The New York Times ran this somewhat smug discussion of the new mammography guidelines, in which the author suggests that women dismiss the guidelines because they are confused or overly emotional. Hmmmm. Hard Truth + Silly Women = Hysteria. Where have I heard that argument before? Oh yeah, all of human history — the parts not written by women, anyway. Without addressing the data that lead to the new guidelines, I’d like to simply offer a few clarifying points for the scientists who are so befuddled by the reaction:

Imagine that you’re a health consumer. It’s not that difficult, there are only a couple of details you need to muster: (1) that you’re concerned about breast cancer, the number 1 killer of women aged 15-59, and (2) that the medical experts have insisted, throughout your entire post-adolescent life, that mammograms do indeed save lives. So although the tests are a gawd awful humiliating misery, you subject yourself to them annually, or plan on doing so when you’re older.

Never mind!

Then one year, these same medical experts take another look at the data during a tense debate on medical costs and issue a Rosanne Rosannadanna-style “Oh. Never mind.” And this “never mind” happens in the same year in which other experts say, Hey, you know that BPA that we insisted is perfectly safe? Well we’re rethinking that. And, uh, sorry about possibly predisposing you or your children to cancer.

And by coincidence the mammogram Never-Mind also happened just a few years after those same medical experts did an epic flip flop on hormone replacement therapy (HRT). That Never Mind came after years of selling HRT as the new fountain of youth that would stave off hot flashes, sleep problems, alzheimers, heart disease, and would pretty much usher us into health nirvana well into old age. And despite finding that HRT increases breast cancer risk, HRT is still being prescribed by doctors and marketed by pharmas. In other words, it’s still an individual choice, now informed by some troubling new information.

Getting back to the mammography guidelines: last month, the radiology and breast imaging director at my regional cancer center (a National Cancer Institutes affiliated clinic) came out strongly in favor of women aged 40 to 49 continuing to have annual mammograms. There’s more than enough debate among the experts out there to justify any woman deciding she’d just as soon keep her options open for now.

So, the reason the scientists and mathematicians are confused is that they’re oversimplifying the issue. It’s not just about the tidy numbers or pretty graphs. It’s about consumer trust, and personal health risk, and individual choice. Consumers have learned, from the history of epic reversals and re-reversals by the experts and policy gurus, that these issues are a complicated, that one-size answers inevitably don’t fit, and that they boil down to a question of individual choice.

This brings me to my final point: women are not demanding mammograms, they’re demanding choice. Plenty of women are already foregoing annual mammograms and undoubtedly view the new guidelines as a welcome absolution from nagging doubt. But others quite reasonably fear that the health insurers will now phase out coverage of mammograms for women under 50. Women are afraid that insurers will rob women of the choice to get a mammogram, thanks to the guidelines. That’s what’s making women angry.

This has nothing to do with mammograms, everything to do with missing Gilda Radner:

A Poem by Gilda Radner (a.k.a. Roseanne Rosannadanna)

Doctors are whippersnappers in ironed white coats

who spy up your rectums and look down your throats

And press you and poke you with sterilized tools

And stab at solutions that pacify fools.

I used to revere them and do what they said

Till I learned what they learned on was already dead.