Wilson On Impact Of Proposed Health Legislation

May 26, 2015

Shadow Health Minister Kim Wilson has expressed concern over proposed legislation which seeks to amend the Standard Hospital Benefit as it pertains to mammograms, saying that “rather than rushing through this important legislation, we call on Minister Jeanne Atherden to pause and gather statistics relevant to Bermuda” as “skipping a year of mammograms could cause death by delay.”

Ms Wilson said, “The proposed legislation, Health Insurance [Miscellaneous] Amendment Act 2015, tabled in the House last Friday, by Health Minister Jeanne Atherden, seeks to amend the Standard Hospital Benefit which provides that screening for mammograms which will be covered as SHB must adhere to guidelines submitted by the United States Preventive Services Task Force [USPSTF] which now recommends biennial screening for healthy, asymptomatic women aged 50-74 years.

Screenshot from the proposed legislation:

Fullscreen capture 5262015 50522 PM

“The USPSTF guidelines have not been accepted by any of the leading agencies , all of whom still recommend that women be screened for breast cancer by having mammograms annually upon turning the age of 40,” Ms Wilson added.

“Further to the above, the Task Force panel contains no one with any expertise in breast cancer care, and no experts in breast cancer screening, so many of the other observations they have made are not supported by scientific evidence.

“Ironically, the guidelines have not yet been accepted by the US Congress, and in fact, the public consultation period for the Task Force Recommendations only ended on May 18, 2015. This begs the question, why should Bermuda be in a rush to adopt US based guidelines which have not even been adopted there?

“The Task Force also made the value judgment that “although lives will be lost by screening every two years, women should allow cancers to grow and spread while being screened biennially instead of annually.”

“The Task Force panel also used the age of 50 as if it is a legitimate threshold for screening. There is no data that shows that any of the parameters of screening change abruptly at the age of 50, or at any other age for that matter. There is no scientific or biological reason to use age 50 as a threshold. We believe that decisions concerning policy formation affecting ones health should be drawn on sound scientific evidence.

“In fact, the “USPSTF guidelines ignore their own findings and are based on the panel’s subjective value judgments as opposed to the confirmed scientific evidence,” this from Dr. Daniel Kopans, a leading expert in the field of radiology, a professor of radiology at Harvard Medical School and a senior radiologist in the Department of Radiology, Breast Imaging Division, at Massachusetts General Hospital.

“Further, with the high incidence of breast cancers in Bermuda, with a population very different from that in America, when will we as a country start allowing local health statistics to drive our local health policy?

“All of the scientific evidence shows that lives are saved by screening starting at the age of 40, which is the best practice as recommend by The American Congress of Obstetricians and Gynecologist; American Cancer Society; The American College of Radiology; and the Society for Breast Imaging.

“Of utmost importance is the fact that the vast majority of women in the US [75%] who are diagnosed with breast cancer each year have not definable excess risk factors.

“In Bermuda, one study of all those women diagnosed last year with breast cancer found that 25% of those women were aged 40-49 years of age.

“Rather than rushing through this important legislation, we call on Minister Jeanne Atherden to pause and gather statistics relevant to Bermuda, consult the Bermuda stakeholders such as the Bermuda Medical Doctors’ Association, and the Oncologists in Bermuda.

“Skipping a year of mammograms could cause death by delay and we would not want to be responsible for such an important change in legislation without accurate data.

“Members of the public who would like their opinions heard on this matter are encouraged to contact their Constituency MP, as well as the Health Minister Jeanne Atherden to provide their feedback,” added Ms Wilson.

Health Insurance [Miscellaneous] Amendment Act 2015, follows below [PDF here]:

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Comments (51)

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  1. Mockingjay says:

    Everything is going up, benefits are getting meager and wages are at a standstill.
    WTF

    • (In reference to an objection made by Shadow Health Minister Kim Wilson.)

