The buzz right now is “public-private partnerships”. What does this mean in the sphere of biomedical research? What is often meant is that private donors should join their dollars with those provided by federal funders to cost-share large projects. One selling point for such projects is the efficient use of resources. What becomes lost when private dollars are yoked to centralized goals is the diversity of decision making that allows for new, and sometimes unpopular, ideas to flourish. private dollars should take more risks, fund ideas early in their inception, provoke new thinking, and question the perceived wisdom of authority. It is this idea of distributed decision making increasing the likelihood that a less than mainstream idea will get funded somewhere that, to me, makes private funding of research and scholarship appealing.
So, it is surprising to me that the study on the utility of screening for breast cancer was funded, not by private dollars, but by a government agency. Of course, it was funded by the government agency that is supposed to look at questions of health care effectiveness. But still, it is a bold study bringing into question common wisdom assumptions.
We assumed that annual mammography for all women over 40 was effective. In reality the data — and not just from this most recent study but from a number of studies over the years has indicated that the truth was more complicated. So why didn’t one of the breast cancer advocacy groups fund a study to answer the question? Why wasn’t ongoing assessment part of the huge public education effort that has made an annual mammogram part of many women’s lives.
False positives have real effects. They require follow-up. They create anxiety. They undermine confidence in our body’s integrity. They turn us from well people into diseased people.
I am completely bemused by the headlines shouting how confused women are about the new recommendations. I am not confused. They make perfect sense to me. All tests carry the risk of error. There is the risk of diagnosing cancer where there is no cancer. There is also the risk of being given a clean bill of health in January and finding out that you have agressive, metastatic disease months later. Diagnostic tests should be used carefully.
Private funders with an interest in breast cancer should have been the ones questioning the common wisdom of authority. There is still much that we do not know about breast cancer. Too many women die from it every year. Diagnosing more and more women with small changes that are unlikely to alter the course of their lives is not progress. Private funders could refocus the question. They could keep researchers’ eyes on the truly ill and keep us all from being distracted by the worried well.
Advocates should embrace the new recommendations and call for bold action. Ask new questions. Fund new ideas. Diversify thinking. We might actually make some real progress.