I don't know about you, but I am really struck by the lack of support for the new USPSTF evidence-based recommendations for mammography screening by the heavy-weights in this area -- American Cancer Society, American College of Radiology, and several institutions that are known bellwethers for clinical practice. But why should I be surprised?
A couple of weeks ago I posted about conflict of interest in healthcare research here. There is a veritable witch hunt by professional organizations and peer-reviewed journals to rout out any appearance of a conflict of interest, but pretty much only as it applies to private research funding. What about mammography screening and the loud chorus of dissent with the recommendation? Well, consider the sources. Does it seem that their opinions may be somewhat tainted by their tremendous financial interest in maintaining and even extending the status quo?
I do not wish to accuse anyone of nefarious motives; I believe Hannah Arendt's considered assertion that evil is banal -- we do not plan it, we just slip into it. In fact I am not even willing to call the dissenters evil. I just want the conflict of interest disclosures to apply to everyone equally. The public relies on our healthcare institutions to promulgate policies with our health and not their financial advancement as the primary goal. As a researcher who takes research and consulting dollars from private industry I am expected to disclose meticulously all of my financial interest in a manuscript that I submit for publication or a talk I give. In the same spirit of full transparency, I call on all organizations voicing an opinion on the subject to disclose their financial stake in the mammography enterprise and how much revenue they stand to lose from adoption of the current USPSTF recommendations. Explicit disclosure of such conflicts of interest is an important step in helping the public understand the implications of the skirmish around this evidence.