid for, straight up. If you did one procedure, you got paid for that. If you did 100, you got paid for that. Obviously, there was a benefit to doing more than one procedure. But that’s not the system anymore. Now we’re in a managed care system. Fees are negotiated; gatekeepers, price caps, and other cost-containing measures try to wrangle skyrocketing health care costs. Even more, we’re moving away from the individual doctor or small practice to the hospital base provider, where the balance between individual patient versus public health and costs will be tilted more heavily to the latter.  I care deeply about the health of my privates, but to a large system, I’m just one data point out of many.  If reducing costly procedures doesn’t cost “significantly more” lives, then new screening procedures will probably be adopted. But for me, my life is always significant.

Or maybe it has nothing to do with the current economics of health care delivery and really is just a straight “the benefit doesn’t warrant the cost — in money, discomfort, or invasive procedures.” And that’s the thing. For some women, annual mammograms and/or pelvic exams are necessary. For the vast majority of us, they probably aren’t. Unless the experts are wrong, which they are all the time. Transfats, anyone?

Here’s a radical thought: maybe I am the best person to make that cost/benefit analysis for me. Every person is different, and their health risks and needs are different. They ought to be given the information and make the decision themselves. Of course, if I’m making that cost/benefit analysis but it doesn’t actually cost me anything — or rather I can’t see the cost because it’s baked into the cake and includes my ability to access that cake — then I’ll probably conclude that of course the benefit outweighs the cost. Heck, if I’m paying the cost anyway, I might as well have the benefit. But if it wasn’t, if I had to pay not only in discomfort and time but also in actually cashy money here and now, maybe the cost would outweigh the benefit.

So what do you think about the latest guidelines? Does it change what screenings you’ll seek?

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