      After having loss an aunt many years ago to breast cancer, I also must support Shadow Health Minister Kim Wilson. I’ve seen / experienced firsthand the “mistakes” made at our King Edward Memorial Hospital…I’d suffered from a ruptured aneurism,(15 yrs. ago) in my brain; and after being misdiagnosed I was sent home, (while brain hemorrhaging. I didn’t receive a Xrays nor a Cat’Scan.)
      So, yes, I believe “an oz. of prevention is worth a lb. of cure” The worse thing any family member wants to hear from a doctor is, “I’m sorry…”

      • Allow me to add this, that medical research has come a “hell-a-va” lot further and Doctors today are able to detect countless ailments far sooner than years gone by…But, people are still just that, “people” and all are subjected to ailments…

        • Note the dates of my letters: As I’d mentioned, there is no way K.E.M.H. / doctors can deny a patient treatment if their doctor recommends they have it. But, if they did not recommend treatment then the patient will still be able to have tests performed but at their own expense e.g. not having their insurance companies “support” / backing. This is now been clarified…

  2. Strike fund says:

    I’m with Kim on this one.

    If this does pass then this is a worthwhile cause for a march as lives could be at risk.

    • hmmm says:

      You took her bait, hook line and sinker…..read on.

  3. SUVIVOR says:

    I am a cancer survivor and worked in the medical field for several years assisting patients with their appointments for mammograms and travel abroad for treatment when needed. When a patient is told a lump has been found or the patient finds the lump it is stressful and devastating no matter what age they are. Mammograms should be allowed on an ongoing as needed basis at whatever age no matter if the patient is 13 years old or 130 years old or any age. I know of a 15 year old who had breast lumps and her doctor quickly arranged a mammogram which was then biopsied. The young lady was okay but is high risk and will require mammograms at age 18 and ongoing mammograms for years as she has a family history of breast cancer. So the decision to say when mammograms should be done should not be a POLICY, a POLL or a bunch of NON MEDICAL PERSONS making this decision. Let mammograms be done on an as needed basis. Patients have the right to request a mammogram no matter what age especially if they feel the need to.

    • Toodle-oo says:

      I completely concur . I know of too many horror stories where young ladies under 30 have been diagnosed with breast cancer .
      IMO screening should take place at the patient’s request and it’s never ‘too young’ .
      Hell , my GP has been giving me a DRI since I was 21 , not that I ever asked for it , but there’s guys out there in their 40s + who haven’t had one yet .

      Another stupid ‘overseas’ thing we seem to be hung up on here as far as insurance companies go is tying the insured cost coverage for dental procedures the rates used by the Ontario Dental Board.

      No wonder there’s always co-pays for everything the dentist does. The insurance companies are using one of the lowest rate scales around as if it applies here.

    • Alicia says:

      I am glad to hear that you are a survivor of cancer, but perhaps I read the original statement from minister atherdeen incorrectly then as it refers to asymptomatic women, ie women with no lumps, no pain, no family history of breast cancer. As soon as you factor in pain, lumps and/or family history that changes it from prevention to diagnostic which is not what this is talking about. The doctors in Bermuda all were at a meeting a few weeks ago on this topic, so they heard first hand what the guidelines are about. It ultimately would come down to your doctor I would think if they will order it, but just because they order something doesn’t mean that your insurer will pay for it.

    • Sickofantz says:

      Tell me why Bermuda women are so much sicker than anywhere else? Why when most of Europe start screening for low risk women at 47 do Bermudians feel they should be treated so much better?

  4. oh dear says:

    And so the powers that be have time to decide upon the increase in health fees and premiums and their resulting continuing upward climb and yet we await (still) the BHB Financial Statements for the years commencing 1st April, 2011 and details of the promised BHB Executive salaries.

  5. J Starling says:

    Well, I’d certainly like to see the scientific evidence myself.

    I do think it makes sense to maintain annual check-ups for those more at risk for breast cancer, such as those with a family history or the genetic marker that increases ones predisposition for breast cancer.

    If the evidence for annual checks for all women shows that those without the risk factors aren’t benefiting from annual checks (and in some cases harmed by them, through stress or false positives), then sure, biennial or even triennial like in the UK’s NHS can make sense, with the resources saved being used to improve medical services/public health

    So… I don’t know. I’d need to look at the evidence, but I look forward to hearing people’s thoughts and such.

    • Double D says:

      That’s exactly what the task force recommended last week which is a simple carry over from 2009. It was very disingenuous of Ms. Wilson to state that public consultation ended last week. As I said the task force’s recommendation remains unchanged since 2009 and is based on substantial medical evidence.

      I also find it very funny that a lawyer politician has the nerve to question the task force’s expertise or abilities. Look at their website and see outstanding qualifications of the 16 members. They don’t make recommendations based on limited evidence or subjective reasoning.

      Their recommendation is for biannual screening for women who are least at risk between the ages of 50-74 while women deemed to be more at risk should begin screenings for women beginning at age 40.

      • Double D says:

        And you are correct regarding the harmful effects of false positives which forms part of the basis for the task force’s recommendations.

      • “The Task Force also made the value judgment that “although lives will be lost by screening every two years, women should allow cancers to grow and spread while being screened biennially instead of annually.”

        How could you possibly defend a so called task force that made the above statement.They have admitted lives will be lost due to screening every two years as opposed to annual screenings.They then foolishly suggest that women allow cancers to grow.Do you have any idea just how dangerous that is?

        Both statements are unfounded, incredibly idiotic and expose this group as nothing but a bunch of henchmen/women with one objective in mind and that is to save money even at the expense of lives.

        What’s disingenuous is for you to support such nonsense!Stop playing games with the lives of our women for the sake of the almighty dollar.

        • Double D says:

          The Task Force never made that statement despite the fact that it appears that Mrs. Wilson attributed it to them.

          Actually the majority of Mrs. Wilson’s argument is verbatim from a Doctor Kopans (see below article link):

          http://www.auntminnie.com/index.aspx?sec=ser&sub=def&pag=dis&ItemID=110771

          It appears that. Mrs. Wilson lifted sections of the above article and tried to pass it off as being a product of her in depth research. I believe when you don’t reference a source it is called plagiarism.

          • Double D says:

            I see that doctor Kopans was referenced midway for one statement, but not for the preceding claims.

            I, like Mr. Starling, would like to see the local scientific evidence and not base my opinion on one mans opinion that was found by the PLP via a google search. If you think using one opinion found via a simple web search by a non-qualified politician that is your right. But I will not be scare mongered by part time politicians that have absolutely no qualifications to pass judgement on their own and a google search of course.

            Given the fact that local doctors have been part of the process lets hear what they say on the subject.

          • Double D says:

            I see that doctor Kopans was referenced midway for one statement, but not for the preceding claims.

            I, like Mr. Starling, would like to see the local scientific evidence and not base my opinion on one mans opinion that was found by the PLP via a google search. If you think using one opinion found via a simple web search by a non-qualified politician that is your right. But I will not be scare mongered by part time politicians that have absolutely no qualifications to pass judgement on their own and a google search of course.

            Given the fact that local doctors have been part of the process lets hear what they say on the subject.

            Also, the change in legislation is for women that are not considered high risk. Ladies with the genetic history will not be subject while ladies that do not have the history in their family have the option to choose whether or not they will undergo a mammogram. On top of that doctors will still be teaching ladies how to perform self assessment in the interim.

            In all honesty the ‘death by delay’ claim is simple fear mongering similar to the Republicans death panel claims on Obamacare.

            • Whitney says:

              You are right – let’s hear what the doctors have to say about the subject…

              By the way, these guidelines were recommended by the Bermuda Medical Doctors Association. They were the ones that wanted guidelines in place to curb ordering of unnecessary testing. Don’t believe me, ask Dr. Sherratt-Wyer who was the head of the BMDA at the time.

            • Tough Love says:

              But unlike ObamaCare, we actually DO have non-medical people on a panel that are dictating how medicine/treatment should be administered.

              How many women who don’t have a history, etc. find themselves with breast cancer out of the blue. More than enough to squash this suggestion. Why? because cancer is not just hereditary, it’s our lifestyles etc. Bermuda has a high concentration of cellphones, cell towers, microwaves and other forms of radiation around this island, all that contribute to cancer. That fact alone is reason enough for annual screenings.

              • SUVIVOR says:

                BINGO. Tough Love you are correct with reference to the cell towers etc. Brigham and Women’s Hospital and Dana Farber in Boston have done specific studies about Bermuda and have said Bermuda has a lot of cancer patients for a small island.

        • Derek A. G. Jones says:

          That statement is very odd indeed. I wonder if it might be a misquote or mix up in something someone said which was changed.

          • Derek A. G. Jones says:

            After reviewing the original, the statement here has added quotation marks therefore making it appear to be a quote. It is not a quote by anyone on the Task Force per se but rather an observation and opinion being posited by Dr Kopans.

        • Zevon says:

          Larry, the point is, that there is no evidence that testing annually does any more good than testing every two years. That is the science of it.

        • Edmund Spenser says:

          Larry, you are correct, I couldn’t support a task force that made such a statement. I also went to read the statement myself on their webpage and could not find the quote anywhere.
          I will continue looking, and if you could find a link to the actual quote I would appreciate it, but for now it looks like another misquote by the PLP for dramatic effect.
          Many people have made statements from the task force both officially and unofficially so it is worth continuing to look without passing any final judgment.
          The important thing to note is the task force is referring to mammograms done as part of routine check-ups. Mammograms performed for cause, because of family history or medical necessity are unchanged by the recommendations of the task force.

    • Zevon says:

      Jonathan, why do you “think it makes sense to maintain annual checkups”?
      The only significance of a year is that it’s the time it takes for the Earth to go around the Sun. There is nothing to suggest that that is the ideal frequency for mammograms.
      If more frequent testing doesn’t do any good, then it is a waste of resources.

      • J Starling says:

        To be clear, I said it makes sense to maintain annual check-ups for those most at risk – and the point being for early detection and increasing survival rates.

        For those not at risk, if the evidence is that annual detection is more counter-productive than not, then I’m cool with a biennial or even triennial check, if that’s what the evidence supports.

        • serengeti says:

          So…you agree with the position of the government then.

          • J Starling says:

            I didn’t say I disagreed – I said I would like to see the evidence behind the policy and ensure that the policy is based on the best available evidence.

            If the evidence supports continued annual mammograms for those most at risk and biennial mammograms for those less at risk, then that makes sense.

        • Sickofantz says:

          I would like to see in which study Ms Wilson found that 25% of women with breast cancer were aged 40-50 as this flies in the face of every other bit of research.

      • Dr.Zevon

        Why do you think it makes sense NOT to maintain annual check ups? Your way puts an untold number of women at risk in order to save money. With annual check ups the likelihood of cancer becoming malignant is diminished considerably. What the current Government should be doing is encouraging more screening not less. We are not talking about the common cold here we are talking about a deadly disease.

        • serengeti says:

          If there is no scientific benefit to testing annually, then it isn’t putting anyone at risk. There is no scientific or medical reason why it needs to be once a year. Saying that it “puts an untold number of women at risk in order to save money” just is not true.
          And when you say “What the current Government should be doing is encouraging more screening not less”, where does that end? Why don’t women demand monthly mammograms, or weekly mammograms, if more frequent screening is somehow automatically better?
          The answer is – because more frequent screening isn’t automatically better. There is an optimum frequency, determined by the science and medical necessity.

  6. To many taxes says:

    Not to discredit this article or the comments placed on this topic, but why isn’t anyone jumping up and down over the fact that the Mutual Reinsurance Fund tax which is placed onto all policies is set to go up 118% with the major increase to pay for the hospital even if you don’t use it. This is where we as residents need to be concerned about as we are being forced to pay for the new wing that the PLP approved to be built even though it was over and beyond what we as a country could pay for and now every person that has an insurance policy through their work or government is going to be forced to pay $23/month to pay for the new wing. That’s $276/year – so if you have a house with two working adults who each have their own policy that’s a total of $552/year extra that we have to pay. I can think of a lot better ways to spend $552/year in my house than on a hospital that I rarely use (and my insurance still gets charged when we do use it – so we’re paying twice) Where is the outcry over this!

    • Tough Love says:

      With that attitude I hope you/your family NEVER need the hospital. As small as Bermuda is, we are a community, despite your protests. My understanding was to upgrade the hospital so that less people would have to fly overseas to get care.

      As a community we should support the hospital because we don’t know when it will be ourselves, our friends or family that need its care. Just because you don’t “use” the hospital doesn’t mean you should rally to stop supporting it.

  7. Jess says:

    Will men be giving up regular prostate cancer screenings? Fair is fair. Shared sacrifice.

  8. rhonda says:

    The only people supporting these recommendations in the USA are Republicans running southern States to disenfranchised the poor. Why would we pick it up.

    The American Cancer Society strongly disagrees and is still recommending annual mammograms for women over 40.

  9. rhonda says:

    Gingrey told FoxNews.com on Tuesday that he and other lawmakers are gravely concerned that insurance companies will seize upon the new guidelines to deny mammogram coverage for women under 50.

    “Early detection is hugely important,” Gingrey said, noting that breast self-exams are critical in looking for cancerous tissue masses.

  10. A Bad Move says:

    Yearly mammograms can make the difference between an early diagnosis and late stage cancer no matter what! If this is about saving money then disgraceful is all I can say. Time to get on with eliminating the uniform services NO copay as was promised in the budget statement and agreed to by the BTUC. There’s your 3+ millions in savings without risking lives or excruciating treatments for cancer! .

  11. rhonda says:

    In absence of our own study, if the UK adopted the USA initiative
    See the chart attached.

    http://www.cancerresearchuk.org/prod_consump/groups/cr_common/@nre/@sta/documents/image/cases_crude_f_breast_png.png

  12. rhonda says:

    Will women with a history and a recommendation from her Dr. still be subjected to pre-certification.

  13. overboardhope says:

    Please, please, please, do not adopt this new screening plan. As a Cancer surviver, I can not agree with the suggested plan. Prevention is worth a pound of cure.

  14. time for the beach says:

    If any case mammograms for people who have a family history should start at 18. And maybe every other year after that….but maybe start mammograms at 30 and every 5 years and mandatory every year after 40. I mean come on. This is ridiculous. Any woman would have not let this pass. Here we are raising money for Relay for Life and here is the government undermining women rights.

  15. Alvin Williams says:

    If it was not clear why a poll would suggest that the PLP is more in touch with the concerns of the people than the OBA government; this issue throws the difference in wide relief. Yet there are still people who want to play politics when this is an issue where one would think would be non-political.

  16. Tough Love says:

    Now here’s a question. Where does the panel stand on ultrasounds instead of mammograms? This gets the same result of examining the breast without squeezing it. We could use ultrasounds instead of mammograms.

  17. Bermudian Momma says:

    There seems to be some confusion. The public consultation period for the United States Preventive Services Task Force recommendations only ended on May 18, 2015 – in the US not Bermuda. If I am understanding the article correctly, these recommendations have NOT been accepted in the US by the American Cancer Society nor has the US Congress approved the recommendations.

    Why are we rushing to put these recommendations in place before the country (USA) that put this taskforce together?

    If these recommendations are passed into Bermuda law, does this mean I need a note from my GP to get a mammography under the age of 50 or else the insurance company does not have to pay for the service?

    As per the task force website http://www.uspreventiveservicestaskforce.org/Page/Topic/recommendation-summary/breast-cancer-screening , The USPSTF recommends against teaching breast self-examination (BSE).
    So, women should not do a self-exam according to the taskforce and we should wait until we are 50 years old to get our first mammography. Is this a scheme to kill the older women off as it is a known fact that women tend to live longer that men.
    Is this a means to an end – kill off the women thus reduce the pension liability in the long term?

    Just wondering.

  18. Mammography facts says:

    From Minister Atherden’s statement in the House on Friday, May 22nd: Screening mammograms will be covered as Standard Health Benefit (SHB) when they are in adherence with specific Clinical Guidelines. Mammography represents 30% of all diagnostic imaging costs in Bermuda. Currently, the health system follows the American College of Radiology guidelines for mammography which recommend annual screenings for all women aged over 40 years. A clinical review has proposed changing the Bermuda standard to follow the United States Preventive Services Task Force (USPSTF) Guidelines, which recommend biennial screening for healthy, asymptomatic women aged 50 to 74 years. Women with a family history or other risk factors will still be covered for testing with a physician referral. This will result in better use of scarce healthcare resources, while following best-practice international guidelines on screening. Accordingly, SHB coverage for screening mammograms will be required to adhere to the USPSTF guidelines.

    These benefit changes will serve to better protect under-insured populations, without a significant cost to the standard premium.

  19. bermudaglobetrottersdotcom says:

    Home birth legislation also needed. Bermuda is lacking. Get it together.

  20. Island empress says:

    I fully support stopping this legislation. We have been taught and research shows that cancer comes at all ages so why move the age up??!! And why rely on legislation based on others countries and that isn’t even passed in that country??!

    Bermudians we have some protesting to but strategy with your friends and families and read the legislation and educate first. No time to mess with our health especially for the sake of political gain.

  21. As mentioned, there is no way KEMH / doctors can deny a patient treatment if their doctor recommends they have it…But, if they did not recommend treatment then the patient will still be able to have tests performed but at their own expense e.g. not having their insurance companies “support” / backing.