FRAUD: Plain $ Simple

Let's say you went to a car dealer and bought a new car that included a CD player that you paid for, as listed on the spec sheet. When the car was delivered there was no CD player.

Mistake, or fraud?

Let's say that this happened not just this once, and not just to you...but, that car dealers were doing this 10 million times per year.

Mistake, or fraud?

Now, let's imagine that in some bizarre way the car dealers not only kept the money, but blamed their customers for this problem. What do you think would follow? I'm thinking national news and prosecution for fraud.

Where's this going? Hold that thought, and read on....

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10 Million Women Who Lack a Cervix Still Get Pap Tests

NYTimes By GINA KOLATA
Published: June 23, 2004

As many as 10 million women who have had hysterectomies and who no longer

have a cervix are still getting Pap tests, a new study finds.

The screening Pap test looks for precancerous cells in tissue scraped from a woman's cervix and can prevent what would otherwise be a common and deadly cancer. But testing most women without a cervix makes little sense, leads to false positives and wastes money.

The women in question do not include the 1.1 million who had a hysterectomy and still have a cervix, which is at the base of the uterus, nor the 2.2 million who had their uteruses and cervices removed because they had cancer or precancerous cells in their cervix. In both of these groups, Pap tests are warranted.

These women are being screened for cancer in an organ that they don't have.

No professional organization recommends Pap tests for most women without a cervix. The screening guidelines ''either have not been heard or have been ignored,'' the investigators wrote. No one is suggesting fraud or mendacity on the part of the doctors or laboratories (WHAT? WHY NOT? This isn't only unmitigated FRAUD, but also malpractice, and sexual assault!). Instead, Dr. Sirovich and others say,the situation seems to reflect doctors' habits (what about standards of care?!) and women's expectations.(Say what?! = blaming the patient!!)

When a woman does not have a cervix, a doctor scrapes cells from her vagina instead, sending them off to be examined. And that, cancer experts say, is problematic.

Vaginal cancer is exceedingly rare, and tests of vaginal cells are much more likely to result in false positives than they are to find vaginal cancers. A result is unnecessary vaginal biopsies that can result in their own false positives. As a result, women can end up having vaginal tissue removed to treat a cancer that is not even present. (Not to mention unnecessary procedures causing adverse events, psychological harm, and death!)

Dr. Alfred Berg, the former chairman of the U.S. Preventive Services Task Force, which issues medical practice guidelines, said Pap tests in women without a cervix has been a longstanding issue. Since 1988 (23 years of fraud, and counting!), Dr. Berg said, the task force has issued more and more adamant statements against it, to little avail. (charge the docs with fraud, and it would stop tomorrow!)

''We're all fascinated as to why this should be,'' Dr. Berg said. In part, he said, it might be because the American public is convinced that cancer screening is an unmitigated good, making women and their doctors reluctant to give up a test as simple and popular as the Pap.

''We have a thing in this country about cancer screening (A thing? Medical disease screening, of all types, is their largest recruitment tool for care.) ,'' Dr. Berg said. ''It has a deep social value, and when evidence points in another direction (BS! There never was ANY evidence supporting the use of Pap tests in women without a cervix!) , people are very skeptical.''

Another possibility, Dr. Sirovich said, is that evaluations of doctors and health care systems count the percentage of women who have Pap tests, giving little incentive to advise against the tests. (treating the wallet and not the patient)

Gynecologists are also puzzled.

Dr. Kenneth Noller, an author of the cervical cancer screening guidelines issued by the American College of Obstetrics and Gynecology, which does not recommend Pap tests for most women who have had hysterectomies, said he suspected that a reason the test was being done in these women anyway was that doctors were used to it.

''It's a relatively cheap (at about $100 per test x 10 million/year = $ 1 billion dollars. That ain't cheap.)and easy procedure,'' he explained. ''It's sort of become a habit.'' (They're kidding, right? FRAUD: pure and simple, and generating big $$$)

Dr. Alan Waxman, another author of the obstetricians and gynecologists' guidelines said women expected the test. ''Many women equate the Pap test with the pelvic exam,'' Dr. Waxman said. ''So they come in every year for their Pap test even if they don't need it any more.''(Blame the patient! Who's in charge here?!)

Instead, he explained, doctors worry about the consequences for themselves if they counsel against a Pap test for the rare woman who turns out to have vaginal cancer. ''If the doctor didn't do a Pap test, then there's the litigation threat,'' he said. (Not true: the standard of care does NOT recommend a PAP test for women without a cervix)

Dr. Noller said he tried to dissuade women who do not need Pap tests. ''I will present the facts to them,'' he said. ''I will try to talk them out of it.'' But, he said, ''if they still insist, I would probably do it.'' (Say What?!! What self-serving nonsense and bad medical judgment! If they insisted on a leg amputation or kidney transplant, would he just go ahead and do it?)