Men are so disparaging about women’s complaints about mammograms.

I liked the cartoon that our (female) lab tech had up depicting a man with a pained expression and his pecker in some kind of an X-ray clamp,  titled “a manogram”.

 From the amount they complain about having their boobs squished in the course of a mammogram, you would think women would be happy that the new recommendations are to do less.

But no.

Well of course I am being facetious and obnoxious here, although this recommendation by the US Preventative Services Task Force (USPSTF) that mammograms should not be routine before age 50 is serious stuff.

Doesn’t mean you shouldn’t ever have one before 50, if you and your doctor think it is the right thing - just the USPSTF thinks there’s not enough evidence of benefit that the upside (detecting breast cancers) out weighs the downside (unnecessary further tests like biopsies, repeat mammograms, sonograms, expense, anxiety, discomfort and even treatment of cancers that would never have grown enough to have affected the woman’s health significantly) that it warrants  being recommended as a routine exam between age 40 and 49 - as it was before these newly forged guidelines.

“But even before age 50, mammograms detect cancers, and there are innumerable women who had breast cancers detected in their 40’s screaming bloody murder about this new guideline” I hear you object.

It all comes down the Orwellian sort of idea of risk/benefit ratio and very often to money. Or how much should we spend to save someone’s life, or extend it?

“You can’t put a price on a human life” I hear you objecting again (I wish you’d just shut up and stop all this objecting).

The reality is that you can and we DO. There are many instances where the cost of some test or treatment is just too prohibitively expensive for the person to get, and they die - and incidentally, if you are one of those people who don’t have insurance, that can often be something as mundane as your blood pressure pills. But often the money you save in one place can produce much greater benifit in another.

You could argue MRI scans are super sensitive at detecting breast cancer - up to 100% in some studies. So why don’t we do MRI scans on every-body? (or every-boob). The answer is, because they’re too damn expensive.

In the world of clinical studies, the common measure for deciding if some treatment is worthwhile is “number needed to treat”. The USPFTS used a rather weird variation on this - “number needed to invite to extend one woman’s life”. Their conclusion was that you have to do 1904 mammograms to extend the life of one woman in the 40 to 49 age group.

So all you punters out there. Is that good odds?

The unfortunate and uncomfortable reality is that funds are limited and somehow we have to decide where we’re going to spend them - and this is emotive stuff.

If you’re the individual who had a breast cancer diagnosed before age 50 by mammogram, you’re probably going to have a pretty strong opinion about this. And the loud and vexatious people of this world are trying to convince us that this the beginning of “Obama-care”. Curtailing of health care. 

But we have to take the global perspective. To my mind, this is what the USPSTF is making a rational stab at - with this new fangled idea of “evidence based medicine”.

.

My back goes out from time to time. It did it again yesterday - just a bit worse. Mrs. Gagg insists I go to the Casualty department (or “Emergency” Room as the drama loving Americans call it.) just because I was gasping and groaning with the back spasm.

“There’s nothing they’re going to do for me” I protest - never having found it easy to be on the receiving end.

We did manage to talk the nice ER doctor into getting an emergent MRI scan (which did show a “slipped” disc). And they did give me Valium (diazepam) and Dilauded (hydromorphone) - so that I felt I was back smoking opium amongst the hill tribes of the Golden Triangle.

Mrs Gagg got reinforcement from the nurse. A conspiracy. A lot of complaining about how men “won’t take care of themselves”.

It’s true, men are more likely to have high blood pressure and heart disease at a young age, more likely to have sleep problems, stress problems, substance abuse problems, riskier sexual practices, more chronic disease, more occupational injuries/diseases and poorer diet. And it’s likely that the various studies showing men are less likely to go to the doctor has something to do with it.

So the nurse and Mrs. Gagg bantered on, with me in the opposing corner. The upshot being that we need to extrapolate the idea of Child Protective Services and Adult Protective Services to all those idiots men who won’t take care of themselves.

We need Man Protective Services.