Should Dissent Be Allowed In Health Care?

Confident DoctorsAn eminent physician has tentatively proposed that published treatment guidelines be accompanied by dissenting expert opinions, much like the U.S. Supreme Court does. Daniel Musher, MD, of Baylor College of Medicine, served on the Advisory Committee on Immunization Practice of the Centers for Disease Control and Prevention, which considered guidelines for a dual vaccine approach for pneumococcal vaccination for adults.

He disagreed strongly with the published recommendation, but was prevented from publishing his opinion alongside the recommendation. Dr. Musher believes the publishing of dissenting opinions is very valuable to the progress of knowledge:

As citizens of the United States, we are as much bound by a 5-4 decision of the High Court as a 9-0 vote (although closely passed decisions are more likely to be overturned in future cases).1 Similarly, as practitioners of medicine, until new guidelines are written, we are seriously constrained by, if not actually bound by, existing ones, without regard to the unanimity of opinion in the recommending committee. Nevertheless, there is much to gain from studying dissenting opinions, as was famously shown by the writings of Justices Holmes and Brandeis, many of whose minority opinions, in time, became the law of the land.2 I propose that the failure to publish differing or dissenting views in medical guidelines presents our profession with an inappropriately monolithic view—one that is studied as gospel by physicians-in-training and forced on practitioners by incorporation into a variety of performance measures.

This seems very reasonable, especially in a time when expert guidelines determine the flow of billions of tax dollars and access to treatment. There was a lot of controversy circa 2009 and 2010, when the Affordable Care Act was passed, about whether women in their 40s would get “free” mammograms every year.

In 2009, the US Preventive Services Task Force issued guidelines recommending annual mammograms for women starting at 50 years, not 40 (as previously recommended). Needless to say, this upset many people. The American Cancer Society maintained its recommendation that preventive screening start at 40, as did the Mayo Clinic. Politicians took note, and made an exception in Obamacare for mammograms, such that the 2009 USPSTF revision was ignored when it came to Obamacare’s “free” preventive care. (In January 2016, USPTF maintained is recommendation.)

We are entering a period when access to care will be centrally determined by political appointees who project an inappropriate degree of certainty when they issue their guidelines. They could at least allow dissenting experts the right be heard.

Comments (4)

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  1. Ron Greiner says:

    The cost of a “free” procedure makes the monthly health insurance premium increase, to cover the cost plus administration and profit, which makes more people not to have health insurance because they can’t afford the higher premiums.

    Why not let insurance cover the unforeseen expense?

  2. Allan says:

    I wonder what the objection is to dissenting opinions. It must be political paternalism promoted by the government. The government says the patient is entitled to his healthcare records, but the people are not entitled to know of dissent against conclusions and policy drawn by government agencies that affect their bodies.

  3. Jeni says:

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  4. Jake Klehe says:

    My wife, a nurse of 30+ years, refuses to participate in what we both call the ‘medical cartel.’ I have no health insurance as I pay my own way for the very few services I occasionally require, usually some kind of non-fatal emergency service I cannot handle on my own. Commenters ‘Exasperated’ and ‘KCFleming’ have the situation pretty well nailed; ‘GoneWithTheWind’ is delusional – the ‘best minds’ are merely well connected members of the club that will allow no dissent period.

    The state medical boards only enforce non-dissent of the practitioners and the true focus of their mission, patient protection, is a joke. Look up doctors in Florida having discovered viable alternative therapies being murdered. There’s a documentary I watched a few years back about a doctor here in Texas being hounded and litigated against for utilizing a cancer therapy that actually worked as opposed to chemo and radiation that typically accelerated a painful death.

    The most telling essay I’ve encountered a few years back, ‘How Doctors Die’, in which the author, a physician, made the point that many doctors, when given a terminal diagnosis, wrap up their affairs, complete their bucket lists, and spend their remaining time with loved ones. They are the ones most familiar with the suffering and cost of radical end-of-life procedures and decline to accept for themselves what they prescribe for their patients. Exactly why I won’t participate as well.

    I’m 68yo and haven’t seen a doctor in years. I take no meds. I lift weights, do a little cardio, I intermittent fast, and eat fairly clean, a combination of Paleo and Ketogenic. I do all the cooking for the household, including for the animals, in order to avoid the poisons promoted by the processed food industry. We take care of dogs for our mental health and take care of our physical health by staying as far away from the medical cartel as possible. The combination of Government and Insurance industry interference in the health care system is simply a death sentence for American health care. Obamacare is simply the final nail in the coffin